Medical Homes and Neighborhoods

for Children with Special Health Care Needs

Developmental-Behavioral Pediatrics Rotation

Kate Orville, MPH, Co-Director, Washington State Medical Home Partnerships Project

UW Center on Human Development and Disability,

, 206-685-1279

  1. Introductions

Name, year of training, Continuity Clinic, interests, plans for future, questions about serving children with special needs, familiarity with medical home…

Medical Home Partnerships Project

2. Health Care Now and Medical Home Initiatives

  • What’s working in health care now and what isn’t?
  • Children with special health care needs – at least 15% of kids- what are the particular gaps for them you see?
  • Medical Home and Quality Improvement Initiatives: From a medical home for children with special health care needs to medical/health homes for all!

From the Patient-Centered Primary Care Collaborative (PCPCC) (

“The medical homeis best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system, and isa philosophy of health care delivery that encourages providers and care teamsto meet patients where they are,from the most simple to the most complex conditions. It is a place where patientsare treated with respect, dignity, and compassion, and enablestrong and trusting relationships with providers and staff. Above all,the medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient'sneeds.

In 2007, the major primary care physician associations developed and endorsed theJoint Principles of the Patient-Centered Medical Home. The model has since evolved, and today the PCPCC actively promotes the medical home as defined by theAgency for Healthcare Research and Quality (AHRQ).

For Health Care Professionals and Clinics:

  • Patient-Centered Medical Home: What you Need to Know
  • Infographic: Why the Medical Home Works: A Framework (March 2013)

The PCPCC has developed a framework to help medical home supporters and advocates explain the benefits and strategies associated with delivering patient-centered primary care. The graphic is organized according to the five key features of the medical home model: Patient-centered, comprehensive, coordinated, accessible, and committed to quality and safety.

  • WA State Medical Home Key Messages:
  • What do you think? Concerns? Right Direction?
  • How do you measure and reward medical homes?

Patient/Family Surveys (example of: National Survey of Children with Special Health Care Needs (NS-CSHCN) 2009/10 data for WA at:

Interactive data set:

Recognition/Accreditation Programs

  • National Committee for Quality Assurance Patient-Centered Medical Home Recognition
  • The Joint Commission Primary Care Medical Home Accreditation Program
  • Accreditation Association for Ambulatory Health Care: Medical Home Certification or Accreditation:
  • URAC (formerly known as the Utilization Review Accreditation Commission) Patient Centered Health Care Home Program

Institute for Healthcare Improvement (IHI):

  • The Institute for Healthcare Improvement offers a program called Open School which includes a very well respected online curriculum on leadership and quality improvement. It is free for health care students enrolled in universities with a medical school.
  • The UW has a local chapter of the Institute for Healthcare Improvement run by health care students website

NOTE: More information about Medical Home and QI efforts in WA available in Medical Home Partnerships Project Fall 2012 newsletter:

  • Medical Home and Residency Programs:

Handing Off Primary Care Patients at the End of a Pediatric Residency

Juniper Lyra Burch. Pediatrics 2013;132;985; originally published online November 18, 2013; DOI: 10.1542/peds.2013-1676

Pediatric Medical Home Program at UCLA:

National Center for Medical Home Implementation (AAP)

Resources for Educating Residents on Medical Home:

  • Medical Home Neighborhood
  • A checklist of recommended information to include on a referral request from a PCMH to a subspecialty/specialty
    PCMH-Neighbor
  • A checklist of recommended information to include on a response from a PCMH-Neighbor to a referring PCMH practice
  • A set of general care coordination/service agreements (compacts) between a PCMH and PCMH-N practice

Frequently Asked Questions About the Relationship of the PCMH to Specialty Physicians (2009)

3. Community Resources

Medical Home as a Team Sport -who’s available in the community to support your and patients?(most information available at: )

Quick Key Contacts on the Medical Home Partnerships Website:

WithinReach

  • Family Health Hotline The Dept of Health CSHCN program supports the WithinReach toll-free information line (1-800 322-2588 or 1-800-883-6388/TTY). Information & Referral Specialists who answer the calls provide local and state resource information for Washington families with children with special health care needs on health care coverage, specialty services, recreational opportunities, and more.
  • ParentHelp123

Public Health: County Children with Special Health Care Needs Coordinator (0-18)

King County: Donna Borgford-Parnell, RN, 206-296-4610


documents/cshcn/CSHCNCoordinators.ashx

Early Intervention Family Resources Coordinator (0-3) and the Early Support for Infants and Toddlers Program

King County: Nona Chitwood, Lead FRC, Community Health Access Program 800-756-5437 or 206-284-0331

  • ESIT program letter: “Dear Primary Care Provider”
  • Early Intervention Eligibility:
  • Information for Families about EI:

Schools- (36 months- 21 years) Special Education

Special education is specially designed instruction that addresses the unique needs of a student eligible to receive special education services. Special education is provided at no cost to parents and includes the related services a student needs to access her/his educational program.

The request for testing to determine if a child qualifies to receive special education must be made in writing. It is a good idea to direct the request both to a district staff member at the building level (school psychologist or special education teacher) and to your district’s special education director at the administrative level.

  • Statewide directory of school officials:
  • Seattle District Director of Special Education. 206-252-0055
  • Info about accessing special ed services in Seattle:

IDEA vs. Section 504

  • The Individuals with Disabilities Education Act (IDEA) of 2004 is the federal law that guarantees a free appropriate public education (FAPE) is provided to students with disabilities.
  • Section 504 of the Rehabilitation Act of 1973 is a federal civil rights law which prohibits discrimination against individuals with disabilities. Section 504 ensures that students with disabilities have equal access to educational programs, services, and activities. The IDEA is a special education law. Section 504 is different from IDEA in that it does not provide for specially designed instruction or require creating an Individualized Education Plan (IEP).

Family Support Organizations (Parent to Parent, Fathers Network, Diagnosis specific groups etc)

  • Parent to Parent - Statewide parent network providing emotional support and information to parents who have children with disabilities or developmental delays. 1-800-821-5927
  • Fathers Network - Advocates for and provides support and resources for all men and families who have children with special needs.
  • PAVE (Partnerships for Action Voices for Empowerment) - Statewide parent training and information center providing assistance to families who children with disabilities, ages birth through adulthood. 1-800-5 PARENT
  • National Alliance for the Mentally Ill (NAMI) - WA State and Local Chapters - provide support, education, information and referral and advocacy for consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, attention deficit/hyperactivity disorder, and other severe and persistent mental illnesses that affect the brain.
More organizations:

Managed Care organizations – Care Coordinators

Medicaid/Apple Health Managed Care plans have care coordination services that can be very helpful for children and other individuals with special health care needs. Representatives from these plans attend the quarterly Children with Special Health Care Needs state meetings and have provided information about their services. The representatives report that the services and processes used are similar from plan to plan.

COORDINATED CARE

Coverage Area: See website

  • Elizabeth Allen, 877-644-4613, ext. 69728

Questions had been supplied to health plans prior to the CSHCN Communication Network Meeting. The following are answers from Coordinated Care.

What criteria are used to identify children with special health care needs enrolled in your plan? There are several ways children with special health care needs are identified. We have a sophisticated computer program that analyzes information about each child and assesses potential level of need. We also receive referrals from a variety of sources including parents, pediatricians, clinics, hospitals, case managers or case workers, physical therapists, occupational therapists, speech therapists and support systems involved with the child with special needs. We identify Children with Special Health Care Needs via ER usage reports, number of times a child has been hospitalized and reports focused on various special health care needs diagnoses for children. All this information is reviewed by health care professionals and

Children with Special Health Care Needs are given the highest priority for outreach by our Case Management Team.

What is your role with children with special health care needs enrolled in your plan and their families? Coordinated Care provides complex case management and care coordination services to Children with Special Health Care Needs and their families. Our Nurse Case Managers provide coordination across the continuum of care for Children with Special Health Care Needs. We also attend to the needs of mothers with high risk pregnancies. Our Social Workers help families network and navigate the health care system while providing psychosocial support. We have behavioral health specialists who also provide services to children with special health care needs. We focus on empowering the families of Children with Special Health Care Needs to advocate for themselves.

How would someone outside of your plan learn what services, treatments, devices, etc. are covered by your plan, at what rate, and if Prior Authorization is required?

We provide a toll free line, 1-877-644-4613, where anyone can speak to our Member Services Representatives who are able to explain all benefits and coverage answering any questions a parent

may have. We also have a very user friendly website for members and providers, online, identifying what necessitates Prior Authorization. In addition, our plan provides community outreach and education through various events including health fairs and conferences. We have Provider Relations Specialists who provide education regarding Health Plan benefits. The Healthy Options Booklet available from DSHS explains our benefits and has our contact information.

Please add any other plan updates that may be of interest to meeting participants who work with children with special health care needs and their families.

Coordinated Care Health Plan has a Foster Care Program for Children with Special

Health Care Needs, a Neonatal Intensive Care Unit Program for premature and/or ill infants, a Start Smart for Baby Program to support all expecting mothers including those with high risk pregnancies and a SSI Conversion Program to assist members in applying for SSI benefits for their children.

COMMUNITY HEALTH PLAN OF WA

- Coverage Area Includes All Counties except Clallam, Columbia, Garfield,

Jefferson, Klickitat, Lincoln, Mason, Skamania and Whitman

  • Stacy Heinle, 206-613-8894
  • Sue Collins, 206-652-7124

UNITED HEALTHCARE

Coverage Area: See website

  • Cindy Spain, 206-749-4347

AMERIGROUP

Coverage Area: See website

  • Lani Spencer, 206-674-4470

Lani Spencer reported that all plans are similar in their processes as Coordinated Care. All contractually do the same. The Centralized Case Manager phone number is 855-323-4688. If caller has specific needs the receptionist will transfer to appropriate case manager.

MOLINA

Coverage Area Includes All Counties except Clark, Island,

Jefferson, Klickitat, Skamania, and Wahkiakum ]

  • Cathi Sears, Molina Healthcare of Washington 800-869-7175,ext. 147148 (covers West side of WA)
  • Nikki Nordstrom, Molina Healthcare of Washington 800-869-7175, ext. 147141 (covers East side of WA)

See Molina handout on “Understanding Molina Healthcare Services.”

4. Practice Tools

Care Organizers:

  • Build a Care Notebook:
  • Order a Care Organizer:

Care Plans:

  • Emergency care plans
  • (AAP and Emergency MDs)
  • Medical Care plans:
  • Other Care plans:helps everyone interacting with the child to understand basic information about the child

Article: Adams et al. “Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC): a qualitative study”. BMC Pediatrics 2013, 13:10 or

Written information about the diagnosis or condition

  • Examples: (for parents, kids and teens)

Medical Home Implementation websites

  • AAP: Building Your Medical Home Toolkit:
  • National Center for Medical Home Initiatives
  • WA State Medical Home Partnerships
  • WA State Dept of Health – WA Healthcare Improvement Network

5. Discussion

  • How does this description of medical homes reflect your experience?
  • What seems like it might be useful to you in practice?
  • What information was most helpful to you today?
  • What is something you might do differently as a result of discussion today?
  • What would you like to know more about?
  • Advice for future inservices for trainees?

Pediatric Resident Medical Home & Community Resources Inservice 12/13 p. 1