Article—Oregon Governor Promotes Coordinated Care Organizations
Oregon Gov. John Kitzhaber plans to place Medicaid recipients into "coordinated care organizations" that would oversee patients' physical, mental, and dental health. The state would pay each team of CCOs a set fee, and they would be rewarded for keeping patients healthy and out of the hospital. CCOs would hire community health workers to address non-medical issues that can affect health, such as transportation and housing.
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Medical Home Chapter Champions Program on Asthma (MHCCPA)
Through the support of the Merck Childhood Asthma Network, Inc. (MCAN), the MHCCPA facilitates the dissemination of best practices and advocacy related to the implementation of the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines within the medical home framework. Program goals include identifying a champion at the AAP chapter and/or state level(s) to educate/mentor providers in their communities, in addition to increasing advocacy efforts, for implementation of the NHLBI guidelines within the context of a medical home. If you would like more information about the project, would like to be connected with your chapter/state's champion 
, or are interested in serving as a chapter champion if your chapter/state does not currently have one, contact Suzi Montasir, MPH, Program Manager at 847/434-4311 or fill out the Contact Us form.
LEND Programs Receive Funding to Improve the Health of Children with Special Health Care Needs
The Health Resources and Services Administration (HRSA) has awarded $28.3 million to 43 Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) programs, including the program at the Oregon Health & Science University, to help improve the health of infants, children, adolescents and young adults with neurodevelopmental and other related disabilities, including autism spectrum disorders. LEND programs prepare trainees from a wide variety of professional disciplines to assume leadership roles, ensure high levels of interdisciplinary clinical competence, and enhance the ability of clinicians to diagnose, treat, and manage complex disabilities in youth and adolescents.
Aligning Forces for Quality (AF4Q) Initiative—Oregon
The Oregon Health Care Quality Corporation (Quality Corp) leads the AF4Q initiative called Partner for Quality Care: Information for a Healthy Oregon in Willamette Valley. The priorities of the Quality Corp are to promote the availability and use of understandable quality information to inform decision-making, stimulate cooperation among all health care stakeholders and support the development of a health information infrastructure so that Oregonians' health information is always available.
Consortium to Advance Medical Homes for Medicaid and CHIP Participants
National Academy for State Health Policy (NASHP)—January 2011
Fifteen state teams were brought together by the NASHP to form a Consortium to Advance Medical Homes for Medicaid and Children's Health Insurance Program (CHIP) Participants. These states will work together to develop and implement policies that increase Medicaid and CHIP program participants' access to high performing medical homes. This past spring, the kick-off meeting was held for the 15 participating states (Alabama, Colorado, Maryland, Massachusetts, Michigan, Minnesota, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, Vermont and Washington); the blog post—Constructive Ideas from Medical Home Builders—features an interview with NASHP policy analyst Jason Buxbaum about the Consortium states' medical homes projects.
Healthy Tomorrows Partnership for Children Grant (2010-2015)—Building Healthy Families
Jackson County School District #6, Central Point, OR
The federal Maternal and Child Health Bureau (MCHB) awarded this five-year grant to provide approximately $50,000 per year to improve child health through community-based initiatives on prevention and access to health service for vulnerable populations. The primary goal of the project is to initiate a community effort to improve the physical and mental health of children in poverty in Central Point, OR. Barriers include lack of awareness, transportation, language and culture and a general sense of anxiety or distrust about getting help from formal service systems. Building Healthy Families will address the physical and mental needs of vulnerable, low income students through the services of a school-based health center. Focusing on prevention, treatment of acute conditions and management of chronic conditions will result in better attendance, and improved behavior of students. For more information contact Jesse Hanwit, MA, ED.S.OTR/L at jesse.hanwit@district6.org.
MCHB State Implementation Grant for Integrated Community Systems of Services for CSHCN (Oregon Health & Sciences University) 
This project will address all 6 Title V Block Grant performance measures, will focus on “adequate public and/or private financing of needed services,” early and continuous screening, evaluation and diagnosis,” and “family-professional partnerships,” and will build on current Title V activities. The project’s objectives for these three measures are: families and youth are informed consumers of health care; communities plan to assure adequate financing of health services for children and you with special health care needs; children are screened early and continuously for developmental/ behavioral differences; family/professional partnerships are developed in health care practices and communities;
and providers design services to meet the needs of culturally diverse groups. For more information contact Robert E. Nickel, MD atnickelr@ohsu.edu.
Oregon START (Screening Tools and Referral Training) Program
The Oregon Pediatric Society and Children’s Health Alliance adapted this educational program from the START program of the Tennessee Chapter of the American Academy of Pediatrics. The goals of START are to improve developmental and behavioral screening in pediatric practices, improve providers’ understanding and utilization of screening tools, educate providers on documentation and coding of screening tools, and improve awareness of community resources for evaluation and intervention. With an effective strategy in place for implementation of these objectives, Oregon START is approved by the American Board of Pediatrics for Part IV Maintenance of Certification as an established quality improvement project. Since its inception, nearly 500 participants from primary care pediatric practices, Federally Qualified Health Clinics, and Oregon Health Sciences University residents have been trained. The primary focus of these trainings was on screening tools for identification of developmental disabilities and autism. Phase II of START began in November of 2009 with a new module related to maternal depression. Other modules are in the planning stages focusing on psychosocial and family risk screening. Additionally in April 2010, through a “Train-the-Trainer” approach, START has added six new physician trainers to the state increasing our ability to share the model with more Oregon communities. Oregon START was made possible by the generous funding of CareOregon, Northwest Health Foundation and other supporting organizations. For more information about Oregon START, please contact Anne Stone, START Manager and Interim Executive Director of the Oregon Pediatric Society.
Children's Health Insurance Program Reauthorization Act (CHIPRA) Grants
Oregon is a lead on one of 10 CHIPRA grants, representing single-state projects and multi-state collaborations, from HHS to improve health care quality and delivery systems for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). The money will help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives.
The Safety Net Medical Home Initiative
In May 2008, The Commonwealth Fund, Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute initiated a demonstration project to help safety net primary care clinics become high-performing patient-centered medical homes (PCMHs). Five Regional Coordinating Centers were selected to participate in the demonstration project, and each partnered with 12-15 safety net clinics in their state. These collaboratives will receive technical assistance on practice re-design topics such as enhanced access, care coordination, and patient experience. They will also receive funding to support a Medical Home Facilitator (who will lead clinic-based quality improvement projects) and other activities. The work of the Regional Coordinating Centers began in April 2009 and the Initiative will continue through April 2013.
- Oregon Primary Care Association & CareOregon
- Paying for the Medical Home—Payment Models to Support Patient-Centered Medical Home
Transformation in the Safety Net
Safety Net Medical Home Initiative
Operating as a medical home requires increased non-reimbursed activity (eg, care team meetings, patient self-management education, care coordination, data analysis, communication with other clinicians) and care management. In order for patient-centered medical home (PCMH) practice transformations to be sustainable, there must be payment reform to incentivize high-value, first-contact, primary care, and support medical home costs that are traditionally not reimbursed (eg, non face-to-face encounters). This publication provides an introduction to a series of policy briefs focusing on payment reform opportunities to support and sustain the medical home.
Oregon Medical Home Project
The Oregon Medical Home Project was one of 15 three year grants funded in 2001-2002 by the MCHB, United States HRSA. The projects were funded to facilitate the development of medical homes throughout each state. The goal of this project was to promote the concept of the medical home by creating a statewide network of parent and professional resource teams. This site contains general information about the medical home and educational materials and resources to support families of children with special health needs (CSHN), health care providers and other community professionals such as teachers and early intervention professionals.
Patients and Families as Health Care Leaders
Six organizations will receive technical assistance and start-up funding from the Oregon Health Care Quality Corporation to implement programs that place patients at every level of decision-making.
The Assuring Better Child Health and Development (ABCD) Program
The ABCD Program is funded by the Commonwealth Fund, administered by National Academy for State Health Policy (NASHP), and designed to assist states in improving the delivery of early child development services for low-income children and their families by strengthening primary health care services and systems that support the healthy development of young children, ages 0-3. The program focuses particularly on preventive care of children whose health care is covered by state health care programs, especially Medicaid. Since 2000, the ABCD program has helped twenty-seven states create models of service delivery and financing through a laboratory for program development and innovation.
Rural Health Information Technology Grants
Funded through HRSA, rural health networks across the nation will receive more than $11.9 million to support their adoption of HIT and certified Electronic Health Records (EHRs). Each of 40 grantee organizations will receive about $300,000 to purchase equipment, install broadband networks and provide training for staff. In Oregon, the grantee is the Mid Rogue Foundation. The pilot program was developed as a result of the President's Rural Health Initiative.
Health Resources and Services Administration (HRSA) in Your State
HRSA in Your State offers overviews of HRSA programs and current information, such as the number and amount of grants awarded down to the County level. It also provides state-specific information about health centers, National Health Service Corps members and the communities they serve, and the number of participating providers through the 340B program.
Early Childhood Comprehensive Systems (ECCS) State Contacts
The Maternal and Child Health Bureau (MCHB) launched the State Maternal and Child Health Early Childhood Comprehensive Systems (ECCS) Initiative to implement the MCHB Strategic Plan for Early Childhood Health. The purpose of ECCS is to support states and communities in their efforts to build and integrate early childhood service systems that address the critical components of access to comprehensive health services and medical homes; social-emotional development and mental health of young children; early care and education; parenting education, and family support. For additional information, you can look up your state's ECCS Grantee Contact or Grantee Web site.
AAP: Community Pediatrics Grant Database
The Community Pediatrics Grant Database archives previously funded Community Pediatrics grant projects, including those funded through the CATCH Program, the Healthy Tomorrows Partnership for Children Program, the Community Pediatrics Training Initiative and the Healthy People 2010 Chapter Grants. The database is searchable by seven major categories: target population, health topic, state/territory, project activity, AAP program, AAP district, and project year. Members of the AAP can obtain grantee contact information by searching through the Member Center. If you are not an AAP member, but have questions please contact docbi@aap.org.
Funding Opportunities
This page houses information on funding opportunities from the AAP and other organizations, as well as links to other key funding contacts and resources.
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This section provides information on state organizations that play a role in implementing various aspects of medical home, and includes links to their Web sites and contact information.
American Academy of Pediatrics (AAP) Chapter—Oregon
AAP chapters are organized groups of pediatrician members and other health care professionals working to achieve AAP goals in their communities. Please contact your local chapter for additional state resources.
American Academy of Family Physicians (AAFP) Chapter—Oregon
AAFP represents more than 94,000 family physicians, family medicine residents, and medical students.
Family Voices Chapter—Oregon
Family Voices aims to achieve family-centered care for all children and youth with special health care needs (CYSHCN) and/or disabilities. Through a national network of chapters, they provide families with tools to advocate for improved public and private policies, and build partnerships among professionals and families.
Family-to-Family Health Information Centers (F2F HICs)
F2F HICs are non-profit organizations that help families of CYSHCN and the professionals who serve them. F2F HICs are typically staffed by parents of CYSHCN who understand the issues that families face, provide advice, offer resources, and tap into a network of other families and professionals for support and information.
Oregon Family to Family Health Information Center
Address: PO Box 574, Portland, OR 97207
Phone: 503/494-0865 | Fax: 503/494-2755
Primary Contact: Tamara Bakewell at bakewell@ohsu.edu
Title V Maternal and Child Health (MCH) Director
Title V Children with Special Health Care Needs (CSHCN) Director
Title V of the Social Security Act is the nation's oldest federal program to improve the health of all mothers, infants, children, adolescents, and CSHCN. Title V is administered by the Federal Maternal and Child Health Bureau (MCHB) as a block grant to states to support core public health functions, such as care coordination and rehabilitation services.
Early Hearing Detection & Intervention (EHDI) Contact(s)
State EHDI programs promote universal newborn hearing screening, develop effective tracking and follow-up as a part of the public health system, promote appropriate and timely diagnosis of hearing loss, prompt enrollment in appropriate early intervention, ensure a medical home for all newborns, and
strive to eliminate geographic and financial barriers to service access.
State Newborn Screening & Genetics Programs
Early Intervention/Part C Coordinators
The Program for Infants and Toddlers with Disabilities (Part C of IDEA) is a federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilities, ages birth through age 2 years, and their families.
State Section 619/Special Education for ages 3-5 Coordinators
This program provides free appropriate public education (FAPE) for children, ages 3 through 5 years, with disabilities.
State Interagency Coordinating Council (ICC) Chairs
This program advises appropriate agencies on the unmet needs in early childhood special education and early intervention programs for children with disabilities, assists in the development and implementation of policies that constitute a statewide system, and assists all appropriate agencies in achieving full participation, coordination, and cooperation for implementation of statewide system.
Children's Health Insurance Program (CHIP) Directors
CHIP is Title XXI of the Social Security Act and is a state and federal partnership that targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage. Within federal guidelines, each state determines the design of its individual CHIP program, including eligibility parameters, benefit packages, and administrative procedures. The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 re-authorized the program through FY 2013, and includes many incentives for states to find and enroll more eligible children in both Medicaid and CHIP. CHIPRA also includes quality provisions that aim to monitor and improve care delivered through the Medicaid and CHIP programs. Each state does have a CHIP program, and the names of these programs differ from state to state. To find information on health coverage programs in your state, visit the InsureKidsNow.gov Web site.
National Association of State Health Policy (NASHP)—Oregon CHIP Fact Sheet
This fact sheet provides a baseline snapshot of state CHIP programs before the enactment of the CHIPRA and the Patient Protection and Affordable Care Act (ACA).
Medicaid State Directors
(Select the SMD Directory on the left side of the site for the current list of Medicaid State Directors)
Medicaid is Title XIX of the Social Security Act and is a federal/state entitlement program that provides medical assistance to certain individuals and families with low incomes and/or special health care needs. Medicaid is of unique importance to children; together with the CHIP, Medicaid insures over 1 in 4 children in the United States, with millions more eligible but currently unenrolled. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program is a critical component of Medicaid, which guarantees that children enrolled in Medicaid are screened for medical or developmental problems early, and that necessary treatments and services are provided. To find information on health coverage programs in your state, visit the InsureKidsNow.gov Web site.
- Medicaid State Reports—2011
The American Academy of Pediatrics, in partnership with the National Association of Children's Hospitals, has created fact sheets that explain the importance of the Medicaid program, and how children in every state rely on it for their health care.
Community Health Centers in the State
HRSA provides a searchable database of federally-funded health centers. Health centers provide care to those with or without health insurance including well-care check ups, treatment when sick, complete care during pregnancy, immunizations and checkups for children, dental care, prescription drugs, and mental health and substance abuse care.
Regional Extension Centers (RECs)
Health Information Technology RECs support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). RECs are designed to make sure that primary care clinicians get the help they need to use EHRs by providing training in adopting EHRs, guidance with implementation, and technical assistance as needed.
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Association of Maternal and Child Health Programs (AMCHP)—Oregon State Profile
These state profiles provide a snapshot of how the Maternal and Child Health Block Grant (Title V) works in specific states. The profiles detail the federal funds appropriated to each state, state match, specific programs funded, numbers of people receiving services and state health needs.
Early Childhood State Policy Profiles
National Center for Children in Poverty (NCCP)
NCCP’s Early Childhood Profiles were produced as part of the Improving the Odds for Young Children project. These comprehensive profiles highlight states’ policy choices that promote health, education, and strong families alongside other contextual data related to the well-being of young children.
Issue Brief: Implementing the Medical Home in Medicaid, CHIP, and Multistakeholder Demonstration Programs
American Academy of Pediatrics (Member access only)
This Issue Brief serves to provide guidance to AAP chapters working with states to implement medical home projects in Medicaid and CHIP as well as multipayer demonstration programs. It also addresses a number of the policy questions that frequently arise in creating state supports for the medical home.
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Medical Home Data Portal—State Data Pages
Child and Adolescent Health Measurement Initiative
The Medical Home State Data Portal profiles provide a state’s medical home performance level for all children and children with special health care needs, based on data from the 2007 National Survey on Children's Health and the 2005/2006 National Survey of Children with Special Health Care Needs.
Child Health USA 2010
US Department of Health and Human Services, Health Resources and Services Administration
This report is the 17th edition of the annual statistical report that highlights the health status and service needs of America's children. The report contains easy-to-access graphs and charts summarizing significant indicators of children's health status, statistics, figures, and references.
America's Children: Key National Indicators of Well-Being, 2011
Federal Interagency Forum on Child and Family Statistics
The purposes of the report are to improve Federal data on children and families and make these data available in an easy-to-use, non-technical format. It organizes well-being indicators into seven sections: family and social environment, economic circumstances, health care, physical environment and safety, behavior, education, and health.
2010 KIDS COUNT Databook
Annie E Casey Foundation
This report is a national and state-by-state profile of the well-being of America's children available as an interactive databook, a complete PDF-format report , and on request, in print. Data and rankings on 10 key indicators of child well-being are available by state, county, and city.
State-at-a-Glance Chartbook on Coverage and Financing for Children and Youth with Special Health Care Needs
The Catalyst Center
The Online State-at-a-Glance Chartbook provides data on carefully selected indicators of health coverage and health care financing for CYSHCN. Using the online Chartbook, you can access data for your state and easily compare it with both national averages and other states' data.
National Healthcare Quality & Disparities Reports
Agency for Health Research and Quality (AHRQ)
50-State Demographics Wizard
National Center for Children in Poverty (NCCP)
This tool allows you to create custom tables of national- and state-level statistics about low-income or poor children. Choose areas of interest, such as parental education, parental employment, marital status, and race/ethnicity—among many other variables.
Adolescent Health Database
National Adolescent Health Information Center (NAHIC)
The NAHIC database includes national and state-level profiles of key measures of the health of adolescents and young adults. National-level data is available by gender and race/ethnicity and also state-by-state, with summaries, data tables, and guidance for using this data to improve the health of adolescents and young adults.
Medical Home Data Fact Sheet—January 2009
American Academy of Pediatrics
To inform key aspects of the pediatric medical home, the AAP has compiled a data fact sheet of summary statistics and facts from various AAP and public and proprietary sources. These data define the current state of pediatric care, and as the efforts surrounding the promotion and expansion of the pediatric medical home accelerate, the fact sheet will change to reflect this new picture.
Profile of Pediatric Visits—April 2010
American Academy of Pediatrics
This report is based on the most current available four years worth of NAMCS and MEPS data (2004-2007). The updated report includes annualized estimates by source of payment, patient age, physician specialty, well vs sick visit, office setting, practice ownership, physician employment status, and geographic location.
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AAP Child Health Informatics Center—State and Territory Specific HIT Resources
This page on the AAP AAP Child Health Informatics Center (CHIC) Web site allows you to identify pediatric specific HIT resources by state related to Meaningful Use, Regional Extension Centers, State Health Information Exchanges, and other important information.
Impact of the Oregon Health Plan on Children With Special Health Care Needs
Mitchell JB, Khatutsky G, and Swigonski N. Pediatrics. Apr 2001;107:736-743.
In the News: 'Medical Home' Strategy Aims to Boost Quality, Cut Costs with Better Primary Health Care
Kaiser Permanente plans to convert all of its clinics in Oregon and southwest Washington to the medical home model over the next year, The Oregonian reports. The nonprofit health plan CareOregon helped 15 community health centers and safety net clinics win grants from The Commonwealth Fund to establish medical homes. And proposed legislation would set aside $400,000 to establish a patient-centered medical home (PCMH) research and training center at Oregon Health & Science University.
In the News: Medical Home Initiative in Oregon
Program Coordinates Foster Kids' Medical Care
This article, published on September 24, 2010 in The Oregonian, highlights the program, Medical Home for Children in Foster Care which is the first of its kind in Oregon. The program provides coordinated health care for foster kids—whether it is preventive, urgent, mental or behavioral care—and tracks their medical histories in binders that go with the children from home to home.
The Medical Home Model of Primary Care: Implications for the Healthy Oregon Act
Office for Oregon Health Policy and Research, December 2007
The aim of this paper is to provide the public with information on the current status of the primary care system in Oregon as well as an overview of the role for medical homes in this environment.
Video on the Oregon Medical Home Network
The Oregon Medical Home Network consists of six primary care practices and the Office of the Oregon Medical Home Project at CDRC who have participated in a 3-year project designed to improve services for families with children and youth having special health care needs. A video is available where you can learn more about the network, meet the community teams, and hear from pediatric clinicians and families on the importance of having a medical home.
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