The COVID-19 pandemic has added a layer of complexity to the challenges faced by pediatric leaders. How they are addressing those complexities was the main topic discussed during a Nov. 11 panel at Becker's CEO + CFO Virtual Event.
Healthcare executives participating in the panel were:
- Jodi Carter, MD, chief clinical integration officer at Phoenix Children’s
- Nancy Mendelsohn, MD, CMO of complex health solutions at UnitedHealthcare
- Michael Lee, MD, executive director and medical director in the department of accountable care and clinical integration at Boston Children's Hospital
- David Rubin, MD, attending physician, director of the PolicyLab and director of population health innovation at Children’s Hospital of Philadelphia
Here is an excerpt from the conversation, lightly edited for clarity. To view the full session on demand, click here.
Dr. Michael Lee: In our pediatric world, we run into a couple of different challenges. One is that our cost trends for children look similar to adults in that we have a large number of kids who are relatively low-cost and then a small number of kids who are high-cost. But the path of care and needs for those children are very, very different from adults. A lot of times, people think the solutions that have worked for adults and accountable care will also work for children, and we found that almost universally not to be true.
The complex kids have a wide variety of disorders. They are often disorders that they will carry for years and decades, as opposed to many of the high-cost adults who are much closer to the end of life. And so it's a very different spectrum. And then we have a large volume of kids for whom we are really working on prevention and wellness and want them to grow into highly productive adults and get the best opportunities in life that they can. So trying to measure those two different things and trying to manage those two different things is a challenge for any large network, including ours.
Dr. Nancy Mendelsohn: From the perspective of our healthcare leaders across the country, trying to partner with the insurance system and provide good coordinated care is a challenge that we all are trying to meet every day. How do we provide care for these children in a way that is helpful to their parents? So many parents of children with multiple birth defects or multiple problems have to come back and forth to the hospital in an uncoordinated fashion. It's really hard for them. They come back and forth across months, and they miss work. It's very hard, and it's taxing on the hospital system. So how do we partner to create a better system that works for families? I think that's one of our biggest challenges.
Dr. David Rubin: COVID-19 has magnified how much is being done away from the office visit, and I think there are things that are going to remain post-COVID-19. One of them is the need to proactively care for folks and not depend on someone showing up to the office. To do that, we're expediting changes to the healthcare system right now that need to happen and need to persist beyond the pandemic.This will take a lot of proactive care management, telephonic outreach and video and telehealth resources.
But health systems run on predictable budgets, and shared savings is not a predictable budget. As I've navigated some of these ACO contracts, what you'd like to be able to do is raise a predictable capitation that funds the services you need to do. But to get to the kind of levels we need off the [per-member-per-month] — because you're still going to have some fee-for-service there for specialty care procedures and those types of things — there has to be some level of a 'give back' to health insurers. So we have to solve the right funding model that allows predictable budgets for health systems to plan every year and gives back to the insurance companies some risks, but also some transparency that the money is being used in a way they would like to see.
Dr. Jodi Carter: David, I want to emphasize that what you just said applies not just to children with special healthcare needs. When most people hear that description, they think of a lot of physical complexity. What we've learned, the more we dive into this pediatric value-based space, is the important role social determinants of health play here. On the surface, these children may not flag as 'complex.' And so I think what you said is very important, but we shouldn't limit that conversation just to children with special healthcare needs that are physical. We should expand it to children and families in social crisis, those with behavioral health complexity and others that really need those services to thrive as well.