Medical Home Work Group

February 11, 20169:15 am – 10:15 am

On the call:Greg Prazar; MD, Chair; Amy Belisle, MD; Kathy Cahill, RN/MSN; Deb Gilbert; Alex Geertsma, MD; Ardis Olson, MD; Karen Smith, Tara Townsend; Holly Tutko, MPH

Agenda

  • Recruitment
  • Future projects
  • Agenda for in-person work group meeting on Thursday, April 7th, 2016, @ 8:30-10:30

Recruitment

Greg noted we are still trying to recruit a work group member from MA, so we’ll have representative(s) from every New England state.

  • Greg contacted MA Family Voices and will keep working on it. They are very organized in terms of parent networks.

Future projects

Supporting providers to more comprehensively address genetic and complex conditions:

  • Greg noted that when he was in practice he didn’t have that many kids with genetic and metabolic conditions didn’t know what to look for, how often he should be asking about various issues.
  • Also, kids are often seen only 1x a year for a physical;we should encourage providers to set up other appointments during the year to discuss issuesspecifically related to the complex condition (including quality of life issues, family respite)
  • Alex agreed – what should they be monitoring from a medical / developmental standpoint.
  • Also, the measures being brought forward for QI / payment, are measuring low-lying fruit, not necessarily our kids. There’s a need for guidelines. There is a value in doctors learning what is evidence based. How do you define yourself as a practice in terms of quality / savings.
  • Greg – other issue is that when pediatrician sees kid for annual visit, using strength based communication (what is going well at school…) especially important
  • Family-strength webinar sets the stage for another webinar about specific visits.

Soliciting suggestions from parents:

Tara agreed to share her experiences as a parent of a child with respiratory/pulmonary issues.

  • Tara’s family chose her son’s initial pediatrician when he was in the NICU. That doctor saw the majority of complex kids in the state. He is retiring and they are transitioning to other doctor with a small office. Worried about exposure to germs in waiting room so it’s nice to get into the room quickly. They also need a wheelchair to be available. Her child doesn’t get fevers but his respiratory rate is affected. Different cues.
  • Greg suggested the pediatrician should be involved in making sure her son’s school knows about his triggers. Communicating with communities is one of the future goals for pediatric care.
  • This could potentially be another webinar topic: what’s the future for providers caring for complex kids?
  • Kathy mentioned another resource, the National Center for Care Coordination Technical Assistance,a collaboration between National Center for Medical Home Implementation and Children’s Hospital in Boston.
  • Developed by Dr. Rich Antonelli
  • may include parameters for more than 1 annual visit
  • Ardis – this is one of the most important things that we have been ineffective in changing. We don’t have this as the norm. Lot of work to do here. People don’t know what to do when they have such a visit.
  • Alex agreed, though individual practices figure out small ways to address this; for example, he would see most complex patients laston a Saturday morning sothat could spend more time with the family.
  • Tara – hard for many families, like her own, to get to the doctor. Need to keeplogistics in mind.
  • Alex – this demonstrates the need to address family needs for visit reimbursement for phone and Skype visits. In his institution they’re working on it with adults but not children.
  • It will be important to know how to document the visit properly.
  • Greg agreed telehealth should be reimbursed and CMS may be looking at it. Let’s ask Judy Shaw to give an update on CMS on our next call
  • Ardis – Bureau of Special Med Services is implementing telehealth visits for kids with epilepsy – slow but getting there
  • Greg noted he will be joining the NEGC’s Health Care Access and Finance work group call on 2/19/16. Will ask for feedback and suggestions.
  • Tara is part of both groups.

Linking with systems for CYSHCN to better do our work:

Alex gave an update on his outreach to two people in CT who might help us.

  • Dr. Ben Doolittle was enthusiasticabout making a linkage. He’d like a description of what we are asking him to disseminate to the New England Med/Peds listserv
  • Karen will send Alex info on our webinar series.
  • Rob Ziboski, ConnecticutMedicaid Director, helped clarifyCT’s SIMS project (State Innovation Models Initiative) around Medicaid care.
  • Quality measures built in
  • Have only 2 methods of incentivizing
  • MQISSP – Medicaid quality improvement shared savings plan
  • Being efficient, taking on some of the coordination…will save state $ and they’ll share some of the savings. Very complex, least likely to happen.
  • Challenge is to help practices not only abide by the standards of National Committee for Quality Assurance (NCQA), but to know what to do and what should be measured (as simple as how many visits, what should be covered)
  • Federally Qualified Health Centers (FQHCs) in CT signed up to participate. Not sure it will extend into private insurance but that is the intent.
  • Discussed how people might get the funds to do this project, but the answer isn’t clear

Linking with experts:

  • Greg contacted Rich Antonelli and will be following up with another person from the office. Hope they can talk to us on a call or maybe at annual meeting.

Webinar development:

  • We are doing another webinar based on feedback from last webinar series; people wanted more info on using a strength base approach with families.
  • We finalized a date, speakers:
  • April 28th at noon – 1 pm (Note: this time was later changed to May 26th @ noon-1 pm)
  • Dr. Jill Rinehart and Dr. Barb Frankowski
  • Greg asked the group if they had thoughts about framing the webinar to help the speakers.
  • Families: what is the future going to be like for my child, quality of life, let’s talk about what is going well
  • Tara – doesn’t want people to just see her son for his medical needs; he has things he likes to do and can do…hearing this from his provider would help build trust in the provider
  • Holly –her child is more than just these problems. Parents might feel guilty for focusing so much on the problems.
  • Greg noted practitioners seem to look at problems because that pediatric training programs emphasize identification and treatment of PROBLEMS and not strengths
  • Amy – Do they have a presentation they have already done? Karen will ask.
  • Amy – providers do want to know how to use strength-based communication
  • Kathy suggested there be a parent as part of the webinar. Tara agreed to do it if the presenters agree. Karen will ask.
  • Greg – should we have a webinar that is parent driven– things that work well and things they’d like to see changed. Physicians really listen when families speak. Maybe someone from Family Voices?
  • Holly – likes this idea; add in… how doyou incorporate family voice into your practice. Small practices to large practices…showing things you could do would be helpful
  • Greg – is it an NCQA requirement that you have parent perspective to be qualified? Alex – yes. Looking to the future you have to have family involvement.
  • Holly – NH FV has strong medical advocacy piece
  • Greg & Kathy – agreed. Would be a good presentation.
  • Tara – would we want to include national FV? They do a lot of webinars. Greg – good idea. Tara will reach out and explore this. Tara is FV coordinator for RI.

Other ideas:

Greg has been thinking about expanding the utilization of the Genetics Education Materials for School Success (GEMSS) website to providers. Could be a cost-effective project

  • Background: Gemss was developed by another work group with the NEGC - Education & Outreach – to help schools better understand the needs of children with genetic conditions.
  • “At a Glance” info on roughly 35 conditions
  • Practical strategies for the classroom
  • Designed for parents, teachers, OT/PT, school nurse, etc. Greg wondered if it would also be useful for providers as well, especially with respect to rare conditions
  • Karen said this was an idea from the beginning and will be endorsed by the other group.

Annual in-person work group meeting on April 7th, 8:30 am – 10:30 am

Our agenda focuses on whole issue of communication, including barriers in electronic medical records, and building on strength-based communication with families.

  • If we invited what could they tell us about working with our target population?
  • Since they are proprietary, Karen will ask Monica McClain if it is appropriate.
  • What is the future of care coordination going to be
  • Mental health
  • Community

Action items

KAREN

  • will email webinar information to Alex so that it can be forwarded to the Dr. Doolittle who will then distribute to the Meds/Peds listserv
  • will contact Judy Shaw and ask her to update the group on her investigation into the CMS Innovation Workshop
  • re: webinar: will ask Jill and Barb if Tara can be a part of the webinar and if Jill and Barb have a copy of a previous presentation (Amy requested this)

TARA: will check to see if folks at national FV would be interested in helping our group formulate a future webinar

GREG: will email Rich Antonelli again

Next call: March 10th @ 9:15-10:15