Post on 04-Jan-2016
description
NFI Grantee MeetingNFI Grantee MeetingSeptember 18, 2007September 18, 2007
Sarah Thorson: Minnesota Department of Health
Sharon Fleischfresser: Wisconsin Division of Public Health
Medical Home and the CommunityMedical Home and the Community
Medical Home Breakout Medical Home Breakout Session OutcomesSession Outcomes Background information on Medical Home
Initiatives in Minnesota and Wisconsin Share activities of Medical Home
implementation in your community Identify challenges and the Lessons
Learned Explore ideas for Medical Home spread
…….We tried a lot of other things first - .We tried a lot of other things first - with sporadic successeswith sporadic successes
AAP-MN Disability Subgroup Efforts– Title V and Part C funded: Raise awareness of ‘Medical Home’ among pediatricians
Universal Standard Benefit Set SAFE at Home Partnership: Title V, Family
Voices, 2 health plans, individual physicians: to identify CSHCN and to improve the quality of primary care.
Minnesota’s promise: Title V, Family Voices, physician leaders
Essential Element of a Medical Home % Success
(MN)
% Success
(US)
a. The child has a usual source of care 88.7 90.5
b. The child has a personal doctor of nurse
84.6 89
c. The child has no problems obtaining referrals when needed
76.5 78.1
d. Effective care coordination is received when needed
40.5 39.8
e. the child receives family-centered care 69.9 66.8
MEDICAL HOME OUTCOME 48.7 52.6
Then we really started “humming”Then we really started “humming”
2002 Minnesota Medical Home Project: Title V, Family Voices, and AAP-MN, DHS
Assumption we’d all work together
Funds reflected a partnership
The Blueprint: Breakthrough The Blueprint: Breakthrough SeriesSeries(9-12 month time frame)(9-12 month time frame)
Select Topic
Planning Group
Develop Framework & Changes
Participants
Prework
Supports
E-mail Visits
Phone Assessments
Senior Leader Reports
LS 1 LS 3LS 2
Summits,
Guides,
Publications,
etc.
A D
P
S
A D
P
S
The CollaboratorsThe CollaboratorsGroup of 11 Primary Care Pediatric
Practices & Family Practice ClinicsTwo parents per teamMeet 3 times a year for 2 days of
learning and sharingPunctuated with action periods where
each team implements MH concepts and improves their Medical Home
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
Act Plan
Study Do
From: Associates in Process Improvement
Functional and Clinical Outcomes
Resources and Policies
Community
Health System
Health Care Organization (Medical Home)Delive
rySyste
mDesign
Decision
Support
ClinicalInformati
onSystems
Care Partnership
Support
Informed,ActivatedPatient/Family
Family -centered
Coordinated and EquitableTimely & efficient
Evidence-based & safe
Supportive, Integrated Community
Prepared,ProactivePractice Team
NFI: 21 NFI: 21 TeamsTeamsTitle V
priorities (Six core outcomes +SPMs) integrated into curriculum
Medical Home IndexMedical Home Index
0
1
2
3
4
5
6
7
8
Org Capacity Chronic Care Mgmt Care Coordination Community Outreach Data Mgmt Quality Improvement
Time 1Time 2
Number of CYSHCN Identified byby Time Period
0448
1147
3823
5285
0
1000
2000
3000
4000
5000
6000
Mar-04 First Report After 9 Months 18 Months AfterThat
Jul-07
Time Period
Inpatient Days Per Year Pre-collaborative through Year Two
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
3/2003 - 2/2004 3/2004 - 2/2005 3/2005 - 2/2006
Year
Me
an
Inp
ati
en
t D
ay
s
Emergency Department Visits Per Year Pre-Collaborative through Year Two
1
1.05
1.1
1.15
1.2
1.25
1.3
1.35
3/2003 - 2/2004 3/2004 - 2/2005 3/2005 - 2/2006
Mea
n N
um
ber
of
Vis
its
Family Survey ResultsFamily Survey Results
Copy of care plan
Visited hospital emergency room in past 3 months
Unplanned hospital admission in the past 3 months
2007 Legislative Session2007 Legislative Session
four pilot projects for children and adults with complex health care needs who are enrolled in fee-for-service medical assistance, to the extent permitted by federal requirements. At least two of the grantees must focus on children with autism or children with complex/multi-diagnoses physical conditions. The purpose of the projects is to pilot primary care clinic models of care delivery focused on care coordination and family involvement
2007 Legislative Session (cont)2007 Legislative Session (cont)
develop and implement a provider-directed care coordination program for medical assistance recipients who are not enrolled in the prepaid medical assistance program and who are receiving services on a fee-for-service basis. This program provides payment to primary care clinics for care coordination for people who have complex and chronic medical conditions. Clinics must meet certain criteria such as the capacity to develop care plans; have a dedicated care coordinator; and have an adequate number of fee-for-service clients, evaluation mechanisms, and quality improvement processes to qualify for reimbursement.
2007 Legislative Session (cont)2007 Legislative Session (cont)
Of the health care access fund appropriation, $500,000 in fiscal year 2008 and $500,000 in fiscal year 2009 are to expand the medical home learning collaborative initiative in collaboration with the commissioner of human services. Services provided under this funding must support a medical home model for children with special health care needs.
Wisconsin-Medical HomeWisconsin-Medical Home
Medical Home - WisconsinMedical Home - Wisconsin CSHCN national performance outcome Participation in the Maternal Child Health
Bureau (MCHB)/American Academy of Pediatrics (AAP) Medical Home Mentorship Meeting - January 2002
Identified as a priority area by the WI MCH/CYSHCN Advisory Committee
National Medical Home Learning Collaborative (NICHQ)
Wisconsin replication in partnership with the Regional CYSHCN Centers
Medical Home for all children as a new WI Title V State Performance Measure
Wisconsin Medical Home Learning Wisconsin Medical Home Learning CollaborativeCollaborativeUtilize rapid QI (Plan, Do, Study, Act)
cycles –Small Steps of Change
Focus of practice change: Family Partnerships (focus groups, family surveys,
creation of Parent Advisory Committee) Identification of CYSHCN within the practice Development of medical care plans (emergency
care, care summary) Linkage to community/state resources
Participating PracticesParticipating Practices
Wisconsin Medical Home Learning Wisconsin Medical Home Learning CollaborativeCollaborative
Regional CSHCN Centers
Regional CSHCN Centers
Measurement: MH IndexesMeasurement: MH Indexes
Mean Item Scores for Each Domain
3.5 3.7
3.0 2.9
3.6
2.83.3
5.1 4.9 4.9 4.7 4.74.3
4.9
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Org Capacity CC Mgt Care Coord CommOutreach
Data Mgt QI Total Mean
WLC 2004 (Apr) WLC 2004 (Nov)
Medical Home Spread: 2006-2007Medical Home Spread: 2006-2007
12 Medical Home local capacity grants (April 2006-Dec 2007) with new cycle January 08
Medical Home Transitions Learning Collaborative (UW and CHW) - ongoing
Medical Home Summit – 2006 and 2007 Transition Community Connector grants Primary Care Practice QI Mini-Grants Wisconsin Medical Home Toolkit:
www.wimedicalhometoolkit.aap.org
Medical Home Practice Sites MH Local Capacity Grants Transition Learning Collaborative Transition Community Connectors
Medical Home Practice Sites MH Local Capacity Grants Transition Learning Collaborative Transition Community Connectors
Medical Home and Community Grant SitesMedical Home and Community Grant Sites
Regional CYSHCN Centers
Regional CYSHCN Centers
Practice MH Mini-GrantsPractice MH Mini-Grants
Medical Home Index 2007Wisconsin Learning Collaborative
0.0
1.0
2.0
3.0
4.0
5.0
OrgCapacity
CC Mgt Care Coord CommOutreach
QI Total Mean
WLC 2007 (Jan) WLC 2007 (May)
Goals: Simple Steps
Introduce health care providers to Medical Home quality improvement strategies
Provide a roadmap to tested tools and strategies
Connect providers, their patients and families, to the Regional CYSHCN Centers
Medical Home Strategies:
Engage Patients/Families as Partners Improve Care Coordination
Create Care Plans Identification & Screening Supporting Transitions Collaborate with Community Resources Improve Coding and Reimbursement
Wisconsin MH Toolkit Website: Wisconsin MH Toolkit Website: Average/Month (March-July2007)Average/Month (March-July2007)1419 visitors/month316 single visits/month179 repeat visits/month188 book marked/month951 down loads/month Favorites: care plans,
reimbursement/CPT codes
Other Opportunities for Medical Other Opportunities for Medical Home SpreadHome Spread Promote spread of MH as QI effort Link Medical Home LC concepts to long term
care reform efforts for children and adults (Family Care)
Child Alert/Preparedness Wisconsin eHealth Initiative Other public health programming-adult
chronic disease programs Health care financing-pay for performance
ChallengesChallenges
MH spread to date is primarily focused at the practice level versus system
Lack of funding/incentives to support care coordination and other MH strategies on a system wide scale
Making the “business case” for MH implementation as a health care delivery model
For More Information Sarah Thorson:
sarah.thorson@health.state.mn.us651-201-3651
Sharon Fleischfresser: fleissa@dhfs.state.wi.us608-266-3674
DiscussionDiscussion Name an activity that you have been
engaged in to support Medical Home implementation in communities in your state?
What are the challenges you’ve encountered?
What strategies have you found to be successful?
Ideas to promote Medical Home Spread in the future?
“A Medical Home does not simply appear over night. Like any quality home, it is built with careful plans and thought, time and effort, leadership and commitment.” - Parent