MEDICAL HOME INFORMATION SHARING FOR AAP LEADERSFan Tait, MD, FAAP, Associate Executive Director Director, AAP Department of Community and Specialty Pediatrics

Mark Del Monte, JD, Director, AAP Department of Federal Affairs

JUNE 30, 2010

Webinar Overview History of Medical Home Medical Home as an AAP Priority National Medical Home Initiatives Health Care Reform and Medical Home Academy Medical Home Initiatives Ongoing Leadership Assistance and

Involvement

History of Medical Home

History of Medical Home Cal Sia, MD, FAAP American Academy of Pediatrics, Family

Voices and Maternal and Child Health Bureau

Initial Priority Focus: Children and Youth with Special Health Care Needs

Defining Medical Home Primary care Family-centered partnership Community-based, interdisciplinary,

team approach to care Preventive, acute and chronic care Quality improvement Current focus: ALL children, including

CYSHCN

Medical Homes: Integrated Health System Patients and Families Primary care physicians Interdisciplinary health clinicians Specialists and subspecialists Hospitals and Healthcare Facilities Public Health Community

Medical Home Care Is…. Accessible Family-centered Coordinated Compassionate Continuous Culturally-effective

Medical Home as an AAP Priority

Medical Home as an AAP Priority

National Medical Home Initiatives

FixingHealthCare

Most hospitals are designedfor the nineteenth century.Most doctors don’t know how to share power. Most patientswith complicated problemsdon’t receive coordinated care.It’s time for a revolution – led from within.

Harvard Business Review April 2010

Premium Price, Poor Performance

The United States spends more on health care per capita – by far – than any of the other OECD countries…yet it ranks at the bottom 25% of those countries on life expectancy.

Statement on the PCMH:President Obama

“I support the concept of a patient-centered medical home, and as part of my health care plan, I will encourage and provide appropriate payment for providers who implement the medical home model, including physician-directed, interdisciplinary teams, care management and care coordination programs, quality assurance mechanisms, and health IT systems which collectively will help to improve care.”

President Barack Obama

National and State Medical Home Activities Federal Agencies: MCHB, CDC, SAMHSA CMS: Medicare, Medicaid and SCHIP

Advocacy National Academy for State Health Policy Council of State Governments Legislation: Federal and State

The Patient-Centered Primary Care Collaborative (PCPCC) Coalition of over 750:

Major employers Consumer groups Primary care physicians Health plans Advocates Others

Mission: To advance the patient-centered medical home

Examples of Broad Stakeholder Support &

Participation ACP

Providers 333,000 primary care

Purchasers –Most of the Fortune 500

Payers Patients

AAP AAFP AOA ABIM ACC ACOI AHI

IBM Ohio

General Electric FedEx

Microsoft

Dow

Merck & Co. Business Coalitions

BCBSA United

Aetna

CIGNA Humana

WellPoint

Kaiser Permanente

AARP AFL-CIO National Consumers League SEIU Foundation for Informed

Decision Making

The Patient-Centered Medical Home 80 Million lives

Geisinger

Iowa

AMA

Patient Centered Primary Care Collaborative Five “Centers”

9

PCPCC Resources

Value-Based Insurance Design

IT GuidePurchaser Guide

Pilot GuideConsumer Guide

Patient-Centered Medical Home

2009 Overview of Pilot Activity and Planning Discussions

RI

Multi-Payer pilot discussions/activityIdentified pilot activityNo identified pilot activity – 6 States

Blue Cross Blue Shield Plan Pilots

(As of March 2010)

Pilots in planning phase for 2010 implementation

Multi-Stakeholder demonstrationPilot activity in early stages of development

Pilots in progress

There are 37 States Working to Advance Medical Homes for Medicaid or CHIP Beneficiaries

AK

NH M

A

ME

NJCT

RI

DE

VT

NY

DCMD

NC

PA

VAWV

FL

GA

SC

KY

IN

OH

MI

TN

MS

AL

MO

IL

IA

MN W

I

LA

AROK

TX

KS

NE

ND

SD

HI

MT

WY

UTCO

AZ

NM

ID

OR

WA

NV

CA

States with at least one effort that met criteria for analysisSOURCE: NASHP analysis

Medical Home Measurement and Evaluation

Medical Home Measurement and Evaluation Center for Medical Home Improvement

Medical Home Index NCQA Physician Practice Connections®

Patient Centered Medical Home™ (PPC®-PCMH™) Recognition Program

Recently released monograph: Measuring Medical Homes...

Pilots/Demonstration Projects Outcomes

Medical Home Index: Pediatric Measuring the Organization and Delivery

of Pediatric Primary Care for All Children, Youth and Families

Available from – Center for Medical Home Improvement

www.medicalhomeimprovement.org

NCQA: PPC®-PCMH™ Access and communication Patient tracking and registries Care management Patient self management Electronic prescribing Test tracking Referral tracking Performance reporting and improving Enhanced electronic communications

www.ncqa.org

Measuring Medical Homes Monograph

Measuring Medical Homes Monograph Presents various tools available and in

use to identify, recognize and evaluate a practice as a pediatric medical home

Reviews relative merits of existing tools to inform purchasers, payers, providers and patients in evaluating pediatric practices

Download from the National Center for Medical Home Implementation Web site:

www.medicalhomeinfo.org/how/performance_management.aspx#tools

Guidelines for Medical Home Demonstration Projects Collaboration and leadership Practice recognition Practice support Reimbursement model Assessment and Reporting of Results

Full descriptions found at www.pcpcc.net

Health Care Reform and Medical Home

Health Reform and Medical HomeThe Affordable Care Act will: Create Medicaid medical home

demonstration projects for people with chronic conditions Payment: tiered to reflect the severity/number of

chronic conditions Not limited to per-member per-month (PMPM) Chronic conditions include: a mental health

condition, a substance use disorder, asthma, diabetes, heart disease and obesity

Health Reform and Medical HomeThe Affordable Care Act will: Provide grants to establish community-

based health teams to support primary care providers Payment: tiered to reflect the severity/number of

chronic conditions; Provides PMPM payments to providers, separate

payment to health teams

Health Reform and Medical HomeThe Affordable Care Act will: Establish a voluntary pediatric State

Accountable Care Organization demonstration Allows pediatricians that meet specialized

requirements to be recognized as an ACO for purposes of receiving incentive payments

Performance guidelines; if lower cost, share savings Secretary of HHS must work with pediatric

providers to establish guidelines

Medical Home “Definition” in the Affordable Care Act Personal physician Whole person orientation Coordinated and integrated care Safe and high quality care

Evidence-informed medicine Appropriate use of health information technology Continuous quality improvement

Expanded access to care Payment that recognizes added value of

primary care components

Academy Medical Home Initiatives

National Center for Medical Home Implementation Cooperative agreement between the

Maternal and Child Health Bureau/HRSA and the AAP

Strategic Oversight: Medical Home Implementation Project Advisory Committee Cal Sia, MD, FAAP, Co-Chairperson Carl Cooley, MD, FAAP, Co-Chairperson

New Web site: www.medicalhomeinfo.org

National Center Initiatives Building Your Medical Home toolkit Transition to Adulthood Interdisciplinary Medical Home

Competencies (Leadership Education in Neurodevelopmental Disabilities)

Medical Home Resident Education Initiative

Medical Home EQIPP Course Technical Assistance

Building Your Medical Home Toolkit

Launched in June 2009 Six “Building Blocks” toward implementation;

progress tracking functionality Tools crosswalk with “must pass” elements

of NCQA PPC®-PCMH™ Recognition Program

www.pediatricmedhome.org

New National Center Web Site

www.medicalhomeinfo.org

Medical Home EQIPP Course Medical Home for Pediatric Primary Care Available in fall 2010 Web-based activity that helps to

evaluate and improve the quality of care provided to patients in practice

ABP-approved Performance in Practice Quality Improvement Activity (Part 4 MOC) and CME credit

www.eqipp.org

Medical Home EQIPP Course: Key Clinical Activities Addresses potential knowledge and practice

barriers with suggestions for change Key Clinical Activities

Improvement team formation Knowledge and management of patient

populations Appropriate access to care Patient and family-centered care Planned, proactive, comprehensive care Coordinated care

Additional Academy Initiatives and Resources

Medical Home Chapter Champions Program on Asthma Overarching Goal: To facilitate dissemination

of best practices and advocacy related to asthma care within a medical home

Program Goals: Increase access to a medical home for all children and

youth, with a specific focus on health disparities Facilitate pediatric practices’ adoption and

implementation of NHLBI asthma guidelines within context of a medical home

Increase advocacy efforts for implementation of asthma care within medical homes at chapter/state level(s)

Medical Home Chapter Champions Program on Asthma Responsibilities and initiatives of chapter

champions: Serve as a conduit for disseminating best policies and

practices through the leadership and networks of AAP chapters

Serve as an advocate for change and assist in aligning national, state, local and/or community priories

Provide technical assistance, tools and resources to pediatricians/pediatric health care providers

To date, 38 champions have been recruited www.medicalhomeinfo.org/training/mhccpa.aspx

National Center Web Site: State Pages

State Page Example - Illinois

Medical Home Data Portal Presents state-by-state summaries and across-

state comparisons on children’s medical home using standardized data

Get one page at-a-glance profiles on how many children in your state meet overall criteria for having a medical home and topic-by-topic specific findings

Compare your state to other states and the nation on the percentage of children who receive care within a medical home

www.medicalhomedata.org

Medical Home in Medicaid/CHIPIssue Brief Provides guidance to AAP chapters on state

medical home projects being implemented in Medicaid and CHIP

Clarifies AAP recommendations on specific issues state medical home projects are dealing with, including: Planning and advisory

committees Defining medical home Recognition Infrastructure and HIT Population specifics Measurement

Establishing payment policies Practice coaching Patient education System education Care transitions

Can be downloaded on the Academy’s State Government Affairs

Member Center site: www.aap.org/moc/stgovaffairs

Medical Home and HIT Supports development of patient registries Informs physicians of overdue and abnormal tests Allows clinical data to be maintained in a

database Organizes information in searchable data fields

supports case and population management Computerized alerts to support evidence-based

medicine Interactive Web sites, secure messaging and

personal health records to support communication between physician and parent/family

Child Health Informatics Center (CHIC) Mission:

To develop HIT infrastructure and leadership in Child Health Informatics and related advocacy

To support pediatricians in implementation and use of electronic health records

To develop model HIT systems for child health care delivery within the AAP

Goals: To develop and advocate for key elements of pediatric

health care information technology To support AAP quality measurement and comparative

effectiveness priorities

Payer Advocacy Medicaid and SCHIP funding National and State MH Pilots: Medicaid and

Multipayor Payment structure: Hybrid funding/payment model Infrastructure Fee For Service Enhanced Per Member Per Month Medical Home Coding Fact Sheet (

www.medicalhomeinfo.org/how/payment_and_finance/)

Pediatric Councils; COCHF White Paper Measurement of MH Activities: NCQA

PCPCC Payment ModelMay 2007

Key physician and practice accountabilities/ value added

services and toolsProactively work to keep patients healthy and manage existing illness or conditions

Coordinate patient care among an organized team of health care professionals

Utilize systems at the practice level to achieve higher quality of care and better outcomesFocus on whole person care for their patients

Performance Standards

Incentives

Incentives

Incentives

Medical Home and Specialists Annual Leadership Forum Resolutions Follow up conference call with

subspecialty leaders Establish workgroup to address the role

of the subspecialist in medical home Ongoing discussion, conference calls and

meeting

Medical Student Education Effort recently initiated by PCPCC Represents AAFP, AAP, AOA, ACP

collaboration Goal to develop principles to guide

education at the medical school level related to medical home

Now What?

What We Know about Medical Home Care... Geisinger Health System

14 % Reduction in total hospital admissions 9 % Reduction in total medical costs in 24

months Estimated $3.7 million net savings

Johns Hopkins Guided Care PCMH Model 24 % Reduction in total hospital days 15 % Fewer ED visits

What We Know About Medical Home Care... Community Care of NC

40% decrease in hospitalizations for asthma

16% lower ED visit rate $400 million in cost savings for the “aged,

blind and disabled population”

What We Know About Medical Home Care... Family satisfaction increases Provider satisfaction increases Reduced ED use Reduced hospital days Reduced redundancy Reduced cost of care per child (CCHAP) Increase in immunization rates and

preventive care visits (CCHAP)

Ongoing Medical Home Implementation Issues Definition of Medical Home “Consumer” knowledge and involvement Evaluation of Pilot/Demonstration Programs HIT Certification vs Recognition Training and education Measurement and Performance Standards Payment Subspecialty involvement/co-management Health care reform implementation

Ongoing Leadership Assistance and Involvement Spread information about AAP medical home priorities

and activities/initiatives Get involved in your state/locally to advocate for medical

homes for children (connect with your AAP medical home chapter champion)

Get involved with PCPCC and represent pediatrics in PCPCC center discussions/activities

Pediatric Councils Subscribe to National Center for Medical Home

Implementation e-newsletter and listserv® (click “contact us” at top of National Center home page www.medicalhomeinfo.org or e-mail medical_home@aap.org)

Next Information Sharing Webinar Save the Date!

Next medical home leadership webinar tentatively scheduled for fall 2010 (October/November)

Webinar Recordings All medical home leadership webinars will be

recorded and posted on the National Center Web site:

www.medicalhomeinfo.org/national/#webinar

Thank You!Questions?

Contact:Suzi Montasir, MPHProgram Manager, AAP Division of Children with Special Needs800/433-9016, ext 4311smontasir@aap.org