9/14/2011. Quality, Care, and Coordination Under One Roof: RDs in the Medical Home. How to Set the Table for a Nutritious Meal in the Medical Home

Transcription

1 Quality,, and Coordination Under One Roof: RDs in the Medical Home Laura Pickler, MD, MPH Debra Hook, MPH, RD How to Set the Table for a Nutritious Meal in the Medical Home Laura Pickler, MD, MPH Debra Hook, MPH, RD Financial Disclosures We have no relevant financial relationships with any commercial interests. Laura Pickler, MD, MPH Debra Hook, MPH,RD Objectives Understand the main tenets of the medical home, including the reimbursement structure and geographic distribution of the medical home, and review current legislation and regulations Define the role of registered dietitians in the medical home and demonstrate the value of RD participation Empower and prepare RDs to advocate for inclusion of nutrition services in the medical home, whether in a facility or private practice setting. 1

2 Medical Home Approach Patient-Centered, Team-Oriented Resources Core Medical Home Components Accessible Recreational Primary Social support of primary and specialty care capacity, insurance eligibility, advocacy Family/Patient Centered Mental Patient & Family Specialty support of families/patients as advocates, participants in community planning Continuous Vocational services are core while needed supports are readily available Oral Educational linking community resources, support of medical information transfer Comprehensive linking medical, mental health and dental providers to ensure global thinking about the total health care Core Medical Home Components Coordinated working with medical components (inpatient and outpatient), educational and community resources to ensure efficiency Compassionate community resources include provision for respite care, linking to faith communities, and behavioral/mental health Culturally Responsive culturally sensitive partners are recognized and linked to families The Role of Systems Building To engage a community to address medical home systems barriers by: Convening stakeholders in health care delivery Encouraging a team approach Ensuring that diverse opinions are voiced Integrating existing resources Linking a public health system to personal health care in an intentional way which includes policy and legislation development Leading evaluation of activities to ensure goals are being met The Role of Leaders Support of a Medical Home System Identify local barriers Provide technical assistance to providers Convene key local stakeholders Provide data Provide gap filling services Educate local sites on legislation involving medical home Implement and support of outreach clinics Previous Colorado State Medical Home Infrastructure Medical Home Advisory Steering Committee Families Youth Family HRTW Voices Family Resource Centers El Grupo Vida Key Stakeholders MDs Insurance Social Dental Professio nals Mental Medicaid Foster y HCP Smiles Kaiser WIC 1 Private Vaccines Specialists Smoking Systems Cessation like DH Data Collection 2

3 State Key Stakeholders Evaluation Demonstrated Colorado Local Medical Home Infrastructure Local Key Stakeholders Resources Primary Recreational Social Mental Patient & Specialty Family Case Example 9 month old boy Significantly undernourished at 79% IBW Poor feeding Dehydration Spanish speaking only primary care giver Sibling with Neurofibromatosis type I Vocational Oral Educational Medical Home Approach Case Study Keys to Success WIC Early Intervention Specialists Feeding Therapist Housing Primary 9 month old baby boy RD Hospital Siblings Social County Nursing A strong public health system at the state level and locally Empowerment of patients and their families who are equipped to inform systems change Engagement of medical providers who are willing to take risks and pilot systems change Convening community stakeholders outside the medical profession to support and problem solve systemic issues Support of policy makers Value of Patient and Family Input Able to identify gaps as well as solutions Core concept of wellness are shared Positive movement in health care reform Demonstrated in other areas of business sector, i.e. product marketing Historically industry elicits minimal consumer input One at a Time The Medical Home Approach is bigger than a clinical experience It s a systemic issue The Colorado Medical Home Initiative is dedicated to building a Medical Home State We are developing systems to support Medical Home communities 3

4 Recommendations for Future Directions Support strategies to credential consumer leaders Develop a Patient Advisory mechanism Support emerging consumer leaders to attend national and state conferences Equitable compensation for all members of a medical home team Share impact of successful patient and family involvement Traditional When Nutrition is at the Center of the Medical Home Example of a medical home coordinated by a dietitian Wait for problems Primary Prevention Treatment of Chronic Disease Chronic Requires Life Skills Patient Activation - Having the knowledge, skills, beliefs and confidence to manage one's health. Self-management - Being responsible for and making decisions about one's health. includes monitoring one's health, making informed decisions about when to use health care providers, practicing appropriate health behaviors, using a problem-solving approach to make decisions, using family, friends, and community resources as appropriate and necessary 4

5 Coordination of the Traditional Medical Home Coordination of the Traditional Medical Home Medical Specialists Medical Specialists Where s the Dietitian School Dental School Dental Primary Primary Pharmacy & Home Therapy (OT, ST, PT) Pharmacy & Home Therapy (OT, ST, PT) Coordination of Medical Home Centered Around Nutrition The journey towards Nutrition Centered School & Pharmacy & Home Dental Nutrition Primary Specialist Other specialists PCP/ Primary Therapy (OT, ST, PT) RD Case Manager Nutrition & Diet Therapy was the main treatment for patients served Clinic RD was already managing complicated nutrition product ordering PCP office Didn t didn t wait understand services and products being ordered to be invited Increased speed of providing services Patients found not ready for adulthood and independent self care Tenants of Personalized Medical Home Clinic Organizational Structure Personal physician specialist : Interdisciplinary Team Medical Director Whole person orientation is coordinated and integrated Dietitian Project Coordinator Quality and safety Dietitian Case Manager Dietitian Educator Nurse Specialist Social Worker Enhanced access 5

6 Patient and Education: moving towards independence Emotional & Nutrition Practices Social Events School Visits Individual Classes Group Classes Supermarket Tours Cooking Classes Whole Child Understanding Provision of Garden Project Clinic Teaching Working with the Coordination of Schools WIC Pharmacy & Home Rehabilitation Programs Laboratory and Prenatal Testing Education Provision of Professional Education & In-services Working with Schools IEP Meetings Modified School Lunch Menus Resource to Public Participate as medical advisors to patient support groups Technical advice to governmental agencies Participate in patient planned/ driven activities School Class Room Visits Increased Communication: Virtual Solution Clinic Website Payment for Medical Home Supplemental fee New service codes Boosted fees Capitation payment with additional performance incentive 6

7 Payment for RD s in Medical Homes Fee for Service Grants Bundled Fees Example: WIC within Medical Homes Improving Early Feeding Practices Improve early feeding practices, including breastfeeding initiation and duration rates; Increase the program s ability to respond proactively to emerging health issues Increase participation in nutrition education activities between certification visits Improve participant retention rates and continuity of enrollment beyond infancy Increase communication and coordination between WIC and the enrolled child s medical home. Becoming Involved in a Medical Home Private Practice Medical Practice Group Hospitals Public Department Thank you Don t Wait to be Invited Contact Information and Resources Laura Pickler, MD, MPH Laura.Pickler@ChildrensColorado.org Debra Hook, MPH, RD dhook@chla.usc.edu American Academy of Pediatrics, National Center of Medical Home Initiatives for Children with Special Needs, Center for Medical Home Improvement, National Initiative for Children s Quality, Colorado Medical Home Initiative, 7