celebrating colorado's medical home initiative
TRANSCRIPT
Celebrating Colorado’s Medical Home Initiative
Eileen ForlenzaColorado Dept. of Public Health and
Environment
Gina Robinson Health Care Policy and Financing
Why the Medical Home approach is a key component within Colorado’s Early
Childhood Framework
Objectives for Today
Understand how the goals of Colorado’s Medical Home Initiative fit into the Early Childhood Colorado Framework
Understand the impact of SB-07-130 Review the Colorado Medical Home
Standards Understand strategies to involve families
in advocating for a Medical Home approach
Colorado’s Medical Home Initiative
The Colorado Medical Home Initiative is a statewide effort to build systems of quality health care for all children in Colorado while increasing the capacity of providers to deliver care to kids in our state.
Colorado Medical Home Initiative
Four Goals:1. Providers will understand the
concepts/components of the Medical Home approach and will implement them in their practices.
2. Families will understand the concepts/components of the Medical Home approach and will advocate for them.
3. Reimbursement will be adequate to provide Medical Homes.
4. A Medical Home awareness campaign will be conducted in Colorado.
Colorado Medical Home Initiative
MEDICAL HOME APPROACHMEDICAL HOME APPROACHPATIENT/FAMILY-CENTERED, TEAM-ORIENTED CAREPATIENT/FAMILY-CENTERED, TEAM-ORIENTED CARE
Patient & Family
MentalHealth
CommunityResources
SocialServices
EducationalServices
VocationalServices
RecreationalServices
PrimaryCare
SpecialtyCare
OralHealth
Health services are core while needed family supports are readily available.
Medical Home Components
•Accessible – support of primary and specialty care capacity, insurance eligibility, advocacy
• Family Centered – support of families as advocates, participants in community planning
•Continuous – linking community resources, support of medical information transfer
•Comprehensive – linking medical, mental health and dental providers to ensure global thinking about the total child and family
Medical Home Components
•Coordinated – working with medical components (inpatient and outpatient), educational and community resources to ensure efficiency
•Compassionate – community resources include provision for respite care, linking to faith communities, and behavioral/mental health
•Culturally Responsive – culturally sensitive partners are recognized and linked to families
Colorado’s Medical Home Legislation
Concerning Medical Homes for Children (SB-07-130)
Integration of efforts Shared leadership - CDPHE and HCPF
Increasing access to Medicaid providers Developing standards
Colorado’s Medical Home Definition per Legislation
“ An appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care and related services for a child. ..If a child’s medical home is not a primary medical care provider, the child MUST have a primary medical care provider to ensure that a child’s primary medical care needs are appropriately addressed.”
Colorado Medical Home Standards
Developed by the Evaluation Task Force Based on Quality Components Developed by key stakeholders Statewide consciousness Assurances
Evaluation Task Force
Membership Included: Family leaders Mental health Physical health NCQA Pediatricians – Colorado AAP AAFP Researchers
Development Process
Structured via 7 Domain Areas Literature outside of Medical Home literature Consolidation Crosswalk with NCQA standards Data sources for each standard Statewide survey for feedback Developed group for edits and consistent
language Steering committee for approval
Colorado Medical Home Standards
1. Provides 24 hour 7 day access to a provider or trained triage service.
2. Child/family has a personal provider or team familiar with their child’s health history.
3. Appointments are based on condition (acute, chronic, well or diagnostic) and provider can accommodate same day scheduling when needed.
Colorado Medical Home Standards
4. A system is in place for children and families to obtain information and referrals about insurance, community resources, non-medical services, education and transition to adult providers.
5. Provider and office staff communicates in a way that is family centered and encourages the family to be a partner in health care decision making.
6. Provider and office staff demonstrate cultural competency.
Colorado Medical Home Standards
7. The designated Medical Home takes the primary responsibility for care coordination.
8. Age appropriate preventive care and screening are provided or coordinated by the provider on a timely basis.
9. The designated Medical Home adopts and implements evidence-based diagnosis and treatment guidelines.
Colorado Medical Home Standards
10. The child’s medical records are up to date and comprehensive, and (upon the family’s authorization), records may be shared with other providers or agencies.
11. The Medical Home has a continuous quality improvement plan that references Medical Home standards and elements.
What we learned…
Providers articulated technical assistance needs
Families were eager for partnerships
Providers had a format to express fears and concerns
Assurances1. The Colorado Medical Home Initiative will continue to provide a platform whereby stakeholders’ input is encouraged, valued and incorporated.
2. Providers who choose to be acknowledged as providing a medical home approach will be offered resources and support.
3. The term ‘provider’ is intended to be inclusive of behavioral, oral and physical health care providers and specialists.
4. Development and refinement of these standards is only the first step in the process of implementation.
5. Medicaid providers can choose to be acknowledged as medical home providers on a voluntary basis.
Principles1. The standards are a framework for continuous quality improvement.
2. The standards are meant to describe Colorado’s goals for quality health care for all children, they are not meant to be punitive or prescriptive.
3. The standards, based on the national components of a medical home, were developed in collaboration with multiple Colorado stakeholders, including physical and behavioral health care providers & physicians, family members, community advocates and evaluators, and are aligned with established national standards.
4. The standards are a way to acknowledge good practice while providing a shared vision and common language for a quality system of care for all children in Colorado.
5. The standards provide a means for evaluation to establish state, payer, family, and practice accountability.
What is a Medical Home System?
The state and local personnel, processes, individuals, procedures, materials that support providers to implement the practice-level medical home standards. Often there are local and state systemic issues such as lack of specialists, access to insurance, and uncertainty of local resources that prohibit providers from providing a medical home approach. A state and local infrastructure to overcome these barriers and to provide technical assistance to providers is called a medical home system.
Families as Partners
Embracing families as a resource not simply as a consumer of services
Integrating the core concept that CYSHCN are not asking to be “fixed”
Understanding the difference between family representatives and family leaders
Invest in family leadership development and utilization thereof
Respect the process of leadership development
Examples of Integrating Family Leaders into Medical Home
Efforts
Understanding that families are a valuable resource and human capital
Supporting emerging family leaders to attend national and state conferences
Equitable compensation Systems approach to leadership
development
Helpful Resources/References American Academy of Pediatrics, National Center of
Medical Home Initiatives for Children with Special Needs www.medicalhomeinfo.org
Center for Medical Home Improvement, www.medicalhomeimprovement.org
National Initiative for Children’s Health Quality, www.NICHQ.org
American Academy of Family Physicians, www.futurefamilymed.org
American College of Physicians, www.acponline.org/advocacy/?hp
Health Care Program for Children with Special Needs www.hcpcolorado.org
Colorado Children’s Health Access Projectwww.cchap.org
Contact Info:[email protected]@state.co.us303-866-6167