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Your Partner in PracticePCMH & Your CommunityPCCUser’sConferenceJuly20th,2017 2017 The Verden Group1
About This TalkBeing a medical home for your patients means more thanjust coordinating care. It also requires bringingresources together to ensure that they have access tothe right care. In this course you will learn how toconnect your patients to services in a number of ways:outreach to specialists, building programs in-house,contracting with other professionals, referring to andhelping to build community programs, even connectingwith Payers to take advantage of theirmember programs and services, or to collaborate oncreating new ones. 2017 The Verden Group2
First, A Bit AboutMedical Homes . 2017 The Verden Group
Are You A ‘Medical Home’?You don’t have to be NCQA recognized. The medical home is best described asa model or philosophy of care that is:1. patient-centered2. comprehensive3. team-based4. coordinated5. accessible, and6. focused on quality and safetyIt is a place where patients are treated with respect, dignity, and compassion,and enable strong and trusting relationships with providers and staff, so thatcare is received in the right place, at the right time, and in the manner thatbest suits a patient's needs.Patient Centered Primary Care home 2017 The Verden Group4
A Medical Home typically provides:ü Excellent, accessible communication between providers,nursing staff and patientsü Full involvement of the patient in the treatment anddecisions made regarding their own healthcareü Care coordination to ensure that patient needs are met,test results and specialist visits are tracked andfollowed-up and all staff are knowledgeable about theirroles and responsibilities towards the patientü After hours access to a providerü Technology that enhances the care of the patientthrough education and data and performancemeasurement 2017 The Verden Group5
How It Works In Practice:Patient-Centered Medical Home. What, Why and How? Jim Adams, Paul Grumdy, MD, Martin S. Kohn, MD, and Edgar dy/pcmh-what-why-and-how/3 2017 The Verden Group6
Does Your Medical Home Offer Services LikeThese?ADHD SupportObesity/NutritionPrograms Lactation Consulting Asthma Education Sports Medicine Behavioral Health 2017 The Verden Group7
Many Practices Want To OfferMore Services,But How Do You Go About It? 2017 The Verden Group
IN-HOUSE: Developing New ServicesCreate ‘Clinics’ within your practice to meetyour patients’ needs-Adolescent clinicsAsthma clinicsNutrition clinicsBreastfeeding servicesEven Travel clinics!Ø Provides excellent marketing opportunities and helps withscheduling 2017 The Verden Group9
IN-HOUSE: Developing New ServicesWhat others are doing:§ Asthma clinics- Certified Asthma Educator to assist withtreatment, education and management of asthmaand asthma related diseases including- Medication monitoring and compliance;- Asthma control and action plan- Spirometry and nebulizer treatments- Patient centered goals and objectives related tocontrol of the disease 2017 The Verden Group10
Sample Asthma PlansPick and choose from variousresources, and customize tofit your needs!Asthma Action Plan fromChildren’s Hospital, St.LouisEasy for parents to follow,pictures that even theyoungest child can hma-education 2017 The Verden Group11
IN-HOUSE: Developing New ServicesWhat others are doing:§ Nutrition clinics- On-site nutritional health evaluation byindependently contracted counselor- Treatment and counseling services forindividuals, families and groups- Tie in with community based weight ins and‘weight watcher’ program at the local YMCA- Schedule alongside well visits 2017 The Verden Group12
Nutrition exampleHow about an 8 month visit or a 21 month visit withthe nurse to teach proper nutrition habits?Calculate by forecasting: You have three hundred 8 month olds a year Nurse payment at 50.00 Don’t forget the cost of your nurse!300 x 20 minutes 100 hours x nurse salary ( 25/hr) 2,500 15,000 - 2,500 12,500 net profit 2017 The Verden Group13
Nutrition Program ExampleExample:www.LetsGo.orgCombatting Pediatric Obesity Encourages use of theirmaterials Allows co-branding ofmaterials andcustomization 2017 The Verden Group14
IN-HOUSE: Developing New ServicesWhat others are doing:§ Adolescent clinics- Specific hours for teens (certain days & hours)- Specified exam rooms for teens that are ageappropriate (not ‘kiddie’)- Teen education programs playing in waiting room- Greater emphasis on teen screens and servicesØ Adolescent Well Visits including depression andsubstance abuse screening, may be a new metriccoming to Payer plans soon 2017 The Verden Group15
IN-HOUSE: Developing New BusinessesDevelop Entirely New Businesses Lactation / Breastfeeding CenterBehavioral / Social Health CenterUrgent Care / After Hours ClinicØ Bringing services in-house either through direct employeecontributions or through sub-contracted professionals,extends your reach in the market.Ø These can be developed as extensively as you like, with theirown tax ID numbers and ‘brand’, or less extensively as abusiness within your practice that is financially separate 2017 The Verden Group16
IN-HOUSE: Developing New Lines of BusinessLactation / Breastfeeding Center Can reside within your pediatric practicefootprint or as a separate area altogetherSome practices designate 2 exams rooms anddesign as newborn & nursing roomsSchedule consultations alongside the newbornvisit and / or the 1 month for patientconvenienceUtilize a trained employee or contract with anindependent agentGreat practice builder and new Moms love thenewborn / nursing rooms 2017 The Verden Group17
Even a small practice can be a BF center! (new servicerather than business for smaller entities) Add a lazy-e-boyAdd a BoppyAdd a baby scaleAdd a mobileNewborns get seenby doc, LC sees Momfor BF consultBecomes the ‘newborn /BF room! 2017 The Verden Group18
IN-HOUSE: Developing New Lines of BusinessBehavioral Health CenterUsually resides within pediatric practice footprintStaff it with an employee (if practice populationsupports it) or contract with an independent agent orlease space to therapist / social worker who isbuilding their practice Usually defined hours, practice staff managesschedule and can set up appointments withoutpatient having to arrange separately Allows for better care, coordination, access Even just start with an ADHD program and aqualified / trained nurse 2017 The Verden Group19
ADHD Program ToolsThe Children’s Hospital of PhiladelphiaCenter for Management of ADHD Health er-management-adhd/healthresources#.V4BM-o3Hz4g 2017 The Verden Group20
IN-HOUSE: Developing New Lines of BusinessUrgent Care Center Typically is a separate building, or has a separateentrance to main practiceStaff with existing providers and staffClose practice at 5pm, all after hours careprovided at the UCNetwork with small practices to be their preferredreferral choice when they are closed (by providingexcellent follow up and pass back)Compete directly with retail-based clinicsMany Payers offer separate contracts for UC, butnote: higher copays for patients is likely! 2017 The Verden Group21
Do Your Research Before UndertakingAsk your patients what they need! You have a captiveaudience of 100s of patients every week / month coming toyour practice – hand them a short survey and ask for theirfeedback!Do your market research too:Number of annual births (www.cdc.gov/nchs/fastats/births.htm) City demographics (citydata.com – it’s free) Distance to competitors (plot viawww.easymapmaker.com of similar free software) Competitor offerings (check out their websites) 2017 The Verden Group22
Utilizing Community Resources 2017 The Verden Group
Types of Community Resources Hospital based baby CPR Weight watchers Multicultural centers (isolation, language issues) Local YMCA(often have weight / diet and health programs) Local churches Yoga studios(parental stress) Local Schools 2017 The Verden Group24
Referral Resource: 211.org211 is a free, confidential service to help find needed local resources: supplemental food and nutrition programs shelter and housing options and utilities assistanceemergency information and disaster relief employment and education opportunities services for veteranshealth care, vaccination and health epidemic information addiction prevention and rehabilitation programsreentry help for ex-offenders support groups for individuals with mental illnesses or specialneedsa safe, confidential path out of physical and/or emotional domesticabuse 2017 The Verden Group25
Shortage of Community Resources?Connect the dots and pull together: Available apps Educational resources National / Government / Open programs Become an Advocate! 2017 The Verden Group26
Mobile Apps – examples: 2017 The Verden Group27
Educational Resources – /literacy-materials/ 2017 The Verden Group28
National / Govt. Programshttp://www.letsmove.gov/ 2017 The Verden Group29
Become an AdvocateSome examples of the role that you as a pediatrician could play in communityadvocacy could include: Partner with child advocacy organizations in your area Inform community leaders, decision-makers, and elected officials about issues thatare affecting children in your community Invite decision-makers to visit your professional setting or community project Provide testimony and telling your story at community forums, events, and in yourlocal media Serve on the board of an organization that supports children’s health and well-beingor children’s interests such as a school board Offer medical expertise to schools, youth organizations or institutions, and child carecenters Ask parents, teachers, and other health care professionals and clinicians in your areato get involved in local efforts to improve children’s health and well-being Initiate a community project or forming a partnership, alliance, or coalition to addressa x 2017 The Verden Group30
Good opportunity foran NP to build aining-Modules.aspx 2017 The Verden Group31
Help the Un- / Under-insuredPrescription earchContext.aspx?topic 696Non-profit s/SearchOrgType.aspx?OrgTypeID 2&show 1State Health & Human rchOrgType.aspx?OrgTypeID 8&show 1Insurance Coverage / Medicaid qualification:https://www.healthcare.gov/ 2017 The Verden Group32
Utilizing Health CareInsurance Company Resources 2017 The Verden Group
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Aetna has aBehavioral Healthprogram and a stepby step checklist tohelp you integratethis into yourpractice. 2017 The Verden Group35
And they are upfront about the numberof visits, coding and the type of clinicianeligible in a primary office.99242 (Office consultation new / estbd) 2.9 RVUs( 104.15 CMS National 2016) 2017 The Verden Group36
Case Management 2017 The Verden Group37
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Patient’s should call you first .but sometimes they don’t. Keepactively engaged with the Nurse Line for continued communicationabout your patient! 2017 The Verden Group39
Free classes. . . 2017 The Verden Group40
Tools to combat childhood obesity 2017 The Verden Group41
FundingAlways check to see if there are any grantsavailable to help get a new program off ntsdatabase/Did you know? Grant match up is a new servicesavailable from the Independent Practice MSO(more information atwww.ipmso.org) 2017 The Verden Group42
Q&AContact InformationThe Verden Group, IncYour Partner in Practicewww.TheVerdenGroup.com877-884-7770Susanne Madden, CEOmadden@theverdengroup.com 2017 The Verden Group43
2017 The Verden Group PCMH & Your Community Your Partner in Practice PCC#User's#Conference# July#20th,20 17# 1
