While all departments in the health space are formulating strategies to win in the value-based care atmosphere, pediatric care is the most foundational and opportune to progress in this avenue.
The shift of value assessment for pediatric organizations
Currently, value means the most for those who pay for healthcare. The common thought among many is “Am I getting what I paid for?” In response, providers and payers have begun to take more responsibility for a patient’s journey across the care continuum and have become more accountable by being compensated on the basis of value.
However, the concept of value changes holistically for pediatrics. The lens has been clearly shifted for value assessment. Controlling high blood pressure and helping a patient recover from a heart attack are not common treatment options for patients below 18 years of age, and don’t regularly apply to the pediatric population. Care in this environment is mostly concentrated around preventive measures such as immunization, screenings, and follow-ups.
Moreover, children are usually healthy and not high-cost users. However, there are several unique areas of very high costs. Utilization of focused care protocols around certain conditions such as asthma or type-1 diabetes are good opportunities for both quality improvement and cost savings.
Another crucial aspect associated here is that children have to be kept in the community, and out of the hospital as much as possible. For this, it requires looping in the family and the entire group of caregivers to move the needle and address their social needs beyond the clinics. The physicians and care teams need to connect children and their families to community and social services through well-defined data sharing- ensuring that every avenue is utilized. Not just improved utilization on the ground level, but also payment models in the bigger picture have a crucial role in capturing value.
Road Ahead With Evolving Payment Models Impacting Pediatric Organizations
Pediatric organizations should quickly act and align their care models so as to ensure children stay healthy irrespective of their socioeconomic factors. Opting for Alternative Payment Models (APMs) to bring about a radical change in how they operate may emerge as a game-changer in this regard. However, organizations getting into such risk-based models must first ensure that they have the right technology and manpower support to bring about this change.
On the flip side, it is also important for pediatric leaders to stay on top of the changing regulations to maximize their earnings amidst the demands of containing soaring healthcare costs.
A prominent initiative in this regard is the Integrated Care for Kids (InCK) Model released in early 2019. Designed to optimize care and cost outcomes for children enrolled under Medicaid and CHIP programs, InCK requires state and local organizations to work towards early identification and treatment of children with health-related issues.
Three broader level goals of the InCK include:
• Improving child health outcomes
• Reducing avoidable inpatient stays and out-of-home placements
• Creating sustainable APMs
To achieve these goals, organizations will have to aim towards identifying and treating diseases at an early stage, enabling integrated care coordination and care management, and developing state-specific APMs. In the current ecosystem, pediatric leaders need to continuously evolve and innovate to meet the growing demands and stay value-dynamic at the same time!
To know how you can optimize care and cost outcomes for your pediatric populations, get a demo.
For more updates, subscribe.
Join Adrienne White-Faines MPA, FACHE, Nathan Riggle, Emily K. Fletcher MPH at 10 AM PT/12 Noon CT/1 PM ET on August 27 in a webinar, titled "Connecting Communities and Care Teams for Improved Population Health." Register now!