Implementing Medical Home for all Children and Youth

1. Implementing Medical Home for all Children and Youth V. Fan Tait, MD, FAAP American Academy of Pediatrics Associate Executive Director Department of Community and Specialty Pediatrics March 3, 2009

2. Disclosure • I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

3. Family-centered Community-based System of Services for Children and Youth Perrin, J. M. et al. Arch Pediatr Adolesc Med 2007;161:933-936.

4. Medical Home Definition • Primary care • Family-centered partnership • Community-based, interdisciplinary, team-based approach to care • Care that is: accessible, family-centered, coordinated, compassionate, continuous, and culturally effective. • Preventive, acute and chronic care • Quality improvement

5. Integrated Health System • Patients and Families • Primary Care Physicians • Specialists and subspecialists • Hospitals and Healthcare Facilities • Public Health • Community

6. The Transformation Model Structural Forces Macro System Environment Cultural,Social, Environmental, Demographic Forces Regulation & Legislation Forces Community Family/Patient Centered Medical Home Finance/Quality Improvement Forces

7. Joint Principles of the Patient-Centered Medical Home • American Academy of Pediatrics • American Academy of Family Physicians • American College of Physicians • American Osteopathic Association March 2007

8. Medical Home Joint Principles: Pediatric Preamble • Family-centered care • Community-based system of care • Transitions • Value

9. Medical Home Joint Principles • Personal physician • Physician directed medical practice • Whole person orientation • Care is coordinated and/or integrated • Quality and safety are hallmarks of a medical home • Enhanced access to care • Payment appropriately recognizes the added value

10. Patient-Centered Primary Care Collaborative (PCPCC) Coalition of: Major employers Consumer groups Primary care physicians Mission: To advance the patient-centered medical home

11. PCPCC Membership • More than 300 members in 2 years • Executive Leadership: AAP, AOA, AAFP, ACP • Examples of membership: National Business Coalition on Health IBM, Exxon Mobil, Kraft, Boeing National Partnership for Women and Families

12. PCPCC Collaborative Centers and Committees • Center for Multi-Stakeholder Demonstration • Center to Promote Public Payer Implementation • Center for Health Benefit Redesign & Implementation • Center for eHealth Information, Adoption & Exchange • Center for Consumer Education • Legislative Committee

13. Multipayor/multiplayer Medical Home Pilots • Aetna • United Healthcare • Humana • Blue Cross Blue Shield Association • Wellpoint, Inc • MVP Health Care • Cigna

14. Patient-Centered Medical Home Overview of Current Pilot Activity and Planning Discussions (as of April 2008) RI Multi-Payer pilot discussions/activity Identified pilot activity PCPCC No identified pilot activity

16. NCQA: Patient-Centered Medical Home Measurement and Recognition • Access and communication • Patient tracking and registries • Care management • Patient self management • Electronic prescribing • Test tracking • Referral tracking • Performance reporting and improving • Enhanced electronic communications

17. National and Federal Medical Home Activities • HHS Federal Organizations: MCHB, CDC, SAMHSA, Headstart, Office of Disability, ACF, CMS • Medicaid and SCHIP Advocacy • National Academy for State Health Policy • Council of State Governments • Legislation: National and State

18. State Initiatives to Advance Medical Homes in Medicaid/SCHIP = Identified to have a medical home initiative Source: National Academy for State Health Policy State Scan, November 2008

19. State Policy Implementation • Introduced Legislation in 2008 Iowa New York Maryland Kansas Oklahoma Maine Massachusetts Minnesota Vermont New Hampshire Washington Utah • Enacted Legislation in 2007 and 2008 Colorado Iowa Maine Louisiana Washington New York Minnesota Oklahoma

20. Examples of AAP Medical Home Membership Support • National Center for Medical Home Implementation • Medical Home Toolkit • Medical Home Conference Call Series • MOC: eQIPP Medical Home module • Family-Centered Care Tools

21. Examples of AAP Medical Home Membership Support • Health Information Technology • Transition initiatives • Payment Advocacy • Chapter Facilitation of Medical Home Implementation in States • Medical Home Public Policy Guidance

22. National Center for Medical Home Implementation • Cooperative agreement funded by MCHB • Collaboration with Public Health: Title V • Examples of initiatives: • Medical Home Toolkit • Transition to adulthood • Interdisciplinary Medical Home Competencies (Leadership Education in Neurodevelopmental Disabilities) • Medical Home eQIPP Module

24. Medical HomeConference Call Series • Implementing Medical Home for All Children and Youth March 3, 2009 • Improving Communication and Comanagement Between Specialty Providers and the Medical Home • Implementing Developmental Screening in the Medical Home • The Role of the Medical Home in Family-centered Early Intervention • Incorporating Family Participation Practices into Your Practice and Project

25. Medical Home eQIPP Module • Education and quality improvement • CME and Maintenance of Certification • Linkage with Medical Home toolkit • Initial meeting January 2009

26. Family-Centered Care Tools • Developed by Family Voices • Quality improvement activities • Tools: Family Tool Provider Tool Users’ Guide

27. The Medical Home and HIT • Notify physician of overdue and abnormal tests. • Allows clinical data to be maintained in database. • Organized information in searchable data fields supports case and population management. • Computerized alerts support evidence-based medicine. • Interactive physician web sites, secure messaging, and personal health records can support communication between physician and parent/family. • E Prescribing may reduce errors and promote cost-effective prescribing.

28. Xavier Sevilla, MD, FAAP

29. Transition Initiative • Review of national initiatives, best practices and literature • Task force: ACP, AAFP, Med-Peds, youth and family representatives, CDC, Healthy and Ready to Work, Adolescent Subspecialty, Medical Home PAC representatives, COCWD • Clinical Report--with algorithm--being developed

30. Payment Advocacy • Medicaid and SCHIP funding • National and State MH Pilots: Medicaid and Multipayor • Payment structure: hybrid funding • Infrastructure • FFS • Enhanced PMPM • Coding • Pediatric Councils; COCHF White Paper • Measurement of MH Activities: NCQA

31. Medical Home: State Public Policy Guidance • Definition • Care coordination • Quality • Payment • Infrastructure and Information Technology • Practice coaching and education • Patient education • Community-based systems • Care Transition • Population specifics • Medical home advisory committees

32. Medical HomeImplementation Issues • Definition of Medical Home • Payment (pmpm, fee-for-service, infrastructure) • Evaluation of Pilots • HIT • Certification vs Recognition • Training and education

33. Medical HomeImplementation Issues • Measurement and Performance Standards • “Consumer” knowledge and involvement • Subspecialty involvement/comanagement • Politics/health care reform • Employer/purchaser attitudes