The Medical Home and Quality Improvement A. Chris Olson, MD, MHPA President Washington Chapter of Pediatrics Medical Director Sacred Heart Children’s Hospital Clinical Professor University of Washington November 2, 2006

The Medical Home and Quality Improvement The Medical Home Quality Improvement Families and Quality improvement

What is a Medical Home? NOT just a building or place but a way of providing health care services that are: Accessible Family-centered Coordinated Comprehensive Continuous Compassionate & Culturally Sensitive

Children with Special Health Care Needs “Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” Adopted by the AAP (October 1998). McPherson M, Arango P, Fox HB, A new definition of children with special health care needs. Pediatrics 1998; 102:

Crossing the Quality Chasm – A new health care system for the 21 st century “The current care systems cannot do the job. Trying harder will not work. Changing systems of care will” “Improved performance will depend on new system designs.”

American Academy of Pediatrics Quality Improvement Medical Home and quality improvement part of the strategic plan for the Academy Maintenance of certification requires quality improvement activities for pediatricians that board certified.

American Academy of Pediatrics May 2005 Board of Directors affirm commitment to quality and approve significant funding for quality initiative  Increase QI staff infrasturcture and resources  Develop and support primary care innovation network Identification, testing and refinement of tools, strategies, and measures to translate guidelines into practice

Measures: how will they be used AAP Draft policy statement on measures  We believe that the primary purpose of performance measurement should be to identify opportunities to improve patient care. We support the use of performance measures that are utilized in the spirit of continuous quality improvement. We affirm the importance of partnership with children and families in these improvement efforts.

State efforts for quality improvement and medical home Immunization registries/immunization rates of the practice Oral Health/Fluoride Varnish Obesity prevention/BMI’s Well visits/Bright futures Collaboratives Medical Home Leadership Network/Website

Medical Home Index Office/Family Organizational capacity Community outreach Chronic condition management Data management Care coordination Quality improvement

Medical Home Index Quality Improvement/Change Level 1 Quality standards for children with special health care needs are imposed upon the practice by internal or external organizations.

Medical Home Index Quality Improvement/Change Level 2 In addition to Level 1, an individual staff member participates on a committee for improving process of care at the practice for CSHCN. This person communicates and promotes improvement goals to the whole practice.

Medical Home Index Quality Improvement/Change Level 3 The practice has it own systematic quality improvement mechanism for CSHCN; regular provider and staff meetings are used for input and discussions on how to improve care and treatment for this population.

Medical Home Index Quality Improvement/Change Level 4 In addition to Level 3, the practice actively utilizes quality improvement (QI) processes; staff and parents of CSHCN are supported to participate in these QI activities; resulting quality standards are integrated into the operations of the practice.

Data Collection Data person FACCT survey criteria Excel spreadsheet/Access Disease specific data collection Insurance plans

Care Coordination Office coordinator Inservice presentations Care Plans Specialty follow up Chronic Care visits  Reminder system Care Coordination costs

Cost of Care Coordination 774 encounters/not reimbursed services Most complex consumed 25% of the time 11% of the patients 51% of the encounters not medical Cost of time spent coordinating  $22,809 to $33,048 Efforts to finance unreimbursable care coordination

Future efforts Increase reimbursement to pediatricians/family physicians who care for children leading to increased access Reimbursement for services directly related to care coordination or preventive services Task force on quality Release of policy this fall Pay for Performance

Family centered care Family is the constant in the care of the patient Connecting families  Newsletter  Bulletin board Family advisory council Asking families and surveys

A medical home should be able to… Form active partnerships with families Identify and monitor CSHCNs Coordinate care in a systematic manner Communicate with other community resources and pediatric specialty services This requires redesign of existing services

References  AAP site for medical home information  State of Washington medical home site  Source for CME on quality improvement  Medical Home Index site  CME on quality improvement  Children and adults