NFI Grantee MeetingNFI Grantee MeetingSeptember 18, 2007September 18, 2007

Sarah Thorson: Minnesota Department of Health

Sharon Fleischfresser: Wisconsin Division of Public Health

Medical Home and the CommunityMedical Home and the Community

Medical Home Breakout Medical Home Breakout Session OutcomesSession Outcomes Background information on Medical Home

Initiatives in Minnesota and Wisconsin Share activities of Medical Home

implementation in your community Identify challenges and the Lessons

Learned Explore ideas for Medical Home spread

…….We tried a lot of other things first - .We tried a lot of other things first - with sporadic successeswith sporadic successes

AAP-MN Disability Subgroup Efforts– Title V and Part C funded: Raise awareness of ‘Medical Home’ among pediatricians

Universal Standard Benefit Set SAFE at Home Partnership: Title V, Family

Voices, 2 health plans, individual physicians: to identify CSHCN and to improve the quality of primary care.

Minnesota’s promise: Title V, Family Voices, physician leaders

Essential Element of a Medical Home % Success

(MN)

% Success

(US)

a. The child has a usual source of care 88.7 90.5

b. The child has a personal doctor of nurse

84.6 89

c. The child has no problems obtaining referrals when needed

76.5 78.1

d. Effective care coordination is received when needed

40.5 39.8

e. the child receives family-centered care 69.9 66.8

MEDICAL HOME OUTCOME 48.7 52.6

Then we really started “humming”Then we really started “humming”

2002 Minnesota Medical Home Project: Title V, Family Voices, and AAP-MN, DHS

Assumption we’d all work together

Funds reflected a partnership

The Blueprint: Breakthrough The Blueprint: Breakthrough SeriesSeries(9-12 month time frame)(9-12 month time frame)

Select Topic

Planning Group

Develop Framework & Changes

Participants

Prework

Supports

E-mail Visits

Phone Assessments

Senior Leader Reports

LS 1 LS 3LS 2

Summits,

Guides,

Publications,

etc.

A D

P

S

A D

P

S

The CollaboratorsThe CollaboratorsGroup of 11 Primary Care Pediatric

Practices & Family Practice ClinicsTwo parents per teamMeet 3 times a year for 2 days of

learning and sharingPunctuated with action periods where

each team implements MH concepts and improves their Medical Home

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

From: Associates in Process Improvement

Functional and Clinical Outcomes

Resources and Policies

Community

Health System

Health Care Organization (Medical Home)Delive

rySyste

mDesign

Decision

Support

ClinicalInformati

onSystems

Care Partnership

Support

Informed,ActivatedPatient/Family

Family -centered

Coordinated and EquitableTimely & efficient

Evidence-based & safe

Supportive, Integrated Community

Prepared,ProactivePractice Team

NFI: 21 NFI: 21 TeamsTeamsTitle V

priorities (Six core outcomes +SPMs) integrated into curriculum

Medical Home IndexMedical Home Index

0

1

2

3

4

5

6

7

8

Org Capacity Chronic Care Mgmt Care Coordination Community Outreach Data Mgmt Quality Improvement

Time 1Time 2

Number of CYSHCN Identified byby Time Period

0448

1147

3823

5285

0

1000

2000

3000

4000

5000

6000

Mar-04 First Report After 9 Months 18 Months AfterThat

Jul-07

Time Period

Inpatient Days Per Year Pre-collaborative through Year Two

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

3/2003 - 2/2004 3/2004 - 2/2005 3/2005 - 2/2006

Year

Me

an

Inp

ati

en

t D

ay

s

Emergency Department Visits Per Year Pre-Collaborative through Year Two

1

1.05

1.1

1.15

1.2

1.25

1.3

1.35

3/2003 - 2/2004 3/2004 - 2/2005 3/2005 - 2/2006

Mea

n N

um

ber

of

Vis

its

Family Survey ResultsFamily Survey Results

Copy of care plan

Visited hospital emergency room in past 3 months

Unplanned hospital admission in the past 3 months

2007 Legislative Session2007 Legislative Session

four pilot projects for children and adults with complex health care needs who are enrolled in fee-for-service medical assistance, to the extent permitted by federal requirements. At least two of the grantees must focus on children with autism or children with complex/multi-diagnoses physical conditions. The purpose of the projects is to pilot primary care clinic models of care delivery focused on care coordination and family involvement

2007 Legislative Session (cont)2007 Legislative Session (cont)

develop and implement a provider-directed care coordination program for medical assistance recipients who are not enrolled in the prepaid medical assistance program and who are receiving services on a fee-for-service basis. This program provides payment to primary care clinics for care coordination for people who have complex and chronic medical conditions. Clinics must meet certain criteria such as the capacity to develop care plans; have a dedicated care coordinator; and have an adequate number of fee-for-service clients, evaluation mechanisms, and quality improvement processes to qualify for reimbursement.

2007 Legislative Session (cont)2007 Legislative Session (cont)

Of the health care access fund appropriation, $500,000 in fiscal year 2008 and $500,000 in fiscal year 2009 are to expand the medical home learning collaborative initiative in collaboration with the commissioner of human services. Services provided under this funding must support a medical home model for children with special health care needs.

Wisconsin-Medical HomeWisconsin-Medical Home

Medical Home - WisconsinMedical Home - Wisconsin CSHCN national performance outcome Participation in the Maternal Child Health

Bureau (MCHB)/American Academy of Pediatrics (AAP) Medical Home Mentorship Meeting - January 2002

Identified as a priority area by the WI MCH/CYSHCN Advisory Committee

National Medical Home Learning Collaborative (NICHQ)

Wisconsin replication in partnership with the Regional CYSHCN Centers

Medical Home for all children as a new WI Title V State Performance Measure

Wisconsin Medical Home Learning Wisconsin Medical Home Learning CollaborativeCollaborativeUtilize rapid QI (Plan, Do, Study, Act)

cycles –Small Steps of Change

Focus of practice change: Family Partnerships (focus groups, family surveys,

creation of Parent Advisory Committee) Identification of CYSHCN within the practice Development of medical care plans (emergency

care, care summary) Linkage to community/state resources

Participating PracticesParticipating Practices

Wisconsin Medical Home Learning Wisconsin Medical Home Learning CollaborativeCollaborative

Regional CSHCN Centers

Regional CSHCN Centers

Measurement: MH IndexesMeasurement: MH Indexes

Mean Item Scores for Each Domain

3.5 3.7

3.0 2.9

3.6

2.83.3

5.1 4.9 4.9 4.7 4.74.3

4.9

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Org Capacity CC Mgt Care Coord CommOutreach

Data Mgt QI Total Mean

WLC 2004 (Apr) WLC 2004 (Nov)

Medical Home Spread: 2006-2007Medical Home Spread: 2006-2007

12 Medical Home local capacity grants (April 2006-Dec 2007) with new cycle January 08

Medical Home Transitions Learning Collaborative (UW and CHW) - ongoing

Medical Home Summit – 2006 and 2007 Transition Community Connector grants Primary Care Practice QI Mini-Grants Wisconsin Medical Home Toolkit:

www.wimedicalhometoolkit.aap.org

Medical Home Practice Sites MH Local Capacity Grants Transition Learning Collaborative Transition Community Connectors

Medical Home Practice Sites MH Local Capacity Grants Transition Learning Collaborative Transition Community Connectors

Medical Home and Community Grant SitesMedical Home and Community Grant Sites

Regional CYSHCN Centers

Regional CYSHCN Centers

Practice MH Mini-GrantsPractice MH Mini-Grants

Medical Home Index 2007Wisconsin Learning Collaborative

0.0

1.0

2.0

3.0

4.0

5.0

OrgCapacity

CC Mgt Care Coord CommOutreach

QI Total Mean

WLC 2007 (Jan) WLC 2007 (May)

Goals: Simple Steps

Introduce health care providers to Medical Home quality improvement strategies

Provide a roadmap to tested tools and strategies

Connect providers, their patients and families, to the Regional CYSHCN Centers

Medical Home Strategies:

Engage Patients/Families as Partners Improve Care Coordination

Create Care Plans Identification & Screening Supporting Transitions Collaborate with Community Resources Improve Coding and Reimbursement

Wisconsin MH Toolkit Website: Wisconsin MH Toolkit Website: Average/Month (March-July2007)Average/Month (March-July2007)1419 visitors/month316 single visits/month179 repeat visits/month188 book marked/month951 down loads/month Favorites: care plans,

reimbursement/CPT codes

Other Opportunities for Medical Other Opportunities for Medical Home SpreadHome Spread Promote spread of MH as QI effort Link Medical Home LC concepts to long term

care reform efforts for children and adults (Family Care)

Child Alert/Preparedness Wisconsin eHealth Initiative Other public health programming-adult

chronic disease programs Health care financing-pay for performance

ChallengesChallenges

MH spread to date is primarily focused at the practice level versus system

Lack of funding/incentives to support care coordination and other MH strategies on a system wide scale

Making the “business case” for MH implementation as a health care delivery model

For More Information Sarah Thorson:

sarah.thorson@health.state.mn.us651-201-3651

Sharon Fleischfresser: fleissa@dhfs.state.wi.us608-266-3674

DiscussionDiscussion Name an activity that you have been

engaged in to support Medical Home implementation in communities in your state?

What are the challenges you’ve encountered?

What strategies have you found to be successful?

Ideas to promote Medical Home Spread in the future?

“A Medical Home does not simply appear over night. Like any quality home, it is built with careful plans and thought, time and effort, leadership and commitment.” - Parent