Medical Home Chapter Champion Orientation Webinar

1. Medical Home Chapter Champion Orientation Webinar November 10, 2010 7 – 8 pm CST

2. Welcome! Chuck Norlin, MD, FAAP MHCCPA Project Advisory Committee Chairperson

3. Webinar Overview • Welcome, Overview & Project History • Medical Home and Asthma: Making it Work in Practice • Project Highlights • Chapter Champion Roles & Responsibilities • Q & A

4. Program History How It All Began…

5. AAP Comprehensive Asthma Program (CAP) • Phase I: Chapter Alliance for Quality Improvement (CAQI) / Chapter Quality Network (CQN) Asthma Pilot Project • Support structure offered by AAP chapters as a provider of QI programs • 4 Chapters: AL, ME, OH, OR (49 practices, 282 clinicians) • Asthma EQIPP module serves as project’s means for concurrent data collection • Phase II: Medical Home Chapter Champions Program on Asthma (MHCCPA)

6. Funding & Timeline • Merck Childhood Asthma Network, Inc. (MCAN) • Foundation, funded by the philanthropic arm of Merck • Non-profit 501 c(3) organization established to address the growing problem of pediatric asthma • 2-year program which started in November 2009

7. Rationale for Phase II (MHCCPA) • Receiving care within the context of medical home has potential to improve care for children and youth with asthma, especially for children living in poverty, who have dramatically higher rates of adverse outcomes such as emergency department visits, hospitalizations and death • MHCCPA is also based on success of Academy’s Early Hearing, Detection & Intervention (EHDI) Chapter Champions Program

8. Program Overview • 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)

9. High Quality Care for Children with Asthma: the Medical Home Foundation Jennifer Lail, MD, FAAP John Meurer, MD, MBA, FAAP MHCCPA Project Advisory Committee Members

10. Imagine: • Staff recognizing a parent when appointment is made • Adequate time scheduled for that child • Prior asthma care plan on chart • Specialist’s records in your hands prior to the visit with lab, allergy testing, spirometry, X-ray results • Parent concerns identified before the visit; multiple tasks completed at the visit • Lab slips ready and EMLA cream on child prior to visit • Help by your staff for families with referrals, resources, equipment, forms • Follow-up to assure completion of tasks

11. What is a Medical Home? “The Medical Home is the model for 21st century primary care, with the goal of addressing and integrating high quality health promotion, acute care and chronic condition management in a planned, coordinated and family-centered manner.” -American Academy of Pediatrics

12. Joint Principles of Medical Home AAP, AAFP, ACP, AOA, 2007 • Personal physician • Physician-directed practice • Whole-person orientation • Coordinated care • Quality and safety • Enhanced access • Appropriate payment

13. Essential Components of a Medical Home System • Ready Access • Relationships/Respect • Registry and Records • Resources • Reimbursement • Recruitment

14. NIH Asthma GuidelinesNHLBI NAEPP, 2007 Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

15. Principle 6: Enhanced Access • Pediatrician availability to assess, classify and monitor asthma severity and control • Reduce disparities in processes and outcomes in asthma care • Socioeconomic • Racial/ethnic • Geographical

16. Ready Access • Accept Medicaid, many insurers • Evening, Weekend and Holiday office hours for asthma flares • 24-hour advice nurses (? To the ED or not?) • Translation Phone • Privacy protection for Teens (cigarettes, THC) • ADA accessible physical plant • Handicapped parking spaces • Policy on Transition to Adult Care (age, process) • Identified Adult Providers

17. Principle 1: Personal Physician • Provide continuity of care in a partnership • Schedule routine follow-up care • Monitor use of beta2-agonist medications

18. Relationships/Respect • Patient and Family—enhanced appt/med compliance • MH Staff—help for asthma teaching, spirometry, flu shots • Specialists—support for difficult cases, education • Schools—asthma care for when parents not present • Insurers—payment, surveillance for med overuse, noncompliance • Community Providers—Medicaid Care managers, social workers, summer camps, smoking cessation

19. Principle 2: Physician-Directed Medical Practice Coordinate services for children with asthma that are: • Family-centered • High-quality • Accessible • Affordable

20. Principle 3: Holistic Orientation • Control of environmental triggers • Allergens • Irritants, especially tobacco smoke • Treat and prevent co-morbid conditions • Promote physical fitness and nutrition for children with asthma • Help address socioeconomic barriers to well-being

21. Principle 4: Coordinated Care • Integrate care across the community • Use information technology • Asthma registry • Electronic health record • Performance and outcomes measures • Accountability • Add electronic health record • Refer to specialist, if needed • Transition teens to adult care

22. Registry/Records:Knowing Who Needs Care • Registry can be paper or electronic • Notebooks  Excel  Access EMR • Alerts schedulers to need for more time for visit • Assures key data to specialist for consult • Track referrals and specialist reports • Prompt Pre-visit contacts • Data management for flu shots, ACP on chart • Data recall for self-assessment of care quality

23. Electronic Records Make Asthma Care Easier • Chart is never “lost” • Permits “tracking” of asthma visits, both acute and planned • Medication doses/strengths/refill dates are recorded • Specialty consults are easily accessed • Asthma plan, allergies are on chart • Asthma education printouts available

24. Principle 5: Quality and Safety • Patient-centered, evidence-based care • Establish the asthma diagnosis • Provide asthma education on patient self-management • Prescribe and adjust medications • Inhaled corticosteroids are preferred for persistent symptoms • Stepwise treatment based on age • Develop a written asthma management plan

25. Resources/Care Coordination Services • Care Coordination services for referrals, visit planning, equipment, collaboration with other providers • Centralized data base (paper or electronic) of local resources • Family Support Networks for Parent-to-Parent support • Community asthma educational supports • Smoking cessation programs for patient, family • School nurse links for acute care • Referral assistance; information exchange with other providers • Specialty providers for allergy, pulmonology evaluations • Local suppliers for environmental controls, spacers, nebulizers, oximeters

26. Care Coordinators Aid Collaboration/Comanagement with Specialists • Care coordinators as bridges to service • Assure that referral data sent and visit accomplished • Access to Specialist records (letter, fax-back, electronic) • Phone/email dialogue re: care • Specialty follow-up at PCP office (hospital/ED follow-up, labs, etc) • Synthesis of thought from multiple specialists

27. AAP Quality and Safety Resources • Chapter Alliance for Quality Improvement www.aap.org/member/chapters/caqi/ • Medical Home Chapter Champions Program on Asthma www.medicalhomeinfo.org/national/mhccpa.aspx • Education in Quality Improvement for Pediatric Practice (EQIPP) www.eqipp.org • CME • MOC Part 4

28. Principle 7: Appropriate Payment • Added value provided to patients with asthma who receive care in a medical home • Adequate fees • Bundled payments • Accountable care organizations

29. Reimbursement for Asthma Management • Schedule and charge for chronic care management visits • If available and trained, charge for spirometry • Proper coding for care of CSHCN • Charge for after hours visits • Contract renegotiations with insurers (data!) • Charge for MDI teaching, asthma education, oximetry, nebulizations • Demonstrate low ED/hospitalization rates to insurers for contract renegotiations

30. Recruitment—Yes, YOU • One family in five has a CSHCN who needs pediatric care; asthma is one of most common chronic condition in Peds • Parents, insurers, government are demanding Quality Improvement in care systems • Planned, supported care is more fun to deliver! • Where do you want to start?

31. Project Highlights Suzi Montasir, MPH MHCCPA Program Manager

32. Project Oversight

33. MHCCPA Project Advisory Committee Members • Chuck Norlin, MD, FAAP, Chairperson • Allen Harlor, Jr, MD, FAAP • Jennifer Lail, MD, FAAP • Julie Katkin, MD, FAAP • Mitchell Lester, MD, FAAAI, FAAP • John Meurer, MD, MBA, FAAP Liaisons • Beth Dworetzky, MS • Rhonda Hertwig, CPNP • Linda Lee, APR • Marie Mann, MD, FAAP

34. Chapter Champion Regional “Networks”

35. Project Initiatives & Activities

36. Education in Quality Improvement for Pediatric Practice (EQIPP) • 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

37. EQIPP Scholarships for Champions • All chapter champions are eligible to receive a scholarship for either of the following EQIPP courses: • Diagnosing and Managing Asthma in Practice OR • Medical Home for Pediatric Primary Care (NOW AVAILABLE!) • Send an e-mail to Corrie Pierce (cpierce@aap.org) to request one of the above scholarships

38. MHCCPA Webinar Series • “Hot Topic” Series (3 total) • Tentative Schedule: 2011—Jan, Apr, Nov • Available to all AAP members • Focus on larger medical home/asthma topics • Chapter Champion Series (3 total) • Tentative Schedule: 2011—Mar, Jun, Sept • Focused webinars, as follow-up to “hot topic” webinars • Continuing Medical Education (CME) anticipated for both

39. Chapter Champions Conference • Save the Date! • February 25 – 26, 2011 • Location • Chicago, IL • Format • 1.5 Days • Plenary & break-out sessions • Chapter champion networking opportunities and more! • Continuing Medical Education (CME) anticipated • ALL travel expenses will be paid by the program

40. MHCCPA Web Page http://medicalhomeinfo.org/national/mhccpa.aspx

41. Visiting Professorship Program • Opportunity for chapter champions and/or chapters to request a speaker who will highlight aspects of medical home implementation and a speaker who will be able to present on optimal asthma care • 10 VP programs offered throughout 2011 • Priority may be given to areas where there is high incidence of health disparities and demonstrated need for education on NHLBI guidelines implementation and medical home • MHCCPA VP program will cover both travel expenses and faculty honoraria

42. Chapter Champion Roles & Responsibilities • Chapter Champion Orientation Guide • On its way to your office/home! • Getting Started • “Roles, Responsibilities & Implementation Ideas” • Chapter Champion “Top Ten” List • Chapter Champion Year 1 Work Plan (template)

43. Questions & Answers

44. Thank You! Questions? Contact: Suzi Montasir, MPH Program Manager, AAP Division of Children with Special Needs 800/433-9016, ext 4311 smontasir@aap.org