Care Coordination Process at the Center for Pediatric Medicine. Blakely Amati, MD January 20, 2016
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1 Care Coordination Process at the Center for Pediatric Medicine Blakely Amati, MD January 20, 2016
2 Center for Pediatric Medicine QTIP Team Blakely Amati, MD Katy Smathers Tammy Gladson, RN Jenny Kelley, RN Cindy Garnett Kristi Caballero Susan Skytte, RN
3 5 practices Close Proximity to Subspecialists Predominately Medicaid Population Ancillary Staff Rich Affiliated with GHS Pediatric Residency Program New EMR Summer 2015 Level 3 NCQA PCMH Status
4 When to Consider Care Coordination Referrals Case Management NICU discharges Diagnosed with systemic diseases, syndromes, chromosomal abnormalities Multiple subspecialists involved Requiring BabyNet and/or therapy services Prescribed multiple medications Recent surgery Social Work Social concerns that may or may not include Department of Social Service involvement-abuse, neglect, family mental illness, domestic violence. Positive Edinburgh and SEEK screens. Newborn with NAS on a Methadone Wean Children who need to be referred to outpatient therapies, behavioral and or mental health resources Diagnosis of ADHD; need for behavioral modification techniques and parenting tips Respiratory Therapist/Asthma Educator Any child with asthma Dietician Child with a G-tube Diagnosis of *obesity* or failure to thrive Any child with a specialized diet
5 Case Management Referral Process Physicians Social Work At Hospital Discharge Chart Review/Huddle* CM performs formal assessment at next visit Added to Caseload; Detailed care plan +/- SMAP Targeted Intervention; SMAP Family declines services Routine follow-up Referred to Complex Care Center No follow-up
6 Morning Huddle
7 Case Management Referral Process Physicians Social Work Chart Review/Huddle At Hospital Discharge CM performs formal assessment at next visit Added to Caseload; Detailed care plan +/- SMAP Targeted Intervention; SMAP Family declines services Routine follow-up Referred to Complex Care Center No follow-up
8 LOC Coordination Acuity Indicator Indicator Level I Level II Level III Medical/Health Management Managed by PCP and 1 subspecialist (seen 1-2x/yr) (1) Requires periodic medical specialty consultation (seen 2-4 times/yr) (3) Requires frequent, complex multi-specialty consultation (seen >4x/yr) (4) Education/Training Needs Requires minimal E/T (1) Requires moderate E/T (3) Requires extensive E/T (4) Resource Utilization Finances Problem Solving Skills Indentifies/utilizes resources appropriately (1) Requires minimal assistance with third party funding (1) Good problem identification and problem solving skills (1) Requires assistance in identification/utilization of resources (2) Requires moderate assistance (2) Requires assistance in identifying problems/ps skills (2) Support Systems Strong SS; SS utilized (1) SS present, may need encouragement in utilizing(2) Coping Family coping independently (1) Able to cope with support and encouragement (2) Transition Transition needs are met (1) Requires minimal assistance with transition (2) Unwilling/unable to identify resources; requires accommodations (3) Requires extensive assistance (3) Unwilling/unable to identify problems and solutions (3) SS not present or not utilized (3) Able to cope with extensive support (3) Requires extensive assistance with transition (3) Level I: 8-13 Level II: Level III: 20-26
9 What CM does for Doctors Reinforces to families what was discussed during office visit HIGHLY encourages families to call office (or nurse line afterhours) for medical questions to determine ER need Follows up with provider about any additional findings from home visits, developmental screenings, etc. Notifies provider of observed family dynamics What CM does for Families Provides written developmental information Attends well child checks with families; consistent presence Provides anticipatory guidance/ parental education Supports families through the challenges of raising children and addresses issues parents are facing Educates on safety issues
10 Case Management Referral Process Physicians Social Work Chart Review/Huddle At Hospital Discharge CM performs formal assessment at next visit Added to Caseload; Detailed care plan +/- SMAP Targeted Intervention; SMAP Family declines services Routine follow-up Referred to Complex Care Center No follow-up
11 Case Management Referral Process Physicians Social Work Chart Review/Huddle At Hospital Discharge CM performs formal assessment at next visit Added to Caseload; Detailed care plan +/- SMAP Targeted Intervention; SMAP Family declines services Routine follow-up Referred to Complex Care Center No follow-up
12 Self Management Action Plan (SMAP)
13 Other SMAP Templates: Compliance issues Therapy referrals Social concerns G-tube dependent Trach dependent Feeding difficulties Asthma ED Utilization
14 Case Management Referral Process Physicians Social Work Chart Review/Huddle At Hospital Discharge CM performs formal assessment at next visit Added to Caseload; Detailed care plan +/- SMAP Targeted Intervention; SMAP Family declines services Routine follow-up Referred to Complex Care Center No follow-up
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