Maternal Child Wellness Home

Integrated Primary Care and Public HealthContinuous communication

Co-location of support servicesShared data, trainings and protocolsCommon patient education materials

Family-centered care and empowerment

IMAGINE

CENTRAL OREGONTri-County CCO

MATERNAL CHILD HEALTH INITIATIVECoordinated Care System

• Expand EB home visiting capacity 4 FTE (CaCoon, NFP, MCM)

• Embed PHN in large OB Practice

• Follow IOM integration continuum model

Isolation Mutual Awareness Cooperation Collaboration Partnership Integration

• Lack of communication between PH and Primary care

• Few depression screenings• Minimal use of community

resources

Maternal Mental Health - An example of integration

Isolation Mutual Awareness Cooperation Collaboration Partnership Integration

• Shared Vision and Values• Building Relationships

• Qualitative interviews measuring attitudes, knowledge and trust

• Face to face meetings

Isolation Mutual Awareness Cooperation Collaboration Partnership Integration

• Sharing resources, space, data or personnel

• Embedded PHN• Algorithm developed• Referral protocol and feedback loop developed• Shared trainings and materials• MOU

Isolation Mutual Awareness Cooperation Collaboration Partnership Integration

• Joint planning and execution

• Screenings in the clinic – as part of patient flow• PHN helps identify/resolve problems

• Sharing data• Partnering with BH, hospital, community resources

Isolation Mutual Awareness Cooperation Collaboration Partnership Integration

• Integration on program level

• Community Wide – full system of monitoring, screening, and referring

Isolation Mutual Awareness Cooperation Collaboration Partnership Integration

Realizing the Triple Aim: Better Health; Better Care;

Better Value

Ultimate Shared Vision: Maternal Child Wellness Home