Synthesis
We're going to do these reports in order - 1 through 8. It will be about 5 minutes per team. Let's hear what you came up with.
Assignment
Go back into the same teams.
Identify 2 initiatives that are worth pursuing and then work those in detail. Develop the detail - what needs to happen, what resources are needed, who needs to be involved, etc.
How will these initiatives happen?
Identify at least one initiative that the foundation could fund.
Each team will report out their work at 1:30PM.
We came up with two initiatives but they are really three. The first is an initiative that is bold and tilted towards kids. The commitment should be to create regional equity for children with special needs.
It might be to develop a medical home or four or five practices. The primary commitment is to insure the perfect match of care for a certain group of children. Bring the players into the room and realize this effort needs to be responsive.
The focus would be on regional equity and the provision of services and outcomes.
The second one is to develop professional training for different types of case workers. This would be for case workers, social workers and others. There is a code of ethics for social workers and this could be explained to young people.
The key to this would be to train everyone to develop a comprehensive plan with specific goals and then to manage to the plan.
When the family would interact with a new care provider the coordinator would have this new provider understand how those goals play into care.
Because we are only allowed two the second component is the provision of transformational technology - some people call liberation technologies. The idea is to create an improvement process for the families and providers.
Use the moral authority and the legitimacy of the foundation to bring the players together to create a comprehensive medical home.
The other one is an interactive training of different disciplines that are traditionally siloed.
We're team two. I just love process and your process is fantastic.
We were working on the ideal system. We had two elements. One is a community based PCP and a link to a tertiary care unit. We also had a financing model and we had a special needs health plan you could access in a number of ways.
We decided to drill down on these.
The PCP medical home model is feasible. I have already tried putting one of these systems into a tertiary care center and it works pretty well there. Think of this as the medical home in the comfortable womb of the mother hospital learning and growing so it can be birthed into the community.
It has comprehensive wrap around services and it has family care in the model. This has to be funded.
The pilot location should be in the resident continuity clinic which also allows for teaching. This is where we have the young residents that could become the community physicians. We are suggesting to do it again in Northern California such as Packard/Stanford to ensure the model could be replicated, and for the long term, it could be rolled-out to multiple sites throughout California.
We also are thinking that the entry criteria is complex patients. Family Centered Care patients have parents working at the clinic and helping to educate other parents. They could be great coordinators. The model calls for everyone to be paid. This would be funded through a grant in the pilot phase. We might want to include a collaborative learning model if we do more than one. We'd also want to develop a plan to replicate this in the community.
On the financing side we're interested in developing a comprehensive health insurance plan for any child with special health needs. What we need is a white paper to understand how a model like this could work. How would it be financed? Is this really going to save money? We feel providers need to be at the table and people from the insurance industry as well to teach us about how this could work - and we need families at the table too.
We also had the original assignment to do an ideal model. Our model said all children are in the system and we created the medical home for children with special needs.
They need some type of coordinated care. In addition to the medical home we had all the school and other organizations located around.
We called this The Child Development Based Health Coordinator Initiative. The target population are those that are being discharged from the hospital and integrating them into the new normal. This new school based coordinator would bring together what is required for a care plan and provide parental support. This would be based on schools to model co-location, collaboration, and coordination.
The other initiative is to create a health care trust. We called this the funding stream blender initiative. We didn't think this was ready for going state wide yet.
We would start by taking funding from existing sources to bring them together. It could be the California coordinated collaborative care plan. It includes things like the personal health record – their IEP, and the other social things that go into that – that would be controlled by the family.
We need money to plan this before you take it beyond the local effort.
Our task was to identify guiding principles for the development of a better system. Then we had to develop 25 problems and then pick three we could develop solutions for and then pick two to give to the foundation for funding.
These are a little more specific.
One of the problems we identified was the structural budget impasse. We thought that was too overwhelming so how about we address the need for a stable budget for kids?
Here are the steps:
The foundation could create an oversight advisory group to develop and test new funding models. It would include business and the major agencies and the governor's office as well as the insurance plans.
A key step would be identifying the desired outcomes of a new funding structure. They would create the measure of success. One such outcome would be a funding structure that is child focused and not adult focused.
With the advisory group’s guidance, the foundation would contract to do a scan of successful models in other states/nations. (Vancouver might be among these.)
The scan might include things like master contracts and alternatives to the state fiscal intermediary which creates problems for kids. It has to be flexible enough for meeting emerging needs.
Then the foundation would convene content and financial experts to review the scan results and agree on a model to test. This pilot would be evaluated and modified, and then we could figure out how to scale it up.
The second problem we selected is that families are not always involved from the outset and not in a leadership position. So we’re not as effective. We talked about a case manager to manage all the case managers. Care coordination and bringing the families in to resolve that problem.
Here are the steps we suggest:
We would start with an advisory group with the family organizations in the leadership role but include all types of providers including employers and health plans. The employer should be included in that advisory group.
The foundation would contract to look for models of comprehensive family advocacy that result in good case management.
Then we would conduct focus groups with families – a needs assessment. We would put together these results with the scan of existing models, and develop a prototype. The foundation also could offer a financial prize to an organization that develops the most effective model.
In the model where families want to be their own case manager then we would train the families.
In general, we should consider innovative use of technology as we develop models. Maybe there is a technology solution to case management?
And pilot test results would be evaluated.
Looking at the system from the perspective of the parents and all that and find five to 10 points of intervention and then find two initiatives.
The top one is about a one stop shop - similar to group two - maybe this includes primary care, pharmacy, advocates, a liaison with the education system, home health services. Really a one stop shop. It could be something that already exists and then adding some things or it could be a new entity that is created in a rural setting.
The care coordinator orchestrates the system for the special needs child in this setting.
The packard funded project was around family support services. Providing funding to several organizations to be a training ground for parents to learn the advocacy skills they need. The would have several roles - providing services and being a trainer. This could be in a medical facility or somewhere else.
We came up with a range of things that could be funded by the foundation.
One of them is to study the outcomes of the changes and the implications of a waiver.
One part of the idealized system would be some entities with oversight and there could be some support for convening getting these entities up and running.
The next one is a social marketing effort. There could be some efforts that put this on the agenda of many in the state.
We talked about the PCP taking more responsibility but their capacity is limited. There isn't a curriculum that exists to train residents to do this kind of thing. Maybe we could have an initiative to come up with that curriculum?
Discussing the medical home. There is a lot of money being put into the medical home and none of them include children.
Another thing is about personal health records that parents control. There could be a scan on what's good and what's not with what's already been done on these.
The other was about how there has been some really nice stuff done by several different disease specific organizations. There could be value in convening a collaborative process for them to come together and learn from each other about what they are doing.
All of this could be called a medical home for children - successful components. We talked about different venues or grantees that could be apart of this.
So we didn't follow the rules.
Our concepts reside in the Family Resource Center. They are on the ground and get a lot of work done for a little money. There are problems so our first concept is a demonstration project to see if a Family Resource Center can be scaled up to serve 100% of the special needs patients in their area.
In order to do this we need a new referral system. They need a more well-rounded scope of services. They do well in a few areas but not in others.
We think that one kind of angle on this is to take a youth orientation - maybe focusing on transition?
The second thing is the success of these things are so dependent on individuals. There might be something we could do about that by training them.
The other one is a sub-piece. Use the case conference or round table approach as the approach for cases in the Family Resource Center. Bringing everyone to the table together and reviewing cases and developing follow-up plans. This is a weekly meeting of all the people in that region.
We think this should be aged based. Maybe something like 0-5, 5-12 and 12 and above.
In our model we tried to do some out of the box thinking.
We need a new look at a state wide system that is more consistent. There ought to be a one stop shop for all services of special needs children.
This is our pie in the sky thing. Look at the state wide system and do an organizational audit. We perceive there are many problems with the current system - a lack of strong leadership and a lack of the ability to command resources are two of them.
There is tremendous variability between counties. There are hand-off issues and there are decisions being made based on personal perspectives.
As part of that what's been mentioned is the issue of eligibility requirements. These date back to the 1920s. We're talking about different diagnosis and different needs now.
With regards to the foundation we felt it should focus on the one stop center - the care coordination center not the medical home. It includes community resources that need to be included.
There should be a pilot study. Perhaps conducted out of the hospital?This could be a model that could be tested in two different county settings.
Develop a model for that and test it to determine what works the best in that model and possibly roll that out in the future.
There is a patient navigator function that needs to be addressed in that model. There should be accountability for the functions of that center. If a program was proposing to be a care center it should be accountable for the services.
The location could be different for certain CCS elements depending on the system of care and the community care of the patients.
