Welcome PCMH Kids Practices and Key Stakeholders PCMH Kids Stakeholder meeting 12-6-18 Pat Flanagan MD, FAAP & Beth Lange MD, FAAP, PCMH Kids Co Chairs

PCMH Kids Cohort 1 Practices: Lead the Charge to Improve Quality Care for Children & Families Improved Clinical Quality: Developmental screening of all children age 9-30 months from a baseline of 41% screened to 85.9% screened which is fundamental to the Governor’s third grade reading readiness initiative; Obesity screening and counseling from a baseline of 55% to 85.8%; 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

PCMH Kids Cohort 1 Practices: Lead the Charge to Improve Integrated Behavioral Health Care for Children & Families Integrated Behavioral Health Services into Pediatric Primary Care through: ADHD screening, diagnosis and treatment plans; Maternal post-partum depression screening : baseline of 22% to 87% and implemented referrals protocols for intervention. Screening, Brief Intervention, Referral, and Treatment (SBIRT) in the adolescents 75 providers, with a total pediatric population of ~34,000, enrolled in the learning collaborative; BEHAVIORAL

PCMH Kids Cohort 1 Practices: Lead the Charge to Improve Care Coordination for Children & Families Addressed needs of “at risk” children and families Developed and implemented a pediatric specific high-risk framework to identify children and families that would benefit from care coordination services; Reduced Emergency Department usage by 2.5% compared with non- PCMH practices;

PCMH Kids Cohort 1 Practices: Lead the Charge for Practice Transformation In its first year, all 9 initial practices achieved NCQA patient centered medical home recognition; Based on the outcomes of PCMH Kids pilot, health plans supported a July 2017 PCMH Kids expansion and continue to support a 2019 PCMH Kids expansion. PCMH-Kids is comprised of 20 practices, covering over 66,000 lives including 200 pediatricians and trainees and representing more than 50% of the state’s pediatric Medicaid population. Increased partnerships with KIDSNET and Family Home Visiting programs

Thank You PCMH Kids Cohort 1 for Leading the Charge Anchor Medical Associates Coastal Medical – Narragansett Bay Pediatrics Coastal Medical – Waterman Pediatrics East Bay Community Action Program – East Providence East Greenwich Pediatrics Hasbro Medicine Pediatric Primary Care Center Hasbro Pediatric Primary Care Pediatric Associates Wood River Health Services (Pediatrics) 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2 We couldn’t have done this without you! (and had so much fun)

Thank You PCMH Kids Cohort 1 Practices for Leading the Charge We want to hear from you (5 minutes) 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

Thank You PCMH Kids Cohort 2 We want to hear from PCMH Kids Cohort 2, also (5 minutes) 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

PCMH Kids Receives National Recognition Chairs, Drs PCMH Kids Receives National Recognition Chairs, Drs. Flanagan and Lange Calvin C.J. Sia Community Pediatrics Medical Home Leadership award Named in honor of Calvin C. J. Sia, MD, FAAP Award honors pediatricians who have advanced the medical home through practice and advocacy, especially for children with special health care needs.  Award was presented during the 2018 AAP National Conference & Exhibition in Orlando, FL on November 3rd during the Community Pediatrics Awards and Poster Display.     Thank you to Drs. Flanagan and Lange for their continued hard work and dedication to pediatric care in Rhode Island, and congratulations on this well-deserved national recognition! 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

Rhode Island First 1000 Days Campaign Elizabeth Burke Bryant, JD Devan Quinn, MPP 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

PCMH Kids Expansion 10 applications, representing 17 practice sites. Fantastic news! 64 pediatric providers Impacting ~44,000 patient population 4 practices do not have NCQA All practices are part of a System of Care More interest than budgeted by the health plans All praiseworthy applicants Working with health plans to develop options and select best path forward for all. 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

Sustainability 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2

Please stay for group photo 2 Quality Measures: BMI and Developmental Screening 100% Cohort 1 met both quality metrics Cohort 2 - 7 out of 11 (64%) practices met both quality measures 3 out of remaining 4 (or 27% of Cohort 2) met one quality measure 1 practice did not meet either quality measure Method 2 criteria not applicable for Cohort 2