Patient-/Family Centered Medical Home for Children Why hasn’t it spread further? Chuck Norlin, MD Professor of Pediatrics, University of Utah Adjunct Professor of Biomedical Informatics Director, Medical Home Portal (medicalhomeportal.org)medicalhomeportal.org Director, Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) Medical Director, Children’s Healthcare Improvement Collaboration (CHIC)

Questions for you Could primary care practices better meet the health-related needs of children and families? Does the Medical Home model offer a framework for doing so? If so, why haven’t primary care practices already become medical homes?

What do children/families need? Help making sure kids grow up with strong bodies and minds Help making decisions about illness, injury, or incapacity Help finding and using the health-related services or other resources they need Help getting help when they need it Help understanding and navigating health care Help affording the care they need

Can clinicians meet those needs? Growing up with strong bodies & minds – Immunizations, screening, early intervention, anticipatory guidance Making decisions about illness or injury – What kind(s) of care are needed, if any – What are the alternatives and how to decide among them – Provide care or facilitate access to care – Coordinate the care provided by others

Can clinicians meet those needs? Help finding needed services/resources – Specialists (medical, surgical, mental health) – Therapies, technology, accommodations, etc. – Community-based services and resources – Coordinating the services/resources Help getting help when they need it – Access to care when and how it is needed  Virtual – phone, , web portal, Skype/FaceTime  In-person – early, late, weekends/holiday  Frequency – enough but not more than needed, particularly for chronic conditions  Notifications and reminders

Can clinicians meet those needs? Help understanding & navigating health care – Effective education, guidance, support for self-care – Interpretation of information (e.g., about labs, from specialists, on the web) – Addressing language, culture, faith Help affording the care they need – Timely access (avoid complications, avoid unneeded absence from work and school) – Use cost-effective alternatives – Avoid services that are unnecessary, low value, duplicative, or likely harmful

Meeting those needs largely describes the Patient-/Family-Centered Medical Home (PCMH) model of primary care … An idea that’s been around for ~20 years “Joint Principles” published in 2007 Now, four agencies offer ‘recognition’ But there are substantial barriers – Knowledge, skills, experience – Access to information and data – Payment and incentives

Why don’t practices embrace PCMH? Doing so requires a lot of change So far, clinicians have only been paid to 1.See patients in person 2.Perform procedures It would mean spending time doing things they won’t be paid for but that won’t decrease costs They don’t have time; to find time, they would have to not do, or do differently, some things they’re currently doing They don’t know how to best meet the needs of patients and families

Which changes would make the most difference? Coordinate Care – Manage chronic conditions with a long- term view – Communicate relevant information to other providers and community resources (schools, therapists, recreation programs) – Track and follow through on care provided elsewhere – Collaborate/co-manage care with key specialists

Which changes would make the most difference? Improve access to care – Use a team to deliver care (prevention, coordination, education, monitoring) – Use electronic ‘visits’ for some advice, assessment, follow-up, treatment – Be available before and after traditional work hours (when many questions arise)

Which changes would make the most difference? Engage patients and parents – Partner in decision-making  Educate; share information and opinions  Ask about goals, preferences, concerns, priorities – Parent/Patient Advisory Group – Parent Partners  Consumer consultant  Resource consultant  Navigator, shoulder for other parents

What’s needed to enable and support those changes? Care coordination – Compensation – e.g., per member per month (PMPM) fee  Add team member(s)  Add expertise – Ready access to all relevant clinical information (health information exchange, e.g., cHIE) – Timely information about use of services (HIE and claims data, partner with payers) – Pay for performance (P4P); shared savings  risk sharing

What’s needed to enable and support those changes? Improve access to care – Compensation for care provided electronically  Secure, easy to use systems for electronic and video communications, linked to the electronic record – Compensation for components of care provided by non-clinicians  Patient education, coaching, coordination – Ready access to clinical data (e.g., cHIE) – PMPM; P4P; shared savings  risk sharing

What’s needed to enable and support those changes? Engage patients and parents – Time and teamwork – Ask and appreciate – Support and compensate – PMPM; P4P; shared savings  risk sharing

What’s needed to enable and support those changes? Data and Measures – To drive ongoing improvement – To assess and reward performance – To assess impact on outcomes, quality, and cost

Thank you.