Health Care Home
aka: Medical Home
Karen Welle, Office of Rural Health and Primary Care
Sarah Thorson, MN Children with Special Health Needs
September 11, 2008
What we’ll cover today
• Development as concept
• Minnesota model: children with
special health care needs
• 2008 Minnesota Legislation
• Implementation
Institute of Medicine,1996:
“Primary Care: America’s Health in a New Era”
Definition of primary care: “the provision of integrated,
accessible health care services by clinicians who are
accountable for addressing a large majority of personal
health care needs, developing a sustained partnership
with patients, and practicing in the context of family and
community.”
Defines “clinician” as “an individual who uses a recognized
scientific knowledge base and has the authority to direct
the delivery of personal health care services to patients.”
May be a physician, nurse practitioner, or physician
assistant.
American Academy of Pediatrics
• 1967: Introduced concept of “Medical Home”
• 2002: Further described as an approach to
providing primary care that is:
– Accessible
– Continuous
– Comprehensive
– Family centered
– Coordinated
– Compassionate
– Culturally effective
Future of Family Medicine Project: 2002
Leadership of 7 national family medicine
organizations.
The goal: to transform and renew the
practice of family medicine to meet the
needs of patients in a changing health
care environment.
Future of Family Medicine Report: 2004
A New Model of Practice
• Patient-centered
• Team approach
• Elimination of barriers to access
• Advanced information systems, including
an electronic health record;
• Focus on quality and outcomes; and
• Enhanced practice finance.
Medical Home in Minnesota:
1990s - 2008
• MDH: Minnesota Children with Special Health
Care Needs
• 1990s: Began partnership
with Mn Dept of Human Services,
American Academy of Pediatrics,
and Family Voices
• 2004: First Medical Home Learning Collaborative
Medical Home Learning
Collaborative
• Began in 2004
• 13th learning session
as we speak
• 32 Teams
– 25 Currently Active
• Teams:
– Physician champion
– Staff person who can
act as a care
coordinator
– 2 Parents or Youth
with special health
care needs
Care Model for Child Health in a Medical Home
Health System
Community
Resources
and
Policies
Health Care Organization (Medical Home)
Care
Partnership
Support
Supportive,
Integrated
Community
C Family ­
M centered
H
I
Delivery
System
Design
Informed,
Activated
Patient/Family
Timely &
efficient
Evidence­
based & safe
Decision
Support
Clinical
Information
Systems
Prepared,
Prepared,
Proactive
Proactive
PracticeTeam
Team
Practice
Coordinated and
Equitable
Functional and Clinical Outcomes
Transforming primary care for kids
and families with special needs
• Care is coordinated, comprehensive, and
satisfying both to deliver and receive.
• Care is planned, monitored and measured
throughout childhood and into adulthood.
• Community-based pediatricians, family
physicians, nurse practitioners, and
physician’s assistants are active co­
managers with specialists.
Transforming primary care for kids
and families with special needs
• Children and their families are supported
as the primary caregivers, decisionmakers, and lead partners in the health
care process.
• Community resources are integrated into
the care process, and
• The unique cultural needs of families are
effectively supported.
Physician Perspective
“I personally have found that a small percentage of
my patients take up a disproportionately large
percentage of my time.
Try as I might, I have always struggled to do a
good job with their care.
Medical home has helped me greatly - both to
manage my schedule, and provide better care!”
Gordon Harvieux, MD
Duluth, MN
Parent Perspective
“Having access to longer appointment times for the
complex children is not only beneficial for the family but
also for the physician because they can give a quality
visit without having to run behind the rest of the day.”
Ashley (Camrynn's mom)
“We have a care plan that is always with us, and the
hospital and clinic are aware of the special needs and
openly give Miriam that much needed “extra” time and
gentleness. All these little changes are making a
significant difference not only for Miriam, but for our
family.”
Jennifer, (Miriam’s mom)
2008 MN Legislation
• Promotes the use of ‘health care homes’
to coordinate care for people with complex
or chronic conditions
• Requires development and
implementation of standards for
certification by July 1, 2009
• Establishes payment for care coordination
from public and private payers for certified
providers.
Standards for certification:
1. Emphasize, enhance and encourage the
use of primary care, and include use of
primary care physicians, advanced
practice nurses, and physician assistants
as personal clinicians.
2. Focus on delivering high-quality, efficient
and effective health care services
Standards for certification:
3. Encourage patient-centered care,
including active participation by family,
legal guardian or agent in decision
making and care plan development.
4. Provide patients with consistent, ongoing
contact with personal clinician or team.
5. Maintain comprehensive care plans for
patients with complex or chronic
conditions.
Standards for certification:
6. Enable and encourage utilization of
range of qualified health care
professionals, including dedicated care
coordinators, in a manner that enables
providers to practice to the fullest extent
of their license.
Standards for certification:
7. Focus initially on patient with chronic
conditions or at risk for developing.
8. Measure quality, resource use, cost of
care, and patient experience.
7. Ensure use of health information
technology and systematic follow-up,
including use of patient registries.
Standards for certification:
10. Encourage use of scientifically-based
health care and patient decision-making
aids to assist them in choosing treatment
options and associated benefits, risks,
costs, comparative outcomes, and other
clinical decision support tools.
Certification: clinics and clinicians
• A personal clinician or primary care
clinic may be certified as a health
care home.
• For a clinic to be certified, all of its
clinicians must meet the criteria.
Certified clinics and clinicians must:
• Offer health care home services to all
patients with complex or chronic
health conditions who are interested
in participating.
• Participate in a health care home
collaborative.
Medical Home Implementation
• Joint project of MDH and DHS
• Standards completed by July 1, 2009
• Health care home collaborative
established by July 1, 2009
• Must consult with national and local
organizations, physicians, health plans,
other providers, patients, and patient
advocates
For more information
http://www.health.state.mn.us/healthreform/