This group pediatric practice successfully implemented the medical home model of care by leveraging existing initiatives within the state of Arkansas and proactively seeking feedback from patients and families to facilitate improvements in care.

Implementation Insights:

  • Leverage state and local initiatives to support pediatric medical home implementation.
  • Identify high priority and/or high risk patients that require enhanced care coordination services.
  • Delegate responsibilities to multidisciplinary staff members to reduce physician burnout.

    Updated: February 2016

 Background Information

  • Type of Practice: Group pediatric practice
  • Location: Little Rock, Arkansas
  • Population Served: The practice has served approximately 13,000 individual patients 0-18 years of age. Approximately half of these patients participate in the patient-centered medical home program. Half of the practice patient population are Medicaid beneficiaries, of which the majority are members of racial/ethnic minority groups.

 Pediatric Medical Home Implementation Strategies

  • Research and identify state and local initiatives that can be leveraged to support medical home transformation, including the following:
      • State Medicaid medical home programs
      • State Innovation Model projects
      • Medical home programs implemented by state chapters of the American Academy of Pediatrics
      • Private payer initiatives
  • Identify high priority patients based on a comprehensive needs assessment which includes the following data sources:
      • State Medicaid claims data
      • Emergency Department utilization rates
      • Patient population hospitalization rates
      • Feedback from families, staff, and clinicians, including results from a practice-administered survey identifying barriers in access to care for children and youth with special health care needs
  • Research promising practices and change concepts for pediatric medical home implementation, such as the Change Concepts for Practice Transformation.
  • Enhance access to care for patients and families by utilizing the following strategies:
      • Reserve time slots for same-day scheduling
      • Establish a 24 hour phone line to access a physician
      • Establish a 24 hour phone line to access a triage nurse
      • Establish extended clinic hours during the winter season
      • Upgrade current Patient Portal to enhance electronic access for patients and families
      • Accomodate group visits for families with multiple children
  • Hire a Registered Nurse care coordinator; re-assign a triage Registered Nurse to provide additional care coordination and referral services, including the following:
      • Track referrals and appointment follow-ups electronically
      • Review daily reports from local hospitals and Emergency Departments to improve the referral process
      • Develop care plans
  • Enhance cultural competency and language access through the following strategies:
      • Provide patient and family educational materials in multiple languages
      • Hire bilingual clinical and non-clinical staff
      • Create a parent/caregiver advisory panel; recruit culturally and linguistically diverse families to serve on the advisory panel
  • Clearly define roles and responsibilities of all clinic staff.

 Challenges

  • Due to a lag time of 6-12 months in Medicaid claims data, the practice often relied on internal reports and needs assessment data to help identify high priority patients.
  • The project struggled to motivate staff and encourage acceptance of culture change to support transformation into a pediatric medical home. The project increased team meetings, staff training, and promoted sharing of data to support staff throughout transformation. 
  • Physician fatigue and burnout is another challenge encountered by this project. The team delegated responsibility to other clinicians and staff within the practice to support physicians and reduce burnout.

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