Nearly one in five children in Wisconsin has a chronic physical, developmental, behavioral, or emotional illness or condition, such as ADHD, autism, cancer, diabetes, or heart disease. But less than half of those children consistently receive care in a “medical home” that focuses on all aspects of their physical and mental health care needs, ensures that they and their families make informed decisions about their health, and coordinates the child’s care across disciplines and health care systems.1
The Children’s Health Alliance of Wisconsin aims to do something about it. The Alliance wants to improve child health outcomes for children and youth with special health care needs (CYSHCN) by increasing the number who receive care in medical homes, increasing the use of developmental and mental health screenings, and supporting families as partners in their children’s care.
“This year we have 14 different pediatric primary care practices and tribal health centers from across the state working to advance family-centered care by developing shared health care plans,” says Arianna Keil, MD, Quality Improvement Director, Children’s Health Alliance of Wisconsin and Wisconsin Department of Health Services’ Family Health Section. “The plans are living documents, developed jointly and shared among families and medical teams.”2
Plans developed by the participating Wisconsin medical teams contain three essential elements:
- A medical summary that details the child’s condition, treatments, and team members;
- A family strengths and preferences section; and
- A negotiated action section with goals, action steps, and timelines.
“Family voices are central to our work and strongly represented in everything we do,” says Dr. Keil. “Participating providers also are required to have a family as part of their quality improvement (QI) project team. The families are involved in team meetings and participate in the decision-making process.”
A recent national survey of maternal and child health and CYSHCN directors supports the Alliance’s requirements. Survey respondents chose their top three benefits of family engagement: heightened understanding of family issues and needs, increased family–professional partnerships and communication, and more services directly responsive to family needs.3
“It’s been satisfying to see intentional representations of family voices within the project teams,” adds Dr. Keil.
The Wisconsin teams must identify a specific patient population when they apply to participate in the shared plan of care project.
“We have some teams who are focusing on kids with medical complexity, others focusing on kids with behavioral or mental health challenges, and others focusing on kids with ADHD,” says Dr. Keil. “Our aim in 2019 was that 85% of the families served by those 14 practices say the shared plan of care ensured that more of their child’s needs were met.”
In Dr. Keil’s joint role with the Children’s Health Alliance of Wisconsin and the Wisconsin Department of Health Services’ Family Health Section, she provides QI support to her colleagues by helping them use QI methods to accelerate learning. Although the Alliance has been providing health care improvement services for more than 25 years, the shared plan of care project is the first to offer Maintenance of Certification (MOC) Part 4 credit.
Dr. Keil was inspired to apply for MOC Part 4 credit on behalf of the Alliance after hearing David Nichols, MD, MBA, President and CEO of the ABP, speak in 2016 at the Wisconsin American Academy of Pediatrics Chapter Open Forum about the ways the ABP had expanded what kinds of projects qualify for MOC Part 4 credit.
“When I heard him speak, I thought this might be an opportunity for us to partner with the ABP to offer MOC Part 4 credit to Wisconsin pediatricians who are already engaged in this work,” says Dr. Keil. “Giving MOC credit is a way to tell clinicians that we value the time and effort they put in to improve their practice. It’s an important way to acknowledge the additional work they do to ensure high-quality care.”
The shared plan of care project in Wisconsin began in 2016 and was approved by the ABP for MOC credit in 2018. Pediatricians who participate in the project can receive 25 points of Part 4 credit.
Other Alliance projects focus on asthma, early literacy, emergency care, grief and bereavement, injury prevention and child death review, medical homes, and oral health. Common threads among the projects include managing health instead of illness, an emphasis on quality of life, and injury prevention. The Alliance hopes to pursue another MOC Part 4 project this year.
“The MOC Part 4 application process was straightforward and not onerous at all,” says Dr. Keil. “It’s a valuable partnership that benefits all involved.”