Washington State Medical Home Plan
News
Washington State Medical Home Activities
Public Sector Initiatives
Clinical Practice Initiatives
Medical Home Fact Sheets
National Medical Home Endorsements
State Medical Home Strategic Plan for Children
Launch of the Medical Home Strategic Plan
News
We welcome your suggestions for additional relevant activities and links to include. Send your ideas or comments to Kate Orville at info@medicalhome.org.
Washington State Medical Home Activities
Formal medical home efforts in Washington have expanded in the past several years from an initial focus on improving care for children with special health care needs to improving care for everyone of all ages and abilities. There are also a growing number of activities looking at how to measure and pay for medical homes.
Public Sector Initiatives
Several laws passed by the Washington State Legislature 2007-09 and signed by Governor Gregoire include medical home activities or components:
- Expanded health care coverage for children and provided quality improvement measures and targeted provider rate increases to coordinate care for children through medical homes (2007- SB 5093). State fact sheet on implementing the 2007 Child Health Care Act.
- The Health Care Authority (HCA) and Department of Social and Health Services (DSHS), in conjunction with the Puget Sound Health Alliance (PSHA) leads the Patient Centered Medical Home Multipayer Reimbursement Model; a project to develop, implement and evaluate a pilot of one or more medical home provider reimbursement models, pursuant to ESSB 5491 of 2009. It is anticipated to become operational in fall of 2010.
See the HCA Medical Homes page for more information. At least eight health insurers have committed to help the state test the medical home model.
NEW! As part of the collaborative work on healthcare payment reform, the Puget Sound Health Alliance sponsored the 2009 Healthcare Payment Reform Summit Oct 29. The overall purpose of the day was to involve a broad cross section of stakeholders--providers of care, purchasers, health plans and policy-makers-- in a "day of dialogue" about specific changes in provider payment systems and other actions needed in Washington State to improve healthcare quality and control costs. The specific focus was on building a more robust primary care delivery system to maximize prevention and effective treatment of chronic disease, minimize uncoordinated care and duplication of efforts, and avoid preventable use of hostpials and emergency rooms. See "High Level Overview and Summary of Discussion" for more information about the summit.
- The Department of Health (DOH) leads the Washington Patient Centered Medical Home Collaborative; a project in conjunction with the Washington Academy of Family Practice (WAFP) and the Washington State Medical Association (WSMA) to expand patient-centered medical homes to improve quality, access and affordability. This project, pursuant to ESSHB 2549 of 2008, became operational in fall of 2009 and includes 33 participating primary care providers.
- The Washington State Health Care Authority (HCA) launched three Consumer Managed Health Record Bank pilot projects in three regions of the state in 2009. The Health Record Banks provide patients an opportunity to securely store personal health information in one location using Web-based tools available from both Microsoft HealthVault and Google Health. These online portals link patients to their Health Record Bank account where they can create, view, verify and share a copy of their health information. These pilots will be one of the first Health Record Banks in the United States that allow patient control. The records will be managed by patients and organized into a format that, when brought to their doctors, will directly support the flow of information from patient to doctor to support clinical decision making.
More information at: www.hca.wa.gov/hit and www.accessmyhealth.org/
- The Department of Social and Health Services (DSHS) was mandated by Section 4 of E2SSB 5930 to work with the Dept. of Health to design and implement Medical Homes for clients who are aged, blind or disabled. This is to be done in conjunction with current chronic care management programs to improve health outcomes, access and cost-effectiveness. DSHS is also mandated to consider expansion of existing Medical Home and chronic care management programs and to build on the WA collaborative initiative. For more information, see the DSHS Medical Home page: http://hrsa.dshs.wa.gov/healthyoptions/newho/rethinkingcare/medicalhomepagefiles/
medicalhomepage.htm
Washington State Medical Home Leadership Network
County-based volunteer teams of pediatricians and other primary care providers, public health nurses, early intervention professionals and parents who work locally to improve medical homes for children and youth, especially those with special health care needs. Sponsored by the Washington State Dept. of Health's Children with Special Health Care Needs Program though a contract with the Univ. of WA's Center on Human Development and Disability.
About the MHLN: www.medicalhome.org/leadership/the_mhln.cfm
MHLN team list: www.medicalhome.org/leadership/teams.cfm
Medical Home Partnership Committee
This state committee serves as a forum for the Department of Health and other public and private partners to assure coordinated and collaborative efforts to develop, implement, and promote Medical Homes for all people in Washington State. The quarterly committee meetings are coordinated by DOH's Children with Special Health Care Needs Program staff.
Washington State Participation in National Quality Improvement Institute
In 2008, AcademyHealth and The Commonwealth Fund launched the State Quality Improvement Institute (SQII) - a technical assistance project for states that have made or are ready to make substantial commitments to health care quality improvement. Washington was one of the nine states competitively selected to participate. The others are Colorado, Kansas, Massachusetts, Minnesota, New Mexico, Ohio, Oregon and Vermont.
The SQII facilitates ongoing collaboration between and among high-level state executive, Legislative, municipal and private-sector team members, and provides opportunities for contact with expert faculty to support care improvement in three priority areas: 1) delivery and financing systems reform, 2) care coordination/chronic care management, and 3) data integration/transparency.
Washington State is focusing on three areas: expanding patient-centered medical homes, developing payment strategies to support medical homes, and developing communication strategies for engaging consumers (with most activities in the first two areas. Source: Oct 2009 WA Team Update)
www.academyhealth.org/Programs/ProgramsDetail.cfm?itemnumber=3148
See who is involved from WA in the Institute and read team updates:
www.academyhealth.org/Programs/content.cfm?ItemNumber=3237&navItemNumber=2503
Washington State Collaborative to Improve Health -- Pediatric Medical Home Track (2008-09)
The Collaborative to Improve Health, sponsored by the Washington State Department of Health, offered proven tools for pediatric and family medical practices to improve outcomes for their patients with chronic diseases. Seven pediatric and family medicine clinics in the new medical home track focused on improving care for their children with special health care needs.
www.doh.wa.gov/cfh/wsc/
Kids Matter
Kids Matter is a collaborative and comprehensive framework for building the early childhood system in Washington State in order to improve outcomes for children. The plan offers a framework that supports the efforts of local and state stakeholders to coordinate, collaborate and integrate efforts that will lead to children being healthy and ready for school. This plan identifies specific achievable outcomes within four goal areas:
- Access to health insurance and medical homes
- Mental health and social-emotional development
- Early care and education/child care and
- Parenting information and support
For more information see the Kids Matter Executive Summary (12 pages) or Full Report (66 pages) at
www.earlylearning.org/resources/publications/kids-matter/kids_matter_
executive_summary.pdf
WA Department of Health Medical Home-related Grants for CSHCN
Clinical Practice Medical Home Initiatives
Primary care practices, health care organizations and insurers from across Washington State are involved in medical home pilots and initiatives. Examples include:
Many health insurers have committed to help the state test the Patient Centered Medical Home Multipayer Reimbursement Model. These insurers include: Premera, Regence, Aetna, Cigna, Community Health Plan of Washington, Group Health Cooperative, Molina and United Healthcare. The Puget Sound Health Alliance is coordinating the group which includes representatives of business, unions, the Washington State Medical Association and the Washington Academy of Family Physicians.
Group Health Cooperative Factoria Clinic medical home pilot: Impressed by the results, Group Health is expanding the medical home pilot from its Factoria medical center in Bellevue, WA to all 26 of its medical centers.
Abstract: Am J Manag Care. 2009 Sep 1;15(9):e71-87. - "Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation."
BACKGROUND: A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with the goals of improving patient experience, lessening staff burnout, improving quality, and reducing downstream costs. Five design principles guided development of the PCMH changes to staffing, scheduling, point-of-care, outreach, and management. OBJECTIVE: To report differences in patient experience, staff burnout, quality, utilization, and costs in the first year of the PCMH demonstration. STUDY DESIGN: Prospective before and after evaluation. METHODS: Baseline (2006) and 12-month (2007) measures were compared. Patient and staff experiences were measured using surveys from a random sample of patients and all staff at the PCMH and 2 control clinics. Automated data were used to measure and compare change components, quality, utilization, and costs for PCMH enrollees versus enrollees at 19 other clinics. Analyses included multivariate regressions for the different outcomes to account for baseline case mix. RESULTS: After adjusting for baseline, PCMH patients reported higher ratings than controls on 6 of 7 patient experience scales. For staff burnout, 10% of PCMH staff reported high emotional exhaustion at 12 months compared with 30% of controls, despite similar rates at baseline. PCMH patients also had gains in composite quality between 1.2% and 1.6% greater than those of other patients. PCMH patients used more e-mail, phone, and specialist visits, but fewer emergency services. At 12 months, there were no significant differences in overall costs. CONCLUSIONS: A PCMH redesign can be associated with improvements in patient experience, clinician burnout, and quality without increasing overall cost.
Premera Blue Cross is testing variations of a medical home. Premera Blue Cross is piloting the approach with physicians at Seattle-based Swedish Medical Center, Tacoma-based MultiCare Health System and other organizations.
- "Premera worked with Swedish on a payment system for Swedish Community Health, its recently opened clinic in Seattle's Ballard area that's based on the medical home model. Premera pays an undisclosed monthly amount for each of its members under care of one of the clinic's primary care-physicians. Depending on how well the doctors do, according to various measures, the monthly fee will go up or down in succeeding years..." (Puget Sound Business Journal, July 24, 2009)
- Starting in early 2010 Premera and Multicare Health System will start a 3 year pilot of this payment model for Premera-covered diabetic patients who volunteer to take part.
The Boeing Company completed a successful medical home pilot in 2009 -- called the Intensive Outpatient Care Program (IOCP). The IOCP was designed to improve quality of care and substantially reduce total spending for the predicted highest-cost quintile of its Puget Sound employees and their adult dependents who participated in Boeing's self-funded, non-HMO medical plans. Participating insurers included Regence BlueShield of WA; The pilot enrolled 740 eligible non-Medicare Boeing patients being treated by physicians at the Everett Clinic, Valley Medical Center IPA and Virginia Mason Medical Center clinics. (source: Health Affairs blog)
The Virginia Mason Winslow Clinic on Bainbridge Island in Kitsap County participated as one of 36 pilot sites nationally in the TransforMED medical home practice redesign project. TransforMED is affiliated with the American Academy of Family Physicians (AAFP). The rich experience led to many changes in how the clinic is run- Dr. Kim Leatham from the Winslow Clinic has a number of updates and videos on the TransforMED websites sharing what they learned, including:
www.transformed.com/Perspectives/HopeforPrimaryCare/KimLeathamMD.cfm
For more, go to the TransforMED website and search for "Winslow".
Aetna Inc. is the first health plan in Washington State to introduce Bridges to Excellence. In the state of Washington, Aetna will employ two pay-for-performance programs operated by Bridges to Excellence: The Diabetes Care Link; and the Cardiac Care Link.
http://bridgestoexcellence.org/BTERegion/BTERegionDisplay.aspx?RegionID=15
Bridges to Excellence is a national not-for-profit organization developed by employers, physicians, health care services, researchers, and other industry experts with a mission to create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care.
Two Washington State not-for-profit health care improvement organizations, Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute, have joined with the national Commonwealth Fund to develop the Safety Net Medical Home Initiative. This initiative helps primary care safety net clinics become high-performing patient-centered medical homes. The goal of the Safety Net Medical Home Initiative is to develop a replicable and sustainable implementation model for medical home transformation. Visit the website information about what a medical home is and how to transform your clinic into a medical home.
www.qhmedicalhome.org/safety-net/index.cfm
Washington State Medical Home Fact Sheets and Brochures
Washington State Medical Home Fact Sheet
A brief fact sheet was developed at the request of participants in the Washington State Partnership for Medical Homes group to have a document that would help people describe the Medical Home concept consistently.
The 2 page document addresses Medical Homes for all children and youth, including those with special health care needs. Topics covered are: What is a Medical home, who can provide one, what are the core components, benefits, how many children and adolescents have a Medical Home in WA, challenges, opportunities to build a foundation for the Medical Home model, and information about the development of the key message document.
Washington State “Medical Home Key Messages” Fact Sheet 
Washington State Care Coordination within a Medical Home Fact Sheet
One of the core elements of a medical home is care coordination. In order to provide consistent language about the definition of care coordination and its key elements, a fact sheet was developed based on the work of the 2006-2007 Financing Care Coordination Workgroup, facilitated by the Department of Health. The Workgroup was made up of stakeholders from across the state representing health care providers, families, and state and private agencies and organizations. The fact sheet us intended to use as a reference when describing care coordination within a medical home.
Download: Care Coordination within a Medical Home
"Does Your Child Have a Medical Home?"
Washington State brochure for families. Available in English and Spanish. An earlier version of the brochure is also available in Chinese, Korean, Russian and Vietnamese.
"What is a Pediatric Medical Home?"
Washington State brochure for health care providers.
Washington State Fact Sheets on Medical Home for Children
The Data Resource Center—funded by the Maternal and Child Health Bureau, Health Resources and Services Administration—is partnering with the American Academy of Pediatrics to help state and family leaders quickly access data on how children and youth in each state experience receiving care within a medical home. Use this easy website to see data specific to Washington or other states medical home performance profile for all children or children with special health care needs.
http://medicalhomedata.org/content/Default.aspx
Washington State CSHCN Program Fact Sheet on Medical Home
One page fact sheet which describes what a medical home is, how many children with special needs in WA have one, and what is being done by the State Children with Special Health Care Needs Program to support medical homes. (April 2009)
www.doh.wa.gov/cfh/mch/documents/MedHomeFS.pdf
National Medical Home Endorsements
The Medical Home Concept has been endorsed as the standard of care by a growing number of health care provider organizations and other groups. The terminology used by organizations can vary slightly and includes "medical home," "personal medical home," "pediatric health care home" and "advanced medical home". National organizations endorsing medical home include:
The professional organizations above have joined with over 500 other organizations in the national Patient Centered Primary Care Collaborative to promote medical homes. The PCPCC is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians and many others who have joined together to develop and advance the patient centered medical home. Many organizations and businesses have joined from Washington State, including Microsoft, Group Health Cooperative, Puget Sound Health Alliance, and Seattle Childrens.
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Washington State Medical Home Strategic Plan for Children and Youth with Special Health Care Needs
Washington State developed a strategic medical home plan for children and youth with special health care needs in 2006. The Washington State Department of Health's Children with Special Health Care Needs Program hosted meetings in February and April 2006 with partners from family organizations, health care provider groups, state agencies, health care plans and other groups to identify how we could achieve a medical home for every child with special health care needs.
- Partners developed this 2010 Strategic Plan to build upon the 2000 “Promise to the State”, Washington’s original “road map” for achieving medical homes for children and youth with special health care needs.
- Action Steps in this plan are designed to increase the percent of children and youth with special health care needs (CSHCN) who have a medical home.
Percentage of Children and Youth (0-18) with Special Health Care Needs with a Medical Home:
WA State: 44.8% (38.5, 51.4)
US: 44.2% (42.9, 45.4)
(source: National Survey of Children’s Health, 2003)
Percentage of all Children and Youth with a Medical Home:
WA State: 48.5% (45.9, 51.1)
US: 46.1% (45.6, 46.7)
(source: National Survey of Children’s Health, 2003)
- Partners involved in implementing the plan acknowledge that strategic planning is a process—that the goals, objectives, and activities of this plan might change over time based upon evolving vision and environment.
Vision: All children and youth with special health care needs will receive coordinated, ongoing, comprehensive care within a medical home.
Organization of Plan: Partners identified three key strategic areas and broke them out by the individuals or organizations involved in carrying out specific objectives.
| |
Individuals or Organizations Involved |
| Strategic Areas |
System |
Family,
Youth, Child |
Primary Care Providers |
Understanding and Promotion Goal
People understand and promote the concept of medical home.
|
Objectives
1-2 |
Objective
3-4 |
Objective
5-6 |
Performance and
Quality Goal
All involved actively strive to create medical homes for children with special health care needs and their families.
|
Objectives
7-9 |
Objectives
10-11 |
Objectives
12-16 |
Financing Goal
Financing for medical homes is adequate.
|
Objectives
17-20 |
Objective
21 |
Objective
22 |
|
Download copy of Washington State Strategic Medical Home Plan for Children with Special Health Care Needs – Making it Happen in Washington State 2006-2010
For more information please contact the Washington State Department of Health, Children with Special Health Care Needs Program at (360) 236- 3571.
Washington State Partners in 2006 Medical Home Strategic Planning Process
Washington State Department of Health
Children with Special Health Care Needs Program
Child and Adolescent Health Section
Washington State Department of Social and Health Services
Infant Toddler Early Intervention Program
Health and Recovery Services Administration
Washington State Medical Home Leadership Network
Washington State Chapter of the American Academy of Pediatrics
Docs for Tots
Washington State Parent to Parent
Washington State Fathers Network
Center for Children with Special Needs, Children’s Hospital & Regional Medical
Center
Health Services, Office of Superintendent of Public Instruction
Washington Health Foundation
Group Health Cooperative
Molina Healthcare of Washington
Family Voices of Washington
Spokane County Children with Special Health Care Needs Program
Public Health Seattle-King County Children with Special Health Care Needs
Program
Clark County Children with Special Health Care Needs Program
Washington State Medical Home Leadership Network Teams
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Launch of the Medical Home Strategic Plan
On November 2, 2006, a wide range of stakeholders committed to promoting Medical Homes met to (1) Officially launch the Washington State Medical Home Strategic Plan for children and youth with special health care needs and (2) begin planning our efforts to promote Medical Homes beyond children and youth with special health care needs. Participants included the WA Chapter of the AAP, Family Voices, Department of Health, Department of Social and Health Services, parents, Kids Get Care, the Medical Home Leadership Network, Spokane Regional Health District, Washington Association of Community and Migrant Health Centers, Public Health Seattle-King County, Clark and Cowlitz County, State Board of Health, Children's Alliance, Molina Health Plan, Center for Children with Special Needs at Seattle Children's Hospital, Docs for Tots, Washington State Parent to Parent, Whatcom Health Information Network. For more information, contact the Washington State Children with Special Health Care Needs Program at 360-236-3571.
Click on the links below to view the following:
 Download PowerPoint Viewer to view below presentations if you don't have it already installed on your computer.
| Cassie Johnston, Family Voices |
Understanding and Promotion Strategy for Medical Home (PowerPoint, 70KB) |
Phyllis Cavens, Cowlitz County
|
Handouts:
|
| Teresa Vollan, DOH |
Medical Home for Children in Washington State: WA State Data from the 2003 National Survey of Children's Health (PowerPoint, 293KB)
Handout: Medical Home Measure – 2003 National Survey of Children's Health |
| Chris Olson, WA Chapter AAP |
The Medical Home and Quality Improvement (PowerPoint, 99KB) |
| Jim Stout, University of Washington |
Children's Health Improvement Collaborative (PowerPoint, 187KB) |
Michelle Bogart, Children's Administration
and
Margaret Wilson, DSHS/HRSA |
Centers of Foster Care Health (PowerPoint, 69KB) |
| Kate Orville, Medical Home Leadership Network |
Quality Improvement: The Medical Home Leadership Network (PowerPoint, 188KB) |
Linda Barnhart, DOH
and
Pat Shaw, Clark County |
Financing Strategies for Care Coordination within the Medical Home (PowerPoint, 1.2MB) |
| Debby Allen, Catayst Center Boston |
Calculating the Cost of Care Coordination: A Quick and Dirty Guide to Estimation (PowerPoint, 46KB) |
| Lorrie Grevstad, Kids Matter |
Kids Matter: A Framework for Improving Outcomes for Children in Washington State: A Framework for Building an Early Childhood System (PowerPoint, 2.7MB) |
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