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Facilitator Desiree Pendergrass


									                                            Medical Home Workgroup
Facilitator: Lesa Walker                                  Note taker: Beverly MacCarty
Participants:                                             HHSC– Harry Barnes, Ivy Bela, Terri Frazier, Marisa
Texas Parent to Parent – Laura Warren                       Luera, Olga Rodriguez, Larry Swift
Baylor College of Medicine Special Needs Primary Clinic – DFPS: Paula Clark, James Rogers, M.D.
Carl Tapia, M.D.                                          DSHS:
Texas Children’s Hospital – Robert Warren, M.D.              Purchased Health Services Unit– Lesa Walker, MD,
Texas Health Resources – Maynard Ewton, M.D.,                Kathy Griffis-Bailey, Beverly MacCarty, Becky Nichols
Catherine Hill, MSN                                          Case Management and Health Screening Unit –
                                                             Kelly Gorham
Parkland Community Health Plan – Barry Lachman, M.D.
                                                             Immunizations – Anita Freeman, Sheila Tucker
Children’s Hospital Association of Texas – Bryan Sperry
Family Voices/Hali Project – Brad Thompson
Hali Project/Amarillo Medical Home Project – Brad Thompson
Brad has worked with Medical Home activities in Texas since 2003 and serves on the AAP Medical Home Advisory
Committee. The Amarillo Medical Home Project was implemented about 2 ½ years ago and arose out of consistent
frustration from physicians who wanted to provide a comprehensive medical home but lacked resources, including
knowledge of community resources. The current project is a model that may be particularly beneficial for smaller rural
practices. The project places a trained counselor or family partner within a practice to lend a family-friendly “listening
ear” to help families with non-medical concerns/needs. The model is currently implemented within one practice with 4
physicians and one PA where well-child visits for children with special health care needs are scheduled (when possible)
on Fridays. Brad brings his skills as a Licensed Professional Counselor and parent of a child with special health care
needs to meet with families at the practice on Friday to listen and talk with families about needs and community
resources. This family-friendly approach meets the families’ needs while increasing efficiency for the physician. The
practice estimates that each physician in the practice generates an additional $400-$1000 in income each month as a
result of this increased efficiency. Families report increased satisfaction in reduced waiting time, and knowing where to
go for resources/services. Bringing in a family partner helps integrate medical and non-medical needs. At the end of
each Friday or more frequently as required, the family partner and physician(s) meet to share and update each other to
ensure a coordinated approach.
The project is currently financed through local foundation grants and is free to the medical practice. Family partners are
being trained and will be placed in two other interested practices in the Fall as the project expands.
Consider expanding to adult-serving practices to cultivate liaisons that focus on transitioning youth with special health
care needs to adult health care.
Frew Initiatives – Olga Rodriguez
Funding status - <$40 million of the $150 million for strategic medical/dental home initiatives has been allocated.
Proposals are brought to the Frew Advisory Committee for review. The Committee will meet in August to review
proposals related to telemedicine, physician directed care coordination, consultation and referral line for pediatric
subspecialty care, additional mobile dental units, and Medicaid Access Card improvements. Committee agenda and
minutes may be found on the HHSC website at
Currently funded proposals
 1 dental home – reimbursement for dentists for oral exams, application of fluoride varnish, and provision of
    anticipatory guidance beginning at 6 months of age.
 Medical home – reimbursement for primary care providers trained to conduct oral exams and apply fluoride varnish.
    Reimbursement to begin in August.
 Mobile dental unit – Valley
 Pilots looking at integrating pediatric and mental health – clusters of physicians will share a mid-level behavioral
    health provider and child psychiatrist. To begin in September.
 Pediatric subspecialty projects – referral guidelines for PCPs and reimbursement for telephone consultation.
 Pending proposals
 Health reward incentives (especially for teens)

                                            Medical Home Workgroup
   Migrant data exchange – working with Texas Educational Agency (TEA)
   Loan repayment – fund 150 recipients (new or currently practicing) physicians, pediatricians, dentists, family
    physicians, and pediatric subspecialists who will serve children with Medicaid
   Vitamins/minerals – contract with an academic institution to determine if Medicaid should cover additional
    vitamins/minerals for certain conditions
   Promotora educators in Emergency Rooms to link patients to a medical home

Have the increased dental rates resulted in an increase in dental providers? Not clear yet, data will be available in
Dr. Lachman discussed shared medical appointments as a model implemented for asthma that may have benefits to a
medical home approach and may be of interest to the Medical Home Workgroup. He will share the contact information
of those implementing this model.
Foster Care Health Passport – Initial Experiences – Ivy Bela
The Health Passport keeps track of health care services received by a child in foster care, including general member
information, PCP, caregiver, case worker, and medical consenter information, immunizations, labs and tests records,
allergies and medications, THSteps forms, doctors visits and claims history (including dental and pharmacy). Providers
are getting more used to entering data and are increasing access and usage of the Health Passport. Superior may also
look at incentives to increase provider use and entering of data in the Health Passport. Superior uploads claims data
daily, and TMHP sends a weekly file for claims outside of Superior. An update is needed on the status of the system
interface with ImmTrac. Implementation has been successful with providers reporting few technical problems in
accessing the Health Passport. Positive feedback was received from a stakeholder meeting on June 30. Provider focus
groups are planned for August to review Health Passport and service management within the new healthcare model.
HHSC will look at ways to get feedback from foster parents through the External Quality Review Organization (EQRO)
probably later in the Fall.
Consider allowing CPW case manager access to the Health Passport to better coordinate medical and case
management services. Consider enabling foster parents to enter data into the Health Passport at a future date.

Texas Parent to Parent – Laura Warren
The Texas Parent to Parent Annual Conference was held in Austin on June 27-28 and offered 55 conference sessions
for more than 300 participants. The Family Gathering was also very successful with a chorus and discussion by self-
advocates. The conference included different panels – parent leaders, siblings, self advocates, and Parent to Parent
staff. Kathy Griffis-Bailey organized and led the Teen Transition Expo, which was attended by 20 young people and
focused on self advocacy, health care transition, a “true colors” exercise, and employment issues. She also presented a
session on transition. Dr. Angelo Giardino (Texas Children’s Health Plan) joined Jeanine Pinner and Carol Harvey in
presenting a creative session on medical homes. The session, entitled “It’s 10 O’clock – Do you know where your
doctor is?” prompted discussion of medical homes from the family, provider, and systems perspectives. Planning will
now begin for the 2009 Annual Conference. The CSHCN Services Program held three focus groups at the conference
to gather family feedback related to the Title V Performance Measures, including Medical Home and distributed a
survey to gather input on the Title V CSHCN performance measures (including access to a medical home). Information
from the focus groups and survey will be tallied and reported.
Jeanine Pinner at Texas Parent to Parent received support from parents attending the conference for developing a
medical home listserv.
Update – Medical Home Supports – Beverly MacCarty
A second amendment has been posted to expand the Medical Home Supports open enrollment to also include internal
medicine practices for proposed medical home quality improvements targeting the transition of youth and young adults
(less than 21 years old) with special health care needs from pediatric to adult health care. Up to $10,000 per Medical
Home practice for a limited number of practices is still available on a first-come, first-served basis to support pediatric
and/or family physician Medical Home services and quality improvement efforts. Additional information and an
application can be found on the Electronic State Business Daily (ESBD):

                                            Medical Home Workgroup
If questions, please contact Lesa R. Walker, M.D.: or Beverly MacCarty:

Texas Health Resources Corp. – Catherine Hill, Maynard Ewton, M.D.
Texas Health Resources has implemented a medical home pilot project related to seniors with congestive heart failure.
Their focus demonstrates the applicability of medical home concepts across the age range. While the Medical Home
Workgroup’s focus is children, there are significant commonalities in the benefits of a medical home for vulnerable
populations at either end of the age spectrum.
Patient-Centered Medical Home Summit – Lesa Walker, M.D.
The Summit, held June 27 by the Texas Academy of Internal Medicine (TAIM), initiated a process for developing a
Medical Home demonstration project in Texas and brought together representatives from TAIM, major employers, the
Texas Medical Association (TMA), Texas Pediatric Society (TPS), and Texas Academy of Family Physicians (TAFP). A
member of the American College of Physicians and representatives from a Colorado demonstration project gave
presentations. Part of Texas’ future discussion will be on the target population. While other states are primarily focusing
on adults, Texas’ demonstration project could choose to focus on children, adults, or both. A steering committee is
being formed to begin planning. Dr. Walker also shared information on other Medical Home projects, including the
Medicare Medical Home Project which looks at a 3-tier reimbursement process. IBM is a major employer of over
500,000 employees and is a champion in promoting interest in medical home concepts. IBM helped launch the Patient
Centered Primary Care Collaborative, a coalition of major employers, consumer groups, and other stakeholders who
have joined with organizations representing primary care physicians to develop and advance the patient-centered
medical home.
Anita Freeman asked if anyone had looked at the high numbers of uninsured and ensuring a Medical Home for this
population (children and adults). FQHCs and Rural Health Centers are a key resource in providing care for the
uninsured population. There may be additional opportunities to partner with FQHCs and Rural Health Centers in
implementing medical home concepts.
2008 Meetings of the Medical Home Workgroup
October 7, 2008 1:30 – 3:00 p.m. DSHS Moreton Building Room 653 or by conference call
Proposed Future Agenda Items:
 Texas Parent to Parent Medical Home Listserv
 Children’s Medical Center Medical Home Research Project Findings– Dr. Christina Bourland
 Patient Centered Medical Home Demonstration Project
 Shared Medical Appointments
 HHSC RFI – Reduce inappropriate ER use
 Nurse Family Partnership
 Medicaid Reform
Please feel free to suggest agenda items – contact or


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