Michigan Childrens Healthcare Access Program (MI-CHAP) Asthma - - PowerPoint PPT Presentation

The Great Start Collaborative of Kent County is a major partner of First Steps

Michigan Children’s Healthcare Access Program (MI-CHAP)

Asthma Initiative of Michigan Partnership Forum 5/31/12

The Great Start Collaborative of Kent County is a major partner of First Steps

Pediatric Medical Home

“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.”

American Academy of Pediatrics

The Great Start Collaborative of Kent County is a major partner of First Steps

History

• Concept originated in 1967 by the American

Academy of Pediatrics (AAP)

• Initially designed for children with special health care

needs

• In last 10-15 years, has expanded to include ALL

children

• Patient-centered medical home (PCMH) movement

arose from this original concept

The Great Start Collaborative of Kent County is a major partner of First Steps

The Beginning: The Kent County Children’s Healthcare Access Program (CHAP)

The Great Start Collaborative of Kent County is a major partner of First Steps

THE NEED

• 41% of Michigan children are currently enrolled in

Medicaid last year – up from 23% in 2001

• 35% of families with children on Medicaid report having

difficulty finding providers who will accept their coverage

• Michigan has one of the lowest Medicaid reimbursement

rates in the country, approximately 50% of Medicare rates

The Great Start Collaborative of Kent County is a major partner of First Steps

THE NEED

• Children on Medicaid in Michigan and Kent County have

poorer health outcomes than children with private insurance

• Low Medicaid reimbursement makes it difficult for

practices to accept large numbers of children with public insurance

• Teaching clinics and FQHCs are overwhelmed by the

numbers of Medicaid patients they are asked to see causing more limits to access

• Costs due to poor preventive care for Medicaid children

are significant in terms of ED use and hospitalization rates

The Great Start Collaborative of Kent County is a major partner of First Steps

THE NEED

• Michigan children with public or no health insurance have poorer

health outcomes than privately insured children, including:

• Significantly higher hospitalization rates
• Higher rates of mortality when hospitalized
• More severe illnesses resulting in hospitalization
• Significantly higher rates of respiratory illnesses, including asthma
• More visits to the emergency room
• Higher readmission rates for newborns after discharge from the

hospital

The Great Start Collaborative of Kent County is a major partner of First Steps

THE NEED

If the hospitalization rate for children

• n Medicaid

was the same as for those with private insurance, the estimated savings for one year would be $300-$400 million.

The Great Start Collaborative of Kent County is a major partner of First Steps

What is CHAP?

Collaborative, community-based medical home improvement program that provides:

• Technical assistance to improve “medical homeness”
• f primary care practices
• Resource coordination of community services
• Increased office, patient and family education
• Needed services for children/families
• Office efficiency assistance
• Convening of community stakeholders to address

systems issues

The Great Start Collaborative of Kent County is a major partner of First Steps

DESIRED OUTCOMES

Improve health outcomes among children on Medicaid while better utilizing existing resources and decreasing costs

• Decrease inappropriate use of emergency departments and

hospitalizations

• Increase appropriate use of medical home.

– Increase access to a medical home – Improve medical home quality – Provide supportive services and parent education

• Advocate for system-level improvements in the delivery of

health care to children

The Great Start Collaborative of Kent County is a major partner of First Steps

CHAP Asthma Program Goals:

• Identify and address systems barriers that prevent

CHAP patients from optimally managing asthma

• Increase access to and coordination of asthma

services for children on Medicaid

• Standardize asthma management in Kent County
• Reduce emergency department use and

hospitalizations related to asthma among target population

The Great Start Collaborative of Kent County is a major partner of First Steps

HISTORY OF CHAP

• Implemented by Kent County in 2008
• Primary Partners
• First Steps
• Helen DeVos Children’s Hospital
• Priority Health
• Great Start Collaborative of Kent County

The Great Start Collaborative of Kent County is a major partner of First Steps

FUNDERS

• W.K. Kellogg Foundation
• Grand Rapids Community Foundation
• Priority Health
• Helen DeVos Children’s Hospital
• Heart of West Michigan United Way
• Steelcase Foundation
• Frey Foundation
• Early Childhood Investment Corporation
• Spectrum Health’s Healthier Communities

The Great Start Collaborative of Kent County is a major partner of First Steps

CHAP Works on Three Levels

• Family
• Provider
• System

The Great Start Collaborative of Kent County is a major partner of First Steps

PROGRAM COMPONENTS – Family Level Strategies

• Parent education re:
• Avoiding ER use
• Importance of preventive visits and immunizations
• Use of medical home
• Referral to community resources
• Home-based asthma case management
• Care coordination and patient navigation
• Same day transportation
• Interpretation services

The Great Start Collaborative of Kent County is a major partner of First Steps

Partnership with ANWM

• Seamless collaboration between ANWM and

CHAP

• Asthma team: AE-Cs, MSWs, CHWs
• Regular case management team meetings
• Shared database and outcomes

The Great Start Collaborative of Kent County is a major partner of First Steps

PROGRAM COMPONENTS – Provider Level Strategies

• Technical assistance to improve practice efficiency

and “medical homeness”

• Provider education re: best practices
• Networking opportunities
• Nurturing new physician leaders in the community

Points Scored 1. Asthma in-service for staff 2. Asthma ed. For patients 3. In-office asthma educator 4. Referral to CHAP/ANWM 5. Teach peak flow monitoring 6. ETS assessment 7. In-office spirometry 8. AAP 9. ACT 10. Asthma registry 11. Routine 6-month asthma visits 12. Document flu shots

CHAP Practice Profiles

The Great Start Collaborative of Kent County is a major partner of First Steps

PROGRAM COMPONENTS – System Level Strategies

• Increase access to primary care by partnering with

MDCH and Medicaid health plans to enhance reimbursement, provide incentives, and increase Medicaid openings in primary care practices

• Improve communication between different health care

systems to improve patient care

• Catalyst for change and convener of stakeholders when

problems are identified in the community

The Great Start Collaborative of Kent County is a major partner of First Steps

PROGRAM COMPONENTS – System Level Strategies

Development of new programs/initiatives/workgroups:

• Asthma
• Dental Access
• Childhood Obesity
• Mental Health Access
• Developmental Screening

The Great Start Collaborative of Kent County is a major partner of First Steps

DEMONSTRATION PROJECT DETAILS:

Target Population: ~15,000 children ages 0-17 receiving Priority Health Medicaid in Kent County Timeframe: August – December 2008: Ramp up 2009 – 2011: 3 Year Demonstration Project 2012: Expansion and Replication Pilot Sites:

• Private Pediatric Practices
• Federally Qualified Health Center - 9 community and school-based clinics
• Pediatric Resident Clinic
• Nurse Practitioner Clinic
• Total Providers: 40 pediatricians and 10-12 FP’s and midlevel providers

The Great Start Collaborative of Kent County is a major partner of First Steps

Partnership with Priority Health

• Priority Health initiated the partnership during CHAP

planning stage

• Participated in the design of the project
• Ongoing involvement at all levels of project
• Participation on ongoing leadership team and CHAP

Advisory Committee

The Great Start Collaborative of Kent County is a major partner of First Steps

2010 Practice-level Outcomes

Change ↓13.8% from baseline period to 2010 Including: Change ↓12.3% from baseline period to 2010 Excluding: Change ↓6% from baseline period to 2010

The Great Start Collaborative of Kent County is a major partner of First Steps

2010 CHAP Client Outcomes (n= 2197)

Change ↓62% from 12 months before to 12 months after 1st referral date

*Clients served defined as clients that were touched by at least one CHAP service

Change ↓35% from 12 months before to 12 months after 1st referral date

*Clients served defined as clients that were touched by at least one CHAP service

The Great Start Collaborative of Kent County is a major partner of First Steps

2010 COST-BENEFIT ANALYSIS

• The immediate social benefits of CHAP exceeded the

costs by 20% -- a return of $1.20 of every $1.00 invested

• Priority Health recouped its investment in 2009 and

2010 – CHAP was cost-neutral for the health plan

The Great Start Collaborative of Kent County is a major partner of First Steps

Program Evolution: Michigan Children’s Healthcare Access Program (MI-CHAP)

The Great Start Collaborative of Kent County is a major partner of First Steps

The Value of a CHAP Model to Michigan

• Locally system specific and owned, with local physician leadership
• Ability to function as neutral convener to bring key stakeholders together
• Outcome-based/data driven – monthly dashboard provided to practices
• Multidisciplinary team infrastructure/multicultural and bilingual staff
• Direct service provision targeted at local needs (i.e. transportation,

asthma, parent education, etc.)

• Community-based collaboration
• Integration with multiple early childhood and health initiatives in the

community, as well as pediatric providers

• Parent involvement and input

The Great Start Collaborative of Kent County is a major partner of First Steps

Formation of MI-CHAP

• ECIC Pediatric Medical Home Summit: 2009
• Wayne County obtains Kresge funding and begins

implementation in fall, 2011

• Formation of MI-CHAP
• Currently implementing CHAP: Kent and Wayne
• Planning stage: Kalamazoo
• Exploration stage: Genesee, Saginaw, Ingham, NW MI (4 county

region), Macomb

• Advocacy at state and national level
• Work toward sustainability

The Great Start Collaborative of Kent County is a major partner of First Steps

Next Steps

• Completion of Kent CHAP 2009-2011 Demonstration

Project evaluation (ETA July 2012)

• Formalization of MI-CHAP infrastructure, shared outcomes,

and data analysis

• Continued advocacy at state and national level
• Work toward MI-CHAP replication and sustainability

The Great Start Collaborative of Kent County is a major partner of First Steps

Contact

Maureen Kirkwood, First Steps Director of Health Initiatives 616-632-1010 mkirkwood@firststepskent.org Tom Peterson, MD, First Steps Medical Director 616-391-7848 tom.peterson@helendevoschildrens.org Website (for CHAP Toolkit, Evaluation Reports): www.firststepskent.org