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Medical Home Workgroup
Strategic Plan Update – July 2008
Strategies and Activities Status
A. Expand statewide focus on American Academy of Pediatrics (AAP)
medical home implementation. Update 7-08
1. Increase public awareness and AAP was awarded a Maternal and Child Health Bureau 5-year grant to continue medical home activities and projects
understanding regarding – grant may rename the National Center of Medical Home Initiatives as ―National Center for Medical Home
Medical Home concept among Implementation‖. They are holding the 'Medical Home Promising Practices Forum' June 24-25 to highlight the past
providers, families, and other four years of work done by the 8 MCHB Medical Home Grantees (Illinois, New Hampshire, New York, Ohio,
stakeholders.* Massachusetts, Pennsylvania, Florida, and Wisconsin)- article or monograph to be published as a result of the
Forum. The 2009 Future of Pediatrics Conference will be held February 27 – March 1, 2009 – Anaheim, CA. Look for
2. Monitor progress to establish a the call for abstracts for posters and oral presentations this summer.
medical home for children. American Academy of Family Physicians (AAFP) - TransforMed Initiative - Trinity Clinic, Whitehouse, TX.
[existing child health data, Title http://tafp.org/news/tfp/07no4/1.asp and www.trinityclinicwhitehouse.com
V CSHCN National Update – 7/08 - The AAFP website has devoted a section of their Web site to defining the patient-centered medical
Performance Measure 04, home: http://www.aafp.org/online/en/home/membership/initiatives/pcmh.html
SLAITS, etc] The Fall 2007 TAFP newsletter, Texas Family Physician, included a cover story entitled ―Home sweet medical
3. Increase the overall number of home‖. The article included links to the AAFP white paper on medical homes and the Patient Centered Medical
health care practitioners Home report from the Robert Graham Center. http://www.tafp.org/news/TFP/08No1/cover.asp. TAFP has also
providing a medical home created a new Task force on the Medical Home, which will have its first meeting at this year's Annual Session.
through work with pediatric and Texas Early Childhood Comprehensive Systems (TECCS) [Raising Texas Initiative]
family practices to increase care Update – 7/08
coordination and other medical Implementation teams (Access to Insurance and Medical Home, Social Emotional Development and Mental
home characteristics.* Health, Early Care and Education, Parent Education and Family Support). The Steering Committee met on April
30th to review the goals and specific activities proposed by the Implementation Teams.
DSHS Medical Home website
Update 7/08 – Posted minutes and materials for the April 2008 Medical Home Workgroup
DSHS Notice of Open Enrollment for Medical Home Supports - The Department of State Health Services
(DSHS), Children with Special Health Care Needs (CSHCN) Services Program, within the Purchased Health
Services Unit, issued a Notice of Open Enrollment (the ―Notice‖) requesting applications from Texas pediatric or
family physician practices to implement practice-level supports to help improve the provision of a Medical Home for
children and youth with special health care needs (CYSHCN) and their families. Applicants may enroll between now
and March 1, 2009. For more information on this Open Enrollment opportunity, please click on the following link to
the posting on the Electronic State Business Daily (ESBD): http://esbd.cpa.state.tx.us/bid_show.cfm?bidid=74328
Please contact Lesa R.Walker, M.D.: lesa.walker@dshs.state.tx.us or Beverly MacCarty:
beverly.maccarty@dshs.state.tx.us if you have any questions.
Update 7-08 - An addendum was posted to allow applicants to request any 6-month period within the project period.
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Strategies and Activities Status
Frew Agreement - The Texas Legislature approved $150 million for the fiscal years 2008-2009 budget period for
strategic initiatives to expand children's access to Medicaid services. The new funding is part of a $1.8 billion plan in
response to the Frew v. Hawkins lawsuit over utilization of preventive services in children's Medicaid. The Texas
Health and Human Services Commission created a committee to help the agency determine how to use the new
funding. A key element in this plan is the creation of a well networked system of medical/dental homes.
Update 7-08 - Two more strategic initiatives designed to improve children’s access to Medicaid dental and medical
services have been approved for funding by the Legislative Budget Board and the Governor’s Office.
Integrated Pediatric and Mental Health – This initiative creates six ―clusters‖ located throughout the state, each
of which will feature five primary care doctors, five licensed mental health professionals and one child
psychiatrist. Two clusters will be housed at academic institutions, two in rural areas and two in urban areas. This
initiative will be managed and evaluated by the Texas Department of State Health Services in coordination with
the University of Texas Health Science Center at San Antonio Division of Child and Adolescent Psychiatry.
Pediatric Subspecialty Access (Telephone Consultations and Referral Guidelines) – This initiative would
establish Medicaid reimbursement for pediatric subspecialists for phone consultations with primary care doctors.
A parallel goal calls for HHSC to develop referral guidelines to help doctors decide when it’s appropriate to
make a referral to a pediatric subspecialist. HHSC plans to work with Texas medical schools to develop these
guidelines.
Meanwhile, HHSC’s Frew Advisory Committee has recommended five additional strategic initiatives for further
consideration.
Business process review of the Medical Transportation Program – This review would be designed to improve
access to the transportation services offered to children and adults enrolled in Medicaid.
State loan repayment program – This initiative would establish a new state loan repayment program designed to
recruit new pediatric subspecialists. The program would repay the medical school loans of doctors who provide
a majority of their services to children on Medicaid for a minimum of four years.
Coverage of medically necessary vitamins and minerals for children on Medicaid – The goal of this initiative is to
develop a list of pediatric conditions and health problems that require vitamin and mineral supplements as the
sole source of treatment or the primary source of treatment. HHSC would use the list to help make policy
decisions and improve the prior authorization process for vitamin and mineral supplements for children on
Medicaid.
Improvements to Medicaid prior authorization – This proposal calls for an independent study of best practices
for prior authorization, resulting in recommendations that, in theory, would make the process less
administratively burdensome and improve quality of care.
Texas Health Steps outreach and informing by community health workers/promotoras – This initiative would
establish pilot programs where certified Community Health Workers and Promotoras would provide information
about Texas Health Steps services to families with children on Medicaid and help families access those
services.
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Strategies and Activities Status
Texas Health Steps Online provider education – The Texas Department of State Health Services and the Texas
Health and Human Services Commission have collaborated to develop a FREE, online education program designed
to educate health care providers about Texas Health Steps (Medicaid for children) and other health care services.
The comprehensive program offers FREE continuing education credits, and its courses are accredited by the Texas
Medical Association, the American Nurses Credentialing Center, the National Commission for Health Education
Credentialing, the Texas State Board of Social Work Examiners, the Accreditation Council of Pharmacy Education,
and the Academy of General Dentistry.
Current Topics
Texas Health Steps Overview Newborn Screening Introduction to Medical Home
Pharmacy Dental Health for Primary Care Dental Screening by Dental Professionals
Providers
Mental Health Screening Developmental Screening Adolescent Health Screening
Newborn Hearing Screening Hearing & Vision Screening Immunization
Cultural Competence Nutrition Weight Management
Case Management
To view a course online, please visit www.txhealthsteps.com . Register and successfully complete the courses to
receive FREE CE’s immediately—No Waiting for certificates in the mail, just print them after successfully completing
the course.
Update 7/08 - A Train-the-Trainer was conducted in April and 46 DSHS employees were trained to deliver the face-
to-face and self-study versions of the modules (available beginning in July. The 16 existing modules were reviewed
and updated to renew the approval for CE credits. A marketing campaign to all providers to make them aware of the
free CE Hours available from these courses will begin in July). The campaign will include full page magazine
advertisements and direct mailings.
Modules are being developed for the following topics in Phase II and should be available by August or Sept. 2008:
Identifying and Treating Children with Identifying and Treating Children Using Developmental
Asthma (assistance provided by the Texas with Diabetes Assessment Tools
Asthma Coalition Medical Management
Committee) - beta tested in July
Identifying, Assessing, and Managing Proper and Accurate Specimen Lead Poisoning - to be beta
Children with a Mental Health/Behavioral Handling and Collection tested in July
Health Diagnosis
Case Management Sickle Cell Trait –beta tested in July Physical Assessment for Nurses
Comprehensive Care When to Refer to a Geneticist High Risk Behaviors
B. Increase accessibility of primary Reimbursement/Coding
care medical home services for The Clinician Directed Care Coordination Policy (reimbursement of face to face and non face to face coordination
children and adolescents and activities) was implemented within Medicaid and the CSHCN Services Program in September 2007 – see Texas
Medicaid Bulletin – Legislative and Rate Changes Special Bulletin #209 – Sept. 2007.
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Strategies and Activities Status
their families. Foster Care Health Plan
1. Expand the community-based Senate Bill 6 (79th Regular Session) mandated the development of a comprehensive medical services delivery
health care infrastructure – model for children in foster care, including a Health Passport. The STAR Health program will begin 4/1/08. STAR
[work with FQHCs and TACHC]. Health services will be delivered through a contract with Superior HealthPlan Network.
Immunization
2. Increase access to services in
rural areas. [?telemedicine] The Immunization Branch continues to promote the medical home as a strategy that is consistent with higher vaccine
coverage levels.
3. Partner with medical and Update – 7/08
nursing schools. 2008 4th DTaP Provider Campaign - The efforts continue to launch the provider campaign on increasing the number
of children who are fully vaccinated including the 4th dose of the DTaP vaccine. The campaign targets healthcare
4. Explore alternative approaches providers, including physicians in family medicine, general medicine, pediatrics, obstetrics and gynecology, nurse
to maximizing compensation for practitioners and physician assistants. The campaign is primarily a direct mail campaign with five phases.
operating comprehensive Phase 1 - Letter of invitation asking the provider to participate in this campaign explaining the reason and the
Medical Homes* - Support parameters of the campaign.
appropriate reimbursement for Phase 2 - Packet of parent education materials, including best practice tip sheets, posters and brochures with the
services provided within the immunization schedule, buttons for staff to wear to remind them to give each child the 4th dose of the DTaP
context of the medical home. vaccine, stickers for children who have received the 4th DTaP, and a DVD for them to play in their waiting room
5. Create or share tools with explaining the importance of vaccines and staying on schedule.
providers [referral forms, fax- Phases 3 & 4 - Post cards reminding the provider to continue to assess, vaccinate, and document.
back] Phase 5 - Thank you letter to each healthcare provider thanking them for their efforts
The program is also surveying parents of children of children in Immtrac who do not have all the recommended
6. Increase continuity of health vaccines – results will be available in August.
care for children in the foster THSteps Program Improvement Process - The PIP will address periodicity and content, outreach and informing,
care system, including children medical home, and automation.
with special health care needs. Update 7/08 – The THSteps PIP workgroup met June 23 to review the recommendations of the Developmental
Screening and Lab sub-groups and to review policy changes recommended by the PIP in previous meetings. Final
recommendations will be forthcoming.
Su Clinica Familiar
Update 7/08 - Will go live with EMR in June. Having people choose the clinic as their medical home is part of the
organization’s strategic plan.
Parkland Community Health Plan
Update 7/08
Developing Physician Profiles to include components related to Medical Home
Dr. Bourland completed an AAP CATCH Grant Study that examined the prevalence of medical homes among
urban children seen in 2 community clinics serving mostly poor, Medicaid-covered children from 6/06-2/07.
Results concluded that only 24% of respondents have medical homes. A consistent prior history of speaking with
healthcare providers by phone and ability to be seen for same-day sick visits were significantly associated with
having medical homes (from parents' perspectives). Study findings suggest greater attention should be paid to
ensuring high-risk children have medical homes, and that improving access to phone consultation and same-day
sick visits could increase the proportion of children with medical homes.
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Strategies and Activities Status
Amarillo Medical Home Project - Brad Thompson (HALI Project, Family Voices) is working with 2 pediatricians in
Amarillo to provide a family liaison within the pediatrician’s office to assist in linking families of CSHCN with non-
medical resources in the community. The project has teamed with a local non-profit foundation for grant funding. The
project’s aim is to build local partnerships between pediatricians and community-based organizations for the purpose
of providing a higher quality, more efficient, and satisfying service for families of children with special needs.
C. Increase partnerships with Texas Parent-to-Parent (TXP2P)
families, providers, and other Update 7/08
stakeholders. th th
TXP2P 4 Annual Parent Conference was held June 27-28 , 2008 in Austin. The 3rd Annual Wrightslaw 2-day Boot
1. Ensure family participation and Camp will be held at the Region XIII Education Service Center in Austin on August 1-2nd, 2008. Information can be
partnership in coordination of found at www.txp2p.org
care and in the education and Family to Family Health Information Centers (F2FHIC) - An important aspect of these grants is exploring ways to
training of health care providers enhance collaboration between families and health professionals, establishing a way to recognize successful health
and ancillary staff *- Partner with delivery models, and helping parents become leaders by joining advisory committees, Boards, etc. We would like to
family organizations. [Family to explore additional options (other than Residency Education Programs) for collaboration between families and health
Family Health Education professionals with the MH Work Group. If anyone on this committee would like to contact us after the meeting,
Center/P2P] please contact Laura Warren at 512-458-8600 or Laura@txp2p.org.
2. Continue to provide leadership Medical Residency Education
through the Medical Home Texas Parent to Parent (TXP2P)
Workgroup. Update 7/08
TxP2P is developing a new Medical Education Program for Pediatric Residents through the Texas Tech University
Health Sciences Center Pediatric Residency Program in Amarillo. Work will begin in July to recruit and train parents
to provide family visits, one-on-one interviews, and presentations in August 2008.
Project DOCC (Delivery of Chronic Care) Houston - Family faculty program at the Dept. of Pediatrics, Baylor College
of Medicine - provides training by parent teachers for pediatric residents.
Update 7-08 – Currently working with project at UT Health Sciences Center through grant from the Texas Council for
Developmental Disabilities.
Quality of Care for CSHCN - HHSC has convened meetings of agency representatives to discuss measurements of
quality of care for CSHCN in response to letters and requests by TPS for HHSC to gather and analyze data on the
quality of care being provided to CSHCN and their families across agency programs.
Update – 7/08 – HHSC and TPS continue to work toward arranging a stakeholder ―round table‖ discussion on a core
set of quality of care outcomes.
2-1-1 – HHSC and 2-1-1 hosted a small focus group in late June to get input from family members to improve the
211 system relating to services for children with disabilities and their families.
MHWG Quarterly Meetings - 1/15/08; 4/8/08; 7/8/08; 10/7/08
D. Improve Infant and Child Early Childhood Intervention (ECI) - Newborn Hearing Screening and Intervention Project
Health Surveillance and Update – 7/08
Screening Programs in 1. Enhancing the DSHS-TEHDI electronic reporting system
conjunction with THSteps. * Allow DHHS Resource Specialists to access the system for follow-up with birth screeners, outpatient
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Strategies and Activities Status
providers and audiologists.
Revised the primary function of the Resource Specialists from follow up with birth screeners to following up
on infants who required referral following their outpatient screen
Allow outpatient providers and audiologists to utilize the system to directly refer to local ECI programs
Allow ECI programs access to receive referrals directly from audiologists and to report the results of the
referral to DSHS-TEHDI
2. Parent to Parent Support through Texas Parent to Parent
TXP2P added a special component to their existing support parent volunteer training to include
considerations important for parents with children who were deaf or hard of hearing.
TXP2P developed a resource guide (English & Spanish) for parents with children who are newly identified as
deaf or hard of hearing.
TXP2P conducted outreach and trained parents as supporting volunteers
3. Public Awareness and Outreach
Ongoing outreach to audiologists
Physician and Audiologist Resource Guide in process
ECI Child Find posters that highlight the 1-3-6 referral protocols
Training Modules in development with the Texas Deaf and Hard of Hearing Leadership Council to provide
training for new professionals and review. The training modules will also serve as information for new
parents and include the Impact of Hearing Loss on Children and Families; Providing Complete Resources to
Families; and Shared Roles and Responsibilities in Service Delivery.
THSteps
Update 7-08 - HHSC and the THSteps program reviewed the THSteps and other policies relate to developmental
screening. The advisory workgroup has recommended a specific tool as well as screening specifically for autism at
certain visits.
Baylor College of Medicine Transition Clinic
E. Strengthen preventive health
Update – 7/08 –Baylor College of Medicine Transition Clinic received grant funding from the Texas Council for
services and transition
Developmental Disabilities to improve health care for individuals with disabilities moving from pediatric health care to
programs for adolescents.
adult health care. In addition to training more health care workers connected with the clinic, the project will provide
1. Identify opportunities to educate consultative services to patients with disabilities and their families and educational sessions for doctors on transition
providers of adult care on issues and services. The first meeting of the project’s Advisory Board will occur in early August.
treating young adults with Dr. Cynthia Peacock presented Grand Rounds to approximately 200 Scott and White medicine and pediatric
chronic conditions. physicians in March. She is currently writing an article on transition and medical home for an AAP newsletter.
Residents, social workers, and a psychologist continue to attend transition clinic routinely. The Clinic is working on
2. Work with medical associations, hiring a med-peds physician to start working the first of the year and consequently have more clinic time to see
primary care associations, and patients.
others to identify medical
providers trained in adolescent
health and special health care
needs.
* Specifically addressed in the Texas Early Childhood Comprehensive Systems Initiative component plan – ―Access to Insurance and Medical Home‖.
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