The Medical Home in Pediatric Practice

1. The Medical Home in Pediatric Practice Medical Home Conference Washington State May 30, 2007 EMRs and Care Plans

2. A High-Performing System for Well-Child Care: A Vision for the Future* ‘…an ideal system would be characterized by: • Advanced access to services • Team-based care • Individualized developmental and behavioral screening • Cultural beliefs and practices accommodated • Care coordination through a medical home • Knowledge transfer and electronic health records • Health care financing *Bergman D, Plsek P, Saunders M. CMWF Report, October 2006.

3. In a nutshell, what is your vision of an ideal system of well-child care? David Bergman, M.D. • First, we have to have some sense of biopsychosocial risk. A lot of this can be determined at birth: Is the child born premature? Does the baby have a congenital defect? Is the family situation chaotic? These are all risk factors. We then have toassign the content of care according to the level of risk. High-risk kids need more visits with a different mix of health care professionals. • In terms of financing, we need to align incentives to more appropriately reimburse for kids with special health care needs. This can be done through tiered capitation—defining kids at a level of biopsychosocial risk and assigning a capitated rate. • Leveraging new technologies is also key.

4. A High-Performing System for Well-Child Care: A Vision for the Future* • Advanced access to services - Secure messaging • Team-based care - Develop comprehensive plan, including education and socialization • Care coordination through a medical home • Knowledge transfer and electronichealth records • Health care financing - Reimbursement for non-physician members of health care teams (Care coordinators) • Individualized developmental and behavioral screening (Vanderbilt in EMR – MBCH, On-line form completion, e.g. ASQ) • Cultural beliefs and practices accommodated (Parent information sheets, screening tools)

5. EMRs • Scope: • Practice-based • Othello: Columbia Basin Health Association [CHARTLOGIC*], • Spokane: Olson Pediatrics • Hospital-based/System-based • Mary Bridge - EPIC (with SmartSet subprogram – ADHD Module) • Group Health Cooperative • Community-wide • Kittitas • Whatcom • Patient accessibility • PHRs - test results, visit summaries, input health information • Email communication • Information resources • Other

6. EMRs – Discussion Points • Pediatric-specific record issues/CSHCN-specific record issues (Needs/hopes/problems) • Provider viewpoint • Individual patient • Diagnosis specific management • Family/Child viewpoint (?cultural, PHRs, email interface, adult child with DD,etc.) • Health plan issues • ID CSHCN • Data pulls for • Patient care issues (often by diagnostic group) • Contract/reimbursement documentation

7. Olson Pediatrics • Spokane Medical Community • One Pediatrician • Three Mid-level providers • Office Staff of 10 FTE’s • Approx. 9,000 patients • 1212 CYSHCN

8. Data Collection • Data person • FACCT survey criteria – CSHCN Screener (5 item, parent-survey based tool) • Excel spreadsheet/Access • Disease-specific data collection • Insurance plans

9. Diagnosis - CYSHCN

10. Severity

11. Insurance Coverage

14. Care Plans • Who creates them? What do they look like? • Health plan • PCP • Family • What else is needed? • Sample forms • Leveraging personnel and time • (Coding and Reimbursement)

15. Care Plans Examples: • Jack Stephens • Jean Popalisky • Health plan • Primary care office • CCSN website – Family • Notebook - other examples • Resources: • WA medical home site • National medical home site • HRTW site