1. Medical Homes in Washington: Reaching the “Tipping Point” Maxine Hayes, MD, MPH Medical Home Conference May 30, 2007

2. Welcome & Introduction

3. What is a Medical Home? A way of providing comprehensive, coordinated care that is built on a foundation of mutual respect and partnership between patients, their families, and health care providers. Also includes connection with community services such as family support.

4. Defined by its Components Accessible Continuous Comprehensive Coordinated Family-centered Compassionate Culturally effective

5. One of the Six National Performance Measures for CSHCN All CSHCN will receive regular ongoing comprehensive care within a Medical Home

6. Providers Develop partnership of mutual responsibility and trust with family and child Deliver or direct primary care Manage and facilitate all aspects of child’s care coordination

7. Families Diverse families empowered to play active role as a Medical Home team partner.

8. Policy partners involved in moving MH concept forward include: Medical Home Teams Washington State AAP Other providers (including oral and mental health) Insurers Families, schools, childcare providers Interagency and community partners

9. We’ve reached the “Tipping Point”! “The Tipping Point, How Little Things Can Make a Big Difference” by Malcolm Gladwell (2000) When an idea becomes commonplace, acceptable, part of the every day usage, and things start to change….

10. What’s changing… Medical Home concept and acceptance has grown! Started with AAP in 1967.

11. History of MH for CSHCN in WA Medical Home Needs Assessment in 1993 led to 1995 “Training & Resource Project” with 12 county medical home teams. “Promise to the State” (2001) Medical Home Leadership Network grew out of this: now 21 teams Medical Home Strategic Plan for CSHCN (2006)

12. DOH Medical Home “Strike Team” “Medical Home Strike Team” 2006-Present Focusing on bringing statewide efforts together to create a Medical Home strategic plan for all children and adults

13. Medical Home Summit – November 2006 Beginning of a strategic planning process to spread the concept of Medical Home, using the new strategic plan for CSHCN as the foundation.

14. The Tipping Point - What’s changing… There’s increasing agreement that MH means more than just having a primary care provider.

15. What’s changing… Partnerships are expanding to include practitioners/specialties beyond Pediatrics. Joint Principles of the Patient-Centered Medical Home, March 2007, exemplify broader acceptance.

16. 2006-2007 public policy initiatives State Initiatives that include Medical Home SSB 5093 (Children’s Health Insurance- aka Cover all Kids) Blue Ribbon Commission (insurance for all) Kids Matter plan (early learning initiatives) Autism Task Force recommendations Oral Health State Access Action Plan for CSHCN

17. What’s changing More communication between medical community, public health, early intervention Family advisory groups Dental homes integrating with medical homes Head Start and Early Head Start require medical homes for children

18. New Medical Home Tools Medical Home website: www.medicalhome.org Medical Home key messages document Medical Home monograph Parent/Family Medical Home Checklist Oral Health and CSHCN monograph and website Bright Futures Oral Health document for CSHCN New brochures for parents and providers 2007-2008 Family Leadership Training Curriculum – CSHCN Program

19. Medical Home Quality Improvement Medical home is an effective approach to improving health outcomes: Learning Collaboratives Performance indicators in SSB 5093

20. Together we can eliminate Health Disparities Significant health disparities Medical Homes defined as culturally competent and family centered Washington State’s increasingly diverse population requires providers to become well versed in cross cultural communication and care.

21. Next Steps Develop strategies for financing care coordination Seek additional funding, e.g. Epilepsy Grant Support Learning Collaboratives

22. What Teams will hear about today Strategies that are working for teams in our state Opportunities to share and learn from each other.

23. Reflections on the day

24. Determinants of Health LIFESPANLIFESPAN Multiple levels of influence HEALTH Access to Health Care – 10% Environment – 20% Genetics – 20% Healthy Behaviors – 50%

25. EnvironmentalRisk Stress due To Social Factors Institutionalized Biases (racism, sexism, etc.) Language and Other Cultural Factors EconomicOpportunity and Equity EducationBackgroundandOpportunity Mental Health and Social Support Access to Health Services Health Behaviors and Personal Risk Factors Trust in Health System and Research SOCIAL DETERMINANTS OF HEALTH

26. Discussion & Questions