The transformation to value-based care has mostly been led by Medicare, with 34% of traditional Medicare reimbursements already paid under an alternative payment model. And the transition has only just begun. However, this emphasis has left pediatric organizations struggling to apply value-based care to a very different population set.
Children aren’t just ‘small adults’
Most people who are involved in the children’s health community know that children’s health conditions and how they utilize healthcare services are different from the adult population. Children are not just ‘small adults’ as many healthcare experts have noted; their physiology is different. Also, there’s a prominent element of prevention efforts in children’s healthcare as compared to the adult population, and the number of children associated with high healthcare spending is relatively small.
What we need to realize is that each of these differences has important implications when it comes to measuring the quality of healthcare. And this, in turn, has implications on value-based payment arrangements. So, pediatric organizations need to realize that even the way they structure their transformation has to be different as well.
Why is pediatric care complicated from the perspective of value-based care?
As of now, value has a more concrete meaning for those who pay for healthcare. The question around which the idea is built is, “Am I getting what I pay for?” In response, providers and payers have begun to take more responsibility for a patient’s journey across the care continuum and become accountable to be compensated on the basis of value.
How exactly will the concept of value change for pediatrics? One thing seems to be clear: the lens has shifted. 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 is mostly concentrated around preventive measures such as immunization, screenings, and follow-ups.
Secondly, children are usually healthy and not high-cost users, but 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.
More important than anything, the kids have to be kept in the community, and that means keeping them 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.
Family-centered care, 365 days a year, with activated data
Considering the many nuances of treating children, providers need to know what’s happening with their patients easily and accurately. This requires in-depth insights into understanding immunizations, due measures, gaps in care, and more. Using this data could also be helpful in understanding the patients and their families better. Data can be immensely helpful in enabling pediatric care management, stratifying the pediatric population and identifying their clinical and social risks, and in turn, the gaps in their care.
And although accessing the right data at the right time has been a challenge in healthcare, it multiplies with the pediatric population.
First, the patchwork of different kinds of EHRs and data systems in a network presents a challenge when it comes to aggregating and integrating data. Again, just like pediatric care differs from adult care, so does the healthcare data. For starters, children are usually not given a name until the first few days of their birth, nor do they have a Medicaid ID, so ensuring the data is harmonized across the network is a difficult but necessary step.
Second, we need to realize that most care delivery is centered on preventive care. Children need to be immunized on time, which means that providers are not looking after ‘due’ measures as much as they are looking for ‘measures which may come up.’ Analyzing and activating healthcare data is required to give providers this proactive edge.
The third is understanding that the children themselves can’t look after themselves; providers need to loop in their family and caregivers. Collaboration is key here to bring members of care teams together and power transformation. Group texting, real-time alerts, automated reminders, and such should be in place to make sure everyone is on the same page.
The road ahead
Despite having discussions around moving from volume-based to value-based care, it has taken all of us some time to get up to speed and understand how the change will affect individual practices or hospitals. Pediatrics is an important part of healthcare, and the value of transformation that changes a young child’s life for the better is likely to be far in excess as compared to the investments needed. The technology is ripe; organizations understand the changing paradigm- it’s time we utilized a great opportunity to improve the health and well-being of children like never before, and in the most efficient way with the best experience possible.