The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October...

The International Autism Summit

The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008

Objectives1. Why the Medical Home concept was

developed.2. The Definition of the Medical Home3. Proof of impact of the Medical Home

Concept

Arthur Lavin MDJulie Hertzer MDKelley Muldoon Rieger APRN, PNP

3733 Park East Drive | Suite 102Beachwood, Ohio 44122-4334phone: 216.591.1515 | fax: 216.591.1544www.advancedped.com



Why a medical home concept?

1. Confusion

2. Lack of Care





Why a medical home concept? Confusion Many, many doctors Many, many appointments So much information All these conflict, little translates from one to the other No overall movement to an overall goal





Why a medical home concept? Lack of Care Each element of the system cares It is very hard for a system to care Without care, no overall movement to an overall

goal





The Definition of a Medical Home

A standard of primary care Key components of care



The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008

Primary Care- An Awkward Term for a Timeless Value. (A Doctor)Someone who knows you

Someone who cares

Someone who knows what to do

Someone who will help you get what needs to be done, done

A place where all this happens




Primary Care- The primacy of relationship over procedureHow the rise of specialty medicine put procedure over relationship

Organization- Appointments, Large Centers Cash Flow Prestige

Primary care under siege





Key Components of Care1. Accessible 5. Coordinated

2. Continuous 6. Compassionate

3. Comprehensive 7. Culturally effective

4. Family-centered




Endorsed in 2007 byAmerican Academy of Pediatrics (1st in 1967)American Academy of Family Physicians American College of PhysiciansAmerican Osteopathic Association





The Impact of a Medical Home-What Makes the Difference-

Medication, Procedure, or Care?





The Impact of a Medical Home-The more care, the better health, the less

cost






cost

If everyone had a medical home, we would spend 5.6% less, $67 billion a year less

Spann SJ, for the members of Task Force 6 and The Executive Editorial T: Report on Financing the New Model of Family Medicine. Ann Fam Med 2004; 2(suppl_3):S1






costIf everyone had a medical home, they would

be healthier- state v. state Shi L, Macinko J, Starfield B,

Wulu J, Regan J, Politzer R: The Relationship Between Primary Care, Income

Inequality, and Mortality in US States, 1980-1995. J Am Bd FamPract 2003; 412






costEuropean nations with better primary care:

Fewer hospitalizations, less use of specialists, less illness, fewer deaths





The Impact of a Medical Home-

Medicaid in N Carolina$5/person in fee increase

$200M in savings 2003

$250M in savings in 2004Willson CF: Community care of North Carolina: saving state money and improving patient

care. N C Med J 2005; 66(3):229-33






A good MH decreased unmet needs66-75% of children with complex needs had no MH

Those with a good MH had more needs met.Benedict RE: Quality Medical Homes: Meeting children’s needs for therapeutic and

supportive services. Pediatrics 2008; 121: e127-34.






Autism and the medical homeChildren with autism had half the chance of having an

effective MH as children with asthmaBrachlow AE et al: Comparison of indicators for a primary care medical home between

children with autism or asthma and other special health care needs: National Survey of Children’s Health. Arch Pediatr Adolesc Med 2007; 161: 399-405.






Special needs and the medical homeHalf of complex kids had a MH, most have usual

source of care, fewer have coordination

Those with a MH had less delay, less foregone care, fewer unmet needs.

Strickland B et al: Access to the Medical Home: Results of the National Survey of Children with Special Health Care Needs. Pediatrics 2004; 113(5 Supp): 1485-92.


3733 Park East Drive | Suite 102Beachwood, Ohio 44122-4334phone: 216.591.1515 | fax: 216.591.1544

www.advancedped.com




PNP and Parent team in a practiceEasier to get: letters of necessity, phone calls

returned, appointments, specialist referrals, prescriptions, goals for care, understanding of situation, good relationship with doctor

Palfrey J et al: The Pediatric Alliance for Coordinated Care: Evaluation of a medical home

model. Pediatrics 2004; 113 (5 Suppl): 1507-16.Crison of indicators for a





Review of Objectives1. Why the Medical Home concept was

developed.2. The Definition of the Medical Home3. Proof of impact of the Medical Home

Concept



BREAK SLIDE


The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008

Objectives1. Review of Medical Home Concept2. Specific Aspects of Implementing the Medical

Home Idea orHow to Evaluate How Close your Place of Care is a Medical Home

3. Specific Resources that Might be Helpful





The Medical Home1. Accessible 5. Coordinated

2. Continuous 6. Compassionate

3. Comprehensive 7. Culturally effective

4. Family-centered





Aspects of Implementation The Relationship The Place Physical Needs Social Needs Mental/Cognitive Needs Resources





Relationship KEY: A person. Someone you know, who

knows you, who you trust PERSPECTIVE: You v. Protocol RESPONSIVENESS ADVOCACY





Aspects of Implementation- The Place, The Staff Access- Geographic, ADA One stop Welcoming- your requests are a plus, not a

burden





Aspects of Implementation- Physical Challenges

Physical Therapy Respite Care Durable Medical Equipment





Aspects of Implementation- Language/Speech Challenges

If social skills are the heart of autism, speech and language concerns are critical as well

Speech therapy Unlocking the cognition within





Aspects of Implementation- Mental/Emotional Needs

The Purpose of Feelings: Affect Primary Abnormalities of Function Reactions of a Frustrated Affect Behavior Programs and Supports





Aspects of Implementation- Social Challenges Social Cognition: The Heart of Autism Social Therapy: An Emerging Field

ABA

Floor Time

Play: ableplay.org The Uncertain Path of Brain Developments





Aspects of Implementation- Record Keeping EMR helps manage information Organized binder with laid out forms for each

category of information (medicalhomeinfo.org/tools/CarePlans/CHMCC%20notebook.doc)





Aspects of Implementation- Resources. Agencies American Academy of Pediatrics aap.org American Academy of Family Practice aafp.org Centers for Disease Control cdc.gov National Institutes of Health nih.gov Family Voices- a tremendous family run advocacy

agency familyvoices.com





Aspects of Implementation- Resources. Autism Groups autismspeaks.org creates an autism community and works to

make its future better. (merged with CAN in early 2007) autism-society.org grassroots awareness, advocacy,

information autism-resources.com Major list of websites about autism milestones.org Local grassroots autism group cdc.gov/ncbddd/autism The autism info page of the CDC





Aspects of Implementation- Resources. Money SSI- a disability insurance program- means tested

ssa.gov/pubs/10026.html#ssi-benefits State disability health insurance, in Ohio, BCMH. Means-tested

odh.ohio.gov/odhprograms/cmh/cwmh/bcmh1.aspx Boards of MR/DD www.oacbmrdd.org Help Me Grow- Finding problems, arranging services (Part C IDEA)

ohiohelpmegrow.org/aboutus/AboutHelpMeGrow.aspx Medicaid- disability related health insurance jfs.ohio.gov/OHP





Aspects of Implementation- Resources. Newsletters autismspectrum.net/DesktopDefault.aspx Interactive autism website ianproject.org AAP Autism newsletter

medicalhomeinfo.org/Publications/eNews/announce.html About.com’s newsletter

autism.about.com/b/2008/04/17/keep-up-with-free-autism-autismaboutcom-newsletters-forums-and-e-courses-3457.htm





Aspects of Implementation- Resources. Web Linksmedicalhomeinfo.org/index.html National Center for Medical Home Initiatives for

Children with Special Health Care Needs (an American Academy of Pediatrics-US initiative)

medicalhomeinfo.org/Publications/eNews/announce.html An e-newsletter on medical home concerns for special needs

medicalhomeinfo.org/states/state/ohio.html Great site to find out what Ohio agencies help





Review of Objectives1. Review of Medical Home Concept2. Specific Aspects of Implementing the Medical

Home Idea orHow to Evaluate How Close your Place of Care is a Medical Home

3. Specific Resources that Might be Helpful



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