Patient Centered Medical Home - Kids

Wednesday, November 20, 20136:00-8:00 p.m.

Department of Health, DOC

Patricia Flanagan, MD, FAAP, Co-ChairElizabeth Lange, MD, FAAP, Co-Chair

CSI 101

Mission

• PCMH Kids will engage providers, payers, patients, parents, purchasers and policy makers to develop high quality primary care medical homes for children and youth that will assure optimal health and development, be committed to quality measurement, accountable for cost and outcomes, focused on population health and dedicated to system improvement. PCMH’s for children will be cost effective and sustainably resourced.

Vision

• Children and youth in RI will be cared for in high quality patient and family-centered medical homes.

Guiding Principles 1. Families and patients are central to our work

2. PCMHs address the physical, developmental, behavioral, social, emotional, environmental and oral health needs of children and youth.

3. Children and youth need access to pediatric sub-specialty care. This entails workforce and payment issues as well as geographic and linguistic access.

4. PCMHs must integrate and coordinate care with community organizations, state agencies, child care and schools.

5. Prevention and public health functions of PCMH's are drivers of the health of the population of children and youth in our state. As such PCMH’s are embedded in communities they serve.

6. PCMHs must be accessible and affordable to all children, with a specific commitment to equity and cultural and socioeconomic diversity.

7. Payment must not only appropriately recognize the cost efficient added value provided by PCMH’s but also support the long-term sustainability of this transformative practice model.

8. PCMH-kids is committed to innovation and data-driven reform of the health care system.

1. PCMH-kids recognizes the importance of transitions, especially transitions from pediatric to adult care settings.

10. PCMH-kids is committed to the sustainability of primary care work force.

Medicaid Perspective Populations of particular interest:

• CSHN/Katie Beckett/CEDARR

• Children in substitute care

• Children with behavioral health needs, esp. adolescents

Measures of Interest:

• Developmental screening/Early recognition and response

• Care coordination

• Continuity of Care

• ED visit rate

• Oral Health

• EPSDT

• Screening for substance abuse

Providers of interest:

• High volume of Medicaid and/or populations of interest

Medicaid Perspective Other Considerations:

• Ability to qualify sites as Medicaid Health Homes under ACA

Number of Sites:

• Will depend on numbers of children at each site and total cost;

• Need to collaborate with other payers

• Consider mix of sites (high Medicaid, high commercial)

Which Sites:

• How to meet challenge of high volume sites that may not feel ready to apply

SHIP

• Public comments being sought by Nov. 26:

http://www.healthcare.ri.gov/healthyri/resources/ri_ship_comment_draft.pdf

• AAP Feedback

Selection Sub-Committee

Charge: • Develop criteria for selection of initial pilot PCMH-Kids practices

• Develop application and scoring process for practice selection

• Develop outreach strategy to insure eligible practices are informed

• Recommend selection process to Planning Committee/Conveners

• With staff support, conduct selection process, score applications, and make recommendations to Conveners

Selection Sub-Committee

• Members– Steve Davis– Renee Rulin– Tina Spears– Andrea Galgay– Deidre Gifford– Beth Lange– Blythe Berger – Deb Florio– Parent representative

Measures Sub-committee

Charge: • Review available data on quality, health disparities, disease

prevalence, utilization and cost of healthcare for children in RI

• Review standardized measures of pediatric healthcare quality, including those used in other pediatric PCMH programs

• Review available measures for feasibility of collection and alignment with other RI programs

• Recommend set of quality, patient experience and utilization measures to Stakeholder coalition for inclusion in contract

Measurement Sub-Committee

• Members – Ronald Seifer– Betty Vohr– Nate Beraha– Jose Polanco– Shirley Spater – Stacey Aguiar– Bill Hollinshead– Oral Health?– Parent representative?– Payer representative?

Race to The Top Early Learning Challenge Updates

• Quality improvement and evidence-based practices

• Aligning screening

Questions

Contact Information

Patricia Flanagan MD, FAAP, Co-Chair

pflanagan@lifespan.org

401-444-7987

Elizabeth Lange MD, FAAP, Co-Chair

elizlange@cox.net

401-751-8683