Maxine Hayes, MD, MPH
Medical Home Conference
May 30, 2007
Medical Homes in Washington:
Reaching the “Tipping Point”
Welcome & Introduction
What is a Medical Home?
• A way of providing comprehensive,
coordinated care that is built on a foundation
of mutual respect and partnership between
patients, their families, and health care
providers. Also includes connection with
community services such as family support.
Defined by its Components
• Accessible
• Continuous
• Comprehensive
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Coordinated
Family-centered
Compassionate
Culturally
effective
One of the Six National
Performance Measures for CSHCN
• All CSHCN will receive regular
ongoing comprehensive care
within a Medical Home
Providers
• Develop partnership of mutual
responsibility and trust with family and
child
• Deliver or direct primary care
• Manage and facilitate all aspects of
child’s care coordination
Families
• Diverse families empowered to play active
role as a Medical Home team partner.
Policy partners involved in moving MH
concept forward include:
• Medical Home Teams
• Washington State AAP
• Other providers (including oral and mental
health)
• Insurers
• Families, schools, childcare providers
• Interagency and community partners
We’ve reached the “Tipping Point”!
• “The Tipping Point, How Little Things Can
Make a Big Difference” by Malcolm Gladwell
(2000)
• When an idea becomes commonplace,
acceptable, part of the every day usage, and
things start to change….
What’s changing…
• Medical Home concept and acceptance has
grown!
• Started with AAP in 1967.
History of MH for CSHCN in WA
• Medical Home Needs
Assessment in 1993 led to
1995 “Training & Resource
Project” with 12 county
medical home teams.
• “Promise to the State”
(2001)
• Medical Home
Leadership Network
grew out of this: now 21
teams
• Medical Home Strategic
Plan for CSHCN (2006)
DOH Medical Home “Strike Team”
• “Medical Home Strike Team” 2006-Present
• Focusing on bringing statewide efforts together
to create a Medical Home strategic plan for all
children and adults
Medical Home Summit – November 2006
Beginning of a strategic planning process to
spread the concept of Medical Home, using
the new strategic plan for CSHCN as the
foundation.
The Tipping Point - What’s changing…
• There’s increasing agreement that MH means
more than just having a primary care provider.
What’s changing…
• Partnerships are expanding to include
practitioners/specialties beyond Pediatrics.
• Joint Principles of the Patient-Centered
Medical Home, March 2007, exemplify broader
acceptance.
2006-2007 public policy initiatives
• State Initiatives that include Medical Home
• SSB 5093 (Children’s Health Insurance- aka Cover
all Kids)
• Blue Ribbon Commission (insurance for all)
• Kids Matter plan (early learning initiatives)
• Autism Task Force recommendations
• Oral Health State Access Action Plan for CSHCN
What’s changing
• More communication between medical
community, public health, early intervention
• Family advisory groups
• Dental homes integrating with medical homes
• Head Start and Early Head Start require
medical homes for children
New Medical Home Tools
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Medical Home website: www.medicalhome.org
Medical Home key messages document
Medical Home monograph
Parent/Family Medical Home Checklist
Oral Health and CSHCN monograph and website
Bright Futures Oral Health document for CSHCN
New brochures for parents and providers 2007-2008
Family Leadership Training Curriculum – CSHCN Program
Medical Home Quality Improvement
• Medical home is an effective approach to
improving health outcomes:
• Learning Collaboratives
• Performance indicators in SSB 5093
Together we can eliminate Health
Disparities
• Significant health disparities
• Medical Homes defined as culturally
competent and family centered
• Washington State’s increasingly diverse
population requires providers to become well
versed in cross cultural communication and
care.
Next Steps
• Develop strategies for financing care
coordination
• Seek additional funding, e.g. Epilepsy Grant
• Support Learning Collaboratives
What Teams will hear about today
• Strategies that are working for teams in our
state
• Opportunities to share and learn from each
other.
Reflections on the day
Determinants of Health
Multiple levels of influence
Access to Health Care – 10%
Environment – 20%
Genetics – 20%
Healthy Behaviors – 50%
HEALTH
L
I
F
E
S
P
A
N
Institutionalized
Biases
(racism, sexism, etc.)
Trust in Health
System and
Research
Stress due
To Social
Factors
Health
Behaviors and
Personal
Risk Factors
SOCIAL
DETERMINANTS
OF HEALTH
Environmental
Risk
Language and
Other Cultural
Factors
Access to
Health Services
Mental Health
and Social
Support
Economic
Opportunity
and Equity
Education
Background
and
Opportunity
Discussion & Questions
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