Health Care Homes Community Meeting - December 12, 2008
Transcript
“Experience from the Minnesota Medical Home Learning Collaborative”
Carolyn Allshouse, Coordinator, Minnesota Learning Collaborative
Minnesota Department of Health
Good morning and thank you for allowing me to be here today. I am hoping to share a little bit with you about the history and the experience that we have developed in Minnesota around medical homes. So I am going to spend just a little bit of time telling you what we’ve been involved with so far. The concept of medical home really began with the American Academy of Pediatrics, and they started talking about this in the late 1960s. And then further in the 1990s really started to describe this much more in depth and started working and partnering with families who have children with special health care needs to come up with a definition and really articulate what the concepts of medical home might be for children with special health care needs. So they described it as a model of delivering primary care that’s accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective. And I hope that as we think about what we are doing in Minnesota and the evolution that will occur around health care home, that some of this background information will be helpful.
So in 2007, some of the professional associations, the American College of Physicians, the American Association of Family Practice, the American Osteopathic Association, along with the AAP, came up with a consensus statement around the concepts of a patient-centered medical home. Moving medical home from children with special health care needs into the adult health care world. And this is just a part of that statement that talks about an approach to providing comprehensive primary care for children, youth and adults that facilitates partnerships between individual patients and their personal physicians.
So we know that a great medical home knows its patients. It partners with and learns from
patients, youth and families. That it uses a team approach to chronic condition care, which includes planned, proactive visits, coordination of services, co-management with patients’ families and specialists, assistance with transitions, connections with community organizations, and is satisfying for patients, families, providers and for clinic staff.
So in the work that we’ve been doing at the Department of Health over the last 15 years around the concepts of medical home, we’ve recognized that evaluating, measuring outcomes is important. So there’ve been a number of ways that we have done that. And I am going to share just a couple of the ways that we have done that and a few of the outcomes that we’ve seen. One of the tools that we have used is the medical home index. There are six components that help physicians and families be able to evaluate how their practice is doing. They look at organizational capacity, chronic condition management, care coordination, community outreach, data management and quality improvement.
So the practices who have been involved in our learning collaborative that I will describe to you a little bit later, have annually completed a medical home index. And this gives you an idea, we have some practices who have now completed this for five years. And this shows you a little bit about how the practices have improved over time. This tells you a little bit about how the improvements have occurred over those domains that I have described from organizational capacity to quality improvement.
We also utilize the medical home family index, so the parent partners on the quality improvement teams complete this. And this just gives you a snapshot of how they have rated how the practices have been doing around care plans. And we want to know are the care plans being used, are they used to help follow the child’s progress, and are they reviewed and updated on a regular basis. We also have had the practices involved track the family perception of care that they are receiving, and families have reported improvements in the areas of emergency room usage, they have reported improvements in the areas of the child missing school, or the parent missing work, and also an improvement in preventive care.
We also worked with the Department of Human Services to conduct a feasibility study looking at the patients in the medical home teams participating in our whole collaborative who are also part of the Medicaid system. And we saw that there was a decrease in inpatient admissions among those children, a decrease in emergency department visits, and also medical supply claims, along with an increase in dental visits and well-child care. And one of the interesting facts was that we were able to associate a decrease in the patient admissions in the hospital with the use of care plans.
So to try to help make this more real to you, some of the things that practices have been able to do who are part of our collaborative to have an identified care coordinator a systematic way of identifying the population that they are serving, and then developing an internal registry so that they can identify that population so they can make those improvements for that population. They have updated and developed care plans, they’ve conduct pre-visit planning with families. They have worked on improving their access, doing things like enhancing their scheduling with longer appointment times, having planned care visits. Direct rooming when needed. Direct phone numbers and e-mail access. Direct access to the lab in some cases, and in some cases evening clinics.
Patient and family involvement have obviously been a very important part of the work that the providers are doing in our collaborative. They’ve seen families and patients as a driver for the changes and improvements they are making, and they are looking at a number of ways to involve families in that process through focus groups and networking groups. There is enhanced communication and co-management with specialty care providers, and they are using some different tools to help improve the way primary care and specialty care is able to communicate.
So how does our learning collaborative look? What has been the process that we have been able to use to make these improvements? We have had this learning collaborative that started in 2003, I think it first met in 2004. We currently have 25 teams that are comprised of one or two primary care providers, that includes pediatric, we now have a couple of family practice physicians and nurse practitioners. There’s a person in the clinic who they’ve identified as a care coordinator who they include as part of that quality improvement team, and then a minimum of two parents who have children with special health care needs, or adult patients with chronic health conditions.
When a team joins the learning collaborative they attend a half-day orientation where they really learn about medical home. The team is asked to develop an aim statement. They receive many tips and tools for success. They identify areas within their practice and their clinic system that need improvement. And then they begin to implement small tests of change in their practice, and they test those changes, to assure that they really are an improvement before they are implemented.
The teams work in their own communities and their own practices, usually meeting twice a month. And then they come together three times a year for a combined learning session, And this is an opportunity where the teams are able to share what they have been working on with other teams, and then learn from other teams what has worked and what has been successful and one of the things that we have been able to see over the course of the years of this collaborative, is that in fact the teams that have joined in the later years have really been able to accelerate the improvements they have made as a direct result of what they learned from the more veteran teams. So one of the other things that we felt was really important is to really have a better understanding of what the experience is of receiving care that’s different in a medical home. So we have asked some families who have participated in medical home to tell us more about that.
Ashley, who is Camerynn’s mom, has said that, “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.”
Marion, Amanda’s mom, has said “Because we always have Amanda’s care plan and medical records with us, the specialist was able to diagnose the problem and give us a game plan right then and there. Otherwise it would have taken days. This is just one example of what having a medical home has done for Amanda and for us as a family.”
And Jennifer, Miriam’s mom, has said, “We have a care plan that’s always with us and the hospital and the clinic are aware of our daughter’s Miriam’s 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.”
We also want to know what physicians think about the experience of delivering care in a medical home. Gordy Harvieux has said, “Medical home has helped me greatly – both to manage my schedule, and provide better care.”
Elsa Keeler has said, “By becoming more of a partner with patients and their families, collaborating with specialists and community services, both the family and I better understand our roles and can work together to achieve the best possible quality of life.”
And I got an e-mail late yesterday from one of the other providers from one of our other medical home teams, Marilyn Peitso who said she thought it was important for me to let the audience know today that she feels medical home has been a “vehicle to empower …” She is a physician. “ …her clinic system, and the patients and families” that she sees, and I think that’s a wonderful statement.
