The Medical Home in Pediatric Practice

							The Medical Home in
 Pediatric Practice

  EMRs and Care Plans
    Medical Home Conference
       Washington State
         May 30, 2007
     A High-Performing System for
     Well-Child Care:
     A Vision for the Future*
‘…an ideal system would be characterized by:
• Advanced access to services
• Team-based care
• Individualized developmental and behavioral
  screening
• Cultural beliefs and practices accommodated
• Care coordination through a medical home
• Knowledge transfer and electronic health records
• Health care financing       *Bergman D, Plsek P, Saunders M. CMWF
                                     Report, October 2006.
    In a nutshell, what is your vision of
    an ideal system of well-child care?

                                               David Bergman, M.D.

• First, we have to have some sense of biopsychosocial risk. A lot of
  this can be determined at birth: Is the child born premature? Does
  the baby have a congenital defect? Is the family situation chaotic?
  These are all risk factors. We then have to assign the content of
  care according to the level of risk. High-risk kids need more
  visits with a different mix of health care professionals.


• In terms of financing, we need to align incentives to more
  appropriately reimburse for kids with special health care
  needs. This can be done through tiered capitation—defining kids
  at a level of biopsychosocial risk and assigning a capitated rate.

• Leveraging new technologies is also key.
     A High-Performing System for
     Well-Child Care:
     A Vision for the Future*
• Advanced access to services - Secure messaging
• Team-based care - Develop comprehensive plan,
  including education and socialization
• Care coordination through a medical home
• Knowledge transfer and electronic health records
• Health care financing - Reimbursement for non-physician
  members of health care teams (Care coordinators)
• Individualized developmental and behavioral screening
  (Vanderbilt in EMR – MBCH, On-line form completion, e.g.
  ASQ)
• Cultural beliefs and practices accommodated (Parent
  information sheets, screening tools)
       EMRs
• Scope:
   – Practice-based
        • Othello: Columbia Basin Health Association [CHARTLOGIC*],
        • Spokane: Olson Pediatrics
   – Hospital-based/System-based
        • Mary Bridge - EPIC (with SmartSet subprogram – ADHD Module)
        • Group Health Cooperative
   – Community-wide
        • Kittitas
        • Whatcom
• Patient accessibility
   –   PHRs - test results, visit summaries, input health information
   –   Email communication
   –   Information resources
   –   Other
    EMRs – Discussion Points
• Pediatric-specific record issues/CSHCN-
  specific record issues (Needs/hopes/problems)
  – Provider viewpoint
     • Individual patient
     • Diagnosis specific management
  – Family/Child viewpoint (?cultural, PHRs, email
    interface, adult child with DD,etc.)
  – Health plan issues
     • ID CSHCN
     • Data pulls for
         – Patient care issues (often by diagnostic group)
         – Contract/reimbursement documentation
           Olson Pediatrics
•   Spokane Medical Community
•   One Pediatrician
•   Three Mid-level providers
•   Office Staff of 10 FTE’s
•   Approx. 9,000 patients
•   1212 CYSHCN
          Data Collection
• Data person
• FACCT survey criteria – CSHCN
  Screener (5 item, parent-survey
  based tool)
• Excel spreadsheet/Access
• Disease-specific data collection
• Insurance plans
                     Diagnosis - CYSHCN
                         11%
                    1%

               3%                    24%   ADHD
          1%
                                           Asthma
      1%
                                           Asthma +
          4%                               Autism
                                           CF
     2%
                                           Cleft Lip
     3%                                    CP
2%                                         Depression
1%                                         Devel. Delay
     3%                                    Diabetes
                                           Downs
           4%
                                           Seizures
                                           Myleodysplasia
                                           Other

                               40%
            Severity
           8%

      4%




15%


                         Severity   1
                         Severity   2
                         Severity   3
                         Severity   4



                   73%
      Insurance Coverage
         9%



                    24%




26%                       DSHS
                          Molina
                          PVT
                          PVT + Medicaid




              41%
           Care Plans
• Who creates them? What do they look
  like?
    – Health plan
    – PCP
    – Family
•   What else is needed?
•   Sample forms
•   Leveraging personnel and time
•   (Coding and Reimbursement)
                Care Plans
Examples:
  – Jack Stephens
  – Jean Popalisky
     • Health plan
     • Primary care office
  – CCSN website – Family
  – Notebook - other examples
• Resources:
  – WA medical home site
  – National medical home site
  – HRTW site