Connecticut | 50 states of population health

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JIM SHMERLING. President and CEO, Connecticut Children's Medical Center (Hartford)

On the top challenge

"Ninety percent of a child's health is affected by social determinants, including their housing, access to food, jobs and safe home environments. So, we have to develop a model of care that addresses the entire spectrum of health and wellness as well as restoration of their health. There is a subset of children who experience chronic and/or complex conditions, so we have two continuums of care that must be coordinated. One involves a cost effective, safe and innovative model of care, while the other resembles more of a public health approach." 

On the hospital's response

"To transform our delivery model, we also have to transform how we get paid. The new delivery model and payment system have to address both ends of the continuum. While serving sick and injured children, we also have to address social determinants for which there is no reimbursement. We are invested in innovative research that includes genomics and stem cell implants in efforts to mitigate complications that arise from intensive therapies and medications. We also have programs that try to mitigate some of the social determinants that impact children at risk. The challenge is maintaining our financial sustainability and maintaining our mission given the costs of providing tertiary care while trying to address social determinants. 

One example is caring for children with asthma, a very common childhood diagnosis. For just several hundred dollars a year, we could provide pest control to rid the home of cockroaches, a significant contributor to exacerbating asthma symptoms. However, if the hospital provided those services, we would not be reimbursed, thus increasing our costs while simultaneously losing reimbursement for the hospital services that would have been provided. This is a perverse reimbursement system that disincentivized health promotion. We do currently provide home environment assessments for children at risk, but because our funding is primarily provided through grants, we are just scratching the surface. The challenge is preserving — as well as restoring — children's health in the current reimbursement system."

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