Medical Homes in Washington: Reaching the “Tipping Point”

Maxine Hayes, MD, MPH

Medical Home ConferenceMay 30, 2007

Welcome & Introduction

What is a Medical Home?• A way of providing comprehensive,

coordinated care that is built on a foundation of mutual respect and partnership between patients, their families, and health care providers. Also includes connection with community services such as family support.

Defined by its Components

• Accessible• Continuous• Comprehensive

• Coordinated• Family-centered• Compassionate• Culturally

effective

One of the Six National Performance Measures for CSHCN

• All CSHCN will receive regular ongoing comprehensive care within a Medical Home

Providers• Develop partnership of mutual

responsibility and trust with family and child• Deliver or direct primary care• Manage and facilitate all aspects of

child’s care coordination

Families • Diverse families empowered to play active

role as a Medical Home team partner.

Policy partners involved in moving MH concept forward include:• Medical Home Teams• Washington State AAP • Other providers (including oral and mental

health) • Insurers• Families, schools, childcare providers• Interagency and community partners

We’ve reached the “Tipping Point”!• “The Tipping Point, How Little Things Can

Make a Big Difference” by Malcolm Gladwell (2000)

• When an idea becomes commonplace, acceptable, part of the every day usage, and things start to change….

What’s changing…• Medical Home concept and acceptance has

grown!• Started with AAP in 1967.

History of MH for CSHCN in WA• Medical Home Needs

Assessment in 1993 led to 1995 “Training & Resource Project” with 12 county medical home teams.

• “Promise to the State” (2001)

• Medical Home Leadership Network grew out of this: now 21 teams

• Medical Home Strategic Plan for CSHCN (2006)

DOH Medical Home “Strike Team”• “Medical Home Strike Team” 2006-Present• Focusing on bringing statewide efforts together

to create a Medical Home strategic plan for all children and adults

Medical Home Summit – November 2006

Beginning of a strategic planning process to spread the concept of Medical Home, using the new strategic plan for CSHCN as the foundation.

The Tipping Point - What’s changing…• There’s increasing agreement that MH means

more than just having a primary care provider.

What’s changing…• Partnerships are expanding to include

practitioners/specialties beyond Pediatrics.• Joint Principles of the Patient-Centered

Medical Home, March 2007, exemplify broader acceptance.

2006-2007 public policy initiatives• State Initiatives that include Medical Home• SSB 5093 (Children’s Health Insurance- aka Cover

all Kids)• Blue Ribbon Commission (insurance for all)• Kids Matter plan (early learning initiatives)• Autism Task Force recommendations• Oral Health State Access Action Plan for CSHCN

What’s changing• More communication between medical

community, public health, early intervention• Family advisory groups • Dental homes integrating with medical homes• Head Start and Early Head Start require

medical homes for children

New Medical Home Tools • Medical Home website: www.medicalhome.org• Medical Home key messages document• Medical Home monograph• Parent/Family Medical Home Checklist• Oral Health and CSHCN monograph and website• Bright Futures Oral Health document for CSHCN• New brochures for parents and providers 2007-2008• Family Leadership Training Curriculum – CSHCN Program

Medical Home Quality Improvement• Medical home is an effective approach to

improving health outcomes:• Learning Collaboratives• Performance indicators in SSB 5093

Together we can eliminate Health Disparities• Significant health disparities • Medical Homes defined as culturally

competent and family centered• Washington State’s increasingly diverse

population requires providers to become well versed in cross cultural communication and care.

Next Steps• Develop strategies for financing care

coordination• Seek additional funding, e.g. Epilepsy Grant• Support Learning Collaboratives

What Teams will hear about today• Strategies that are working for teams in our

state• Opportunities to share and learn from each

other.

Reflections on the day

Determinants of Health

LIFE

SPAN

Multiple levels of influence HEALTHHEALTH

Access to Health Care – 10%

Environment – 20%

Genetics – 20%

Healthy Behaviors – 50%

EnvironmentalEnvironmentalRiskRisk

Stress dueStress due

To SocialTo Social

FactorsFactors

InstitutionalizedInstitutionalized

Biases Biases (racism, sexism, etc.)(racism, sexism, etc.)

Language andLanguage andOther CulturalOther Cultural

FactorsFactors

EconomicEconomicOpportunityOpportunityand Equityand Equity

EducationEducationBackgroundBackground

andandOpportunityOpportunity

Mental HealthMental Health

and Socialand Social

SupportSupport

Access to Access to

Health ServicesHealth Services

HealthHealthBehaviors andBehaviors and

PersonalPersonalRisk FactorsRisk Factors

Trust in HealthTrust in Health

System andSystem and

ResearchResearchSOCIAL

DETERMINANTS OF HEALTH

Discussion & Questions