Submission #14644

Beyond Medical Home Project
Carl Cooley
Chief Medical Officer
Crotched Mountain Foundation
Medical home implementation
Children/youth with special healthcare needs, Infant (< one year), Toddler (>1 yr to 3 yrs), Preschoolers (>3yrs to 6 yrs), Elementary age children (>6 to 10 years), 6. Tweens (>10 year to 13), Teenager (>13 to 18 years)
Involved 8 practices, Exeter Pediatrics, DH Plymouth, Monadnock Pediatrics, DH Keene, DH Concord, New London Pediatrics,Rochester Pediatrics office, and Dover Pediatrics
Project sought to help pediatric practices to transform themselves as primary care medical homes. Coordination of care with schools, early intervention programs, and mental health agencies and transitions from pediatric to adult care were emphasized as well. For example, at Exeter Pediatrics, the pediatricians, school special education director, and early intervention programs started meeting to address issues.
Practice setting, Community Setting
All practice sites achieved 30% or more improvement in Medical Home Index scores during the collaborative. All sites were able to develop and sustain the role of care coordinator on their office staff.