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Medical
Home Listserv Archives
This page provides information on past questions
posted on the Medical Home LISTSERV. Responses are provided
by physicians, allied health professionals and parents of
children with special needs.
The inclusion of any resource or link in these pages does
not imply endorsement. As information changes rapidly, please
check with each sponsoring organization as to whether the
information you are receiving on their web site is current.
If you have information or resources to add to this request,
please e-mail us at medical home@aap.org.
Posted September 12, 2003
Request:
Looking for information from states on how primary
care offices receive reimbursemeMarch 20, 2007
Responses:
Tools/Resources on Care Coordination
reimbursement:
- In Florida, research was done to assess
if increased effectiveness of care coordination, as evaluated
by the parent, would be associated with lower financial
burden to families, (i.e. Help getting specific services,
Experience of care)
Research Design
- Title V program in Jacksonville, FL:
- 2500 CHSCN,
- 60+ pediatrician providers but less than 25%
care for > 75-100 children in the Title V program
- Selected 3 intervention and 3 control practices
- Intervention:
- Placed Title V care coordinator into offices.
- Active CQI program to implement “Medical
Home,”
- Measurement/feedback to practices on Medical
- Prospective cohort study of 150 children & families
in the intervention and 150 in the control practices
- Survey of families at baseline, and every 6 months
for 3 years
- Costs
- Effectiveness of care coordination
- Effectiveness of primary care services
- Child health outcomes
- Qualitative study of families and practices
For more information on the preliminary data
from this research, you can view the following presentation
from the CATCH and Medical Home National Conference
- July 16, 2004 The
Impact of a Medical Home on Financial Burden to Families
with Children with Special Needs (206 KB)
David Lee Wood, MD, MPH, FAAP
Associate Professor of Pediatrics
Chief, Division of Community Pediatrics
University of Florida & Duval County Health Department
- In Illinois, a
Medical Home CME
Monograph has been developed by the Title V CSHCN
Program, the Division of Specialized Care for Children
(DSCC) to introduce primary care providers to the concept
of a medical home and define how the DSCC will integrate
this concept within the agency's care coordination activities.
The monograph addresses new reimbursement parameters for
DSCC-approved providers managing children with special
health care needs. This CME monograph has been reviewed
and accepted for up to 2 Prescribed Credit Hours by the
Illinois Academy of Family Physicians. IAFP Prescribed
Credit is accepted by the AMA as equivalent to AMA PRA
Category 1 Credit for the AMA Physician's Recognition
Award (PRA). When applying for the AMA PRA, Prescribed
Credit Hours earned must be reported as Prescribed Hours,
not as Category 1. Completion of the CME monograph is
part of the process for becoming a DSCC medical home provider.
Primary care physicians who
become approved DSCC medical home providers are reimbursed
for the care coordination activities provided for eligible
children with special health care needs. Physicians interested
in becoming a medical home provider need to successfully
complete the CME Monograph. For additional information
about becoming a DSCC medical home provider, contact DSCC
for more information.
- Massachusetts Consortium for Children with Special
Health Care Needs: Care Coordination Work Group
Chair: Deborah Allen, Sc. D.
Health & Disability Working Group
B.U. School of Public Health
617 414-1416; 617 426-4447 x33
dallen@bu.edu
Many organizations that participate in the Consortium
provide some level of care coordination for some segment
of children with special health care needs. In order
to weave this patchwork of services into a coherent
and comprehensive system, Consortium members have established
a work group to develop a unified and operational definition
of care coordination for CSHCN, and a model for blending
financing of these services across agencies and sectors.
This definition will address the varied responsibilities
of different agencies and levels of the health care
system for providing components of the service. The
Care Coordination Work Group began its work in December
2002 by reviewing the literature on care coordination
for CSHCN. Under the leadership of Dr. Deborah Allen,
the Work Group held a day-long workshop in February
2003 for fifty invited participants to conduct a critical
review of expectations and models of care coordination
in use within our own state and across the country.
Following the February workshop, the Work Group began
drafting a proposed operational definition for enhanced
care coordination for consideration by the full Consortium.
The second phase of this work will include: developing
a structural model and a proposed mechanism for financing
to an effective system of care coordination for CSHCN
in the state, across multiple payers. This work is supported
by the Maternal and Child Health Bureau within the Health
Services and Resources Administration, U.S. Department
of Health & Human Services.
April 8, 2004 Care Coordination Work Group Update:
The group has interviewed a variety of care coordination
programs and is now doing site visits of four primary
care practices that deliver care coordination through
several models and staffing arrangements: one where care
coordination is done by a nurse, one by a social worker,
one where outside community-based agency staff perform
the function, and one where a mix of office based clinical
and administrative staff perform some of the functions
of care coordination. One site visit has been completed
and the interview team is currently identifying other
practice sites willing to participate; recommendations
are welcomed. The results of these efforts will be a proposal
for a model of care coordination that is cost effective
and addresses diverse needs.
- In Ohio, the Title V CSHCN program
Bureau for Children with Medical Handicaps (BCMH), allows
primary care providers (who are BCMH providers for eligible
children) to bill for physician directed care management
services in their office. If the BCMH program serves the
children, physicians can bill for conference calls or
in person discussion with other providers of services
for these children, whether the services be medical, school,
mental health, or community supports. It is a small percentage
of children with special health care needs compared to
those insured by private or Healthy Start agencies. It
was intended by the Medical Director Jim Bryant, as a
model to other state insurers of a service that adds value
to care and therefore should be reimbursed. It has been
in effect about 2 years and is under utilized. For more
information on goals, eligibility and the fee schedule
click
here.
- In Pennsylvania,The Educating Physicians
in Community Integrated Care - Medical Home Project (EPIC
IC) established a training program for primary care providers
and their office staffs on how to create a medical home
for children with special health care needs. Twenty-one
practice teams across the state have been recruited to
engage in a process of quality improvement in the care
of their special needs patients. Teams are comprised of
a clinician, staff member and a family representative.
These teams attended a two day training conference and
participate in monthly conference calls on a medical home
concept or topic that the practices want to address. Each
practice team has developed and started to implement a
quality improvement cycle based on needs identified by
the practice.
Collaboration with various State and Local agencies has
provided resource and referral information for practices.
Parent to Parent, Family Voices (who, as of January 2004,
no longer have a Pennsylvania representative), The Special
Kids Network, and the DOH Special Needs Nurse Consultants
have made in person presentations and provided resource
information to many of the practices. They have also participated
as speakers in some of our monthly conference calls. The
Pennsylvania Elks Home Service Program has been collaborating
with practices across the state to provide community based
care coordination for CSHCN and their families
EPIC IC received grant funding from the Pennsylvania Department
of Health to develop inclusive child care training for
providers across the state of Pennsylvania. A full time
nurse, Mauri Druash-Gladys was hired in April 2002 to
address the needs of families and child care providers
across the state around child care for CSHCN. Mauri has
continued to develop contacts throughout the sate and
has provided training for childcare providers on issues
around CSHCN.
Another component of the State grant was to develop a
demonstration project for community based care coordination.
Following a conference call with the Advisory Committee
in May 2002, a sub-committee of the EPIC IC Advisory Committee
was formed to determine those practices best prepared
to receive funding for care coordination. Practices were
required to submit a proposal to describe their plan for
care coordination, and from those proposals received,
9 sites were selected to receive funding in Year 1. St.
Christopher’s Primary Pediatrics was supported with
8 hours of care coordination and the Tenet system, which
they are a part of, has seen the value in the initiative
and is supporting the additional 4 days a week for a full
time care coordinator. Tenet has recently given approval
to hire another full time care coordinator. Market Street
Pediatrics, part of the Children’s Hospital of Philadelphia
system, also supports a full time care coordinator. Under
the new State funding, beginning in January 2005, another
15 practices will be eligible for care coordination support
during the 3 year period of the grant.
During the first grant period, care coordination was
either practice-based or community-based. In reviewing
some of the collected data, it appears that a hybrid
of these will offer CSHCN and their families the most
comprehensive care coordination. The strength of practice-based
care coordination was that paperwork and documentation
that is needed from the physician’s office was
easily obtained such as letters of medical necessity,
referrals, medical records and physician signatures.
The strength of community-based care coordination is
the ability to do home assessments, attend IEP meetings,
and attend specialty visits, links to other community
resources and attendance at advocacy meetings. During
the next phase of the care coordination funding, each
practice will benefit from a care coordinator working
within the practice and also working directly with a
community-based care coordinator.
Each practice supported with care coordination is required
to submit a monthly time tracking sheet to document
the care coordination services that they are providing,
community agencies that they are collaborating with
to provide care, and gasps and barriers to services
in their communities. Currently, data collected through
May 2004 is being assessed to define areas of success
and areas of need. A new care coordination tracking
sheet is being developed that will be more indicative
of outcomes of care coordination such as avoided Emergency
Department visits, the number of unplanned hospital
visits, visits to specialists, school days missed, and
parent work days missed.
Five Curriculums have been developed during the EPIC
IC initiative. Three have been presented to the practices
including, Family Centered Care, The Medical Home, and
Care Coordination.
- The South
Carolina Medical Home Team currently uses state health
department dollars to draw down Medicaid matches to fund
case managers in a few pilot sites, in addition to using
some Maternal Child Health Bureau (MCHB) dollars that
funded the original case manager. Their case managers
are health department employees, but work in outpatient
based pediatric medical homes. Two of the sites that have
care coordinators in the office were recently written
up to report on their experiences and the data that supports
this model as being cost effective and improving family
satisfaction.
- Case
study of the first South Carolina medical home mentor
site (June, 2004)
The Data: "Specifically, Medicaid
data is used to examine office visits, inpatient hospitalizations,
emergency room visits, pharmacy claims, and dental
services. A comparison group matched on demographic,
diagnostic, and health service utilization descriptors
was created... The most dramatic difference, which
was statistically significant, was the rate of emergency
room visits resulting in inpatient hospitalizations
for the case group from the pre-medical home quarters
(1 4) to the medical home year quarters (5 8)."
- Palmetto
Pediatrics - A Case Study of Dr. Robert Walker's Medical
Home Mentor Site
"Palmetto Pediatric and Adolescent Clinic is
a large practice that includes 16 physicians working
in 4 office locations in the Greater Columbia Metropolitan
Area in central South Carolina. The practice patient
population is characterized as fairly educated and
affluent with the majority of parents of children
with special health care needs equipped and empowered
to navigate their systems of care and advocate on
their children’s behalf. Approximately 26% of
practice patients are Medicaid eligible."
-
 MCHB and JSI Release Review of Care Coordination Activities of DSCSHN State Implementation Grantees
Several of the health insurance and financing implementation grantees funded by the Division of Services for Children with Special Healthcare Needs (DSCSHN) of the Maternal Child Health Bureau (MCHB), had expressed an interest in examining care coordination models. An initial recommendation to review care coordination activities among these grantees sparked an interest to expand this review to all state implementation grantees. While a previous study had focused on the role of Title V in care coordination, there had never been a review of the role of state implementation grantees in this critical aspect of developing a system of care for CYSHCN.
As part of their current contract with DSCSHN, John Snow, Inc. (JSI) was asked to develop a survey to capture the range of activities among the state implementation grantees. This report addresses all 6 of the Healthy People 2010 outcomes, through a survey of all MCHB State Implementation grantees. The survey focused on the care coordination activities of the grantees, such as methods of care coordination program development and implementation, methods of financing, and effectiveness of care coordination. Click here to view full report.
- Examining Costs and Child Health Outcomes Related
to the Provision of Medical Homes for CYSHCN
(CATCH and Medical Home National Conference - July 16,
2004)
This mini-plenary took a broad look at financing issues
for CYSHCN. Claims and enrollment data was used to describe
health care use patterns, associated expenditures, and
reimbursement strategies. Data was presented on financial
implications of care coordination in primary care practices,
as well as progress on a study looking at costs and child
health outcomes related to a medical home learning collaborative
intervention.
Richard
Antonelli, MD, MS, FAAP+ (274 KB)
Nashaway Pediatrics
Elizabeth
Shenkman, PhD (322 KB)
Associate Professor of Pediatrics and Health Policy and
Epidemiology
College of Medicine, University of Florida
David
Lee Wood, MD, MPH, FAAP (206 KB)
Associate Professor of Pediatrics
Chief, Division of Community Pediatrics
University of Florida & Duval County Health Department
- Additional tools on this web site can
provide an overview of coding and reimbursement issues
related to caring for CSHCN. Included are coding resources
as well as key points for addressing reimbursement problems.
For more information on these tools and resources, click
here.
Last Updated
March 19, 2007
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