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Patient Centered Medical Home - Kids

Patient Centered Medical Home - Kids. Wednesday, November 20, 2013 6:00-8:00 p.m. Department of Health, DOC Patricia Flanagan, MD, FAAP, Co-Chair Elizabeth Lange, MD, FAAP, Co-Chair. CSI 101. Mission.

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Patient Centered Medical Home - Kids

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  1. Patient Centered Medical Home - Kids Wednesday, November 20, 2013 6:00-8:00 p.m. Department of Health, DOC Patricia Flanagan, MD, FAAP, Co-Chair Elizabeth Lange, MD, FAAP, Co-Chair

  2. CSI 101

  3. Mission • PCMH Kids will engage providers, payers, patients, parents, purchasers and policy makers to develop high quality primary care medical homes for children and youth that will assure optimal health and development, be committed to quality measurement, accountable for cost and outcomes, focused on population health and dedicated to system improvement. PCMH’s for children will be cost effective and sustainably resourced.

  4. Vision • Children and youth in RI will be cared for in high quality patient and family-centered medical homes.

  5. Guiding Principles • Families and patients are central to our work • PCMHs address the physical, developmental, behavioral, social, emotional, environmental and oral health needs of children and youth. • Children and youth need access to pediatric sub-specialty care. This entails workforce and payment issues as well as geographic and linguistic access. • PCMHs must integrate and coordinate care with community organizations, state agencies, child care and schools. • Prevention and public health functions of PCMH's are drivers of the health of the population of children and youth in our state. As such PCMH’s are embedded in communities they serve. • PCMHs must be accessible and affordable to all children, with a specific commitment to equity and cultural and socioeconomic diversity. • Payment must not only appropriately recognize the cost efficient added value provided by PCMH’s but also support the long-term sustainability of this transformative practice model. • PCMH-kids is committed to innovation and data-driven reform of the health care system. • PCMH-kids recognizes the importance of transitions, especially transitions from pediatric to adult care settings. 10. PCMH-kids is committed to the sustainability of primary care work force.

  6. Medicaid Perspective Populations of particular interest: • CSHN/Katie Beckett/CEDARR • Children in substitute care • Children with behavioral health needs, esp. adolescents Measures of Interest: • Developmental screening/Early recognition and response • Care coordination • Continuity of Care • ED visit rate • Oral Health • EPSDT • Screening for substance abuse Providers of interest: • High volume of Medicaid and/or populations of interest

  7. Medicaid Perspective Other Considerations: • Ability to qualify sites as Medicaid Health Homes under ACA Number of Sites: • Will depend on numbers of children at each site and total cost; • Need to collaborate with other payers • Consider mix of sites (high Medicaid, high commercial) Which Sites: • How to meet challenge of high volume sites that may not feel ready to apply

  8. SHIP Public comments being sought by Nov. 26: http://www.healthcare.ri.gov/healthyri/resources/ri_ship_comment_draft.pdf AAP Feedback

  9. Selection Sub-Committee Charge: Develop criteria for selection of initial pilot PCMH-Kids practices Develop application and scoring process for practice selection Develop outreach strategy to insure eligible practices are informed Recommend selection process to Planning Committee/Conveners With staff support, conduct selection process, score applications, and make recommendations to Conveners

  10. Selection Sub-Committee • Members • Steve Davis • Renee Rulin • Tina Spears • Andrea Galgay • Deidre Gifford • Beth Lange • Blythe Berger • Deb Florio • Parent representative

  11. Measures Sub-committee Charge: Review available data on quality, health disparities, disease prevalence, utilization and cost of healthcare for children in RI Review standardized measures of pediatric healthcare quality, including those used in other pediatric PCMH programs Review available measures for feasibility of collection and alignment with other RI programs Recommend set of quality, patient experience and utilization measures to Stakeholder coalition for inclusion in contract

  12. Measurement Sub-Committee • Members • Ronald Seifer • Betty Vohr • Nate Beraha • Jose Polanco • Shirley Spater • Stacey Aguiar • Bill Hollinshead • Oral Health? • Parent representative? • Payer representative?

  13. Race to The Top Early Learning Challenge Updates • Quality improvement and evidence-based practices • Aligning screening

  14. Questions

  15. Contact Information Patricia Flanagan MD, FAAP, Co-Chair pflanagan@lifespan.org 401-444-7987 Elizabeth Lange MD, FAAP, Co-Chair elizlange@cox.net 401-751-8683

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