The inaugural Pediatric Leadership Forum debuted Wednesday, Nov. 11, as part of Becker's 2020 CEO + CFO Roundtable. A collaboration between Becker’s Hospital Review, healthcare’s most trusted information platform, and Phoenix Children’s, one of the nation’s top pediatric health systems, the informative session brought together four leading experts in children’s healthcare to discuss “Unique Challenges Faced by Pediatric Leadership and What to do About Them.”
- Jodi Carter, MD, Chief Clinical Integration Officer, Phoenix Children’s
- Michael A. Lee, MD, MBA, Executive Director and Medical Director, Department of Accountable Care and Clinical Integration, Boston Children's Hospital
- Nancy J. Mendelsohn, MD, Chief Medical Officer, Complex Health Solutions, UnitedHealthcare
- David Rubin, MD, MSCE, Attending Physician; Director of PolicyLab; Director of Population Health Innovation, Children’s Hospital of Philadelphia
Responding to questions from Mackenzie Bean, moderator of the panel and managing editor of Becker’s Hospital Review, the panelists offered insight and expertise to conference patrons.
Here are the key takeaways:
- Value-Based Care: Cost trends in pediatrics are far different than adult systems. In both populations, there is a large percentage of individuals with a relatively low cost of care, and a small percentage of patients whose needs are much more costly. The difference between pediatric and adult populations is that children with complex health conditions must live with them for years or decades, while many adults with high-cost health needs experience illness much closer to the end of life. In addition, even with healthy kids, we must make investments in order to keep them healthy. As a result, kids’ care can be considerably more expensive over time
At the same time, many payers view value-based care and clinical integration in the context of Medicare. They look at early year-one savings as well as continued saving in subsequent years. The investments we make in children’s health don’t yield immediate cost savings – the return on investment requires time. For these and other reasons, accountable care solutions, which work well in adult populations, do not translate as well in pediatrics.
- Proactive Care: Point-of-care applications and solutions are well-positioned to improve proactive care in pediatrics. Healthcare is not as effective when providers must wait for a patient to seek treatment. Proactive care – like telehealth, prescription refills and follow-ups after emergency room visits – can improve care delivery and lower costs. These proactive care initiatives change the workflow dynamics of medicine.
- Care Coordination: Care coordination and wrap-around services are critical elements of an effective pediatric value-based system. The challenge is finding the right payment model to mesh with this clinically integrated network design.
- Payer Partnerships: Payers and health systems are working collaboratively to increase patient and family satisfaction, provide best-in-class care and deliver cost savings. UnitedHealthcare and Phoenix Children’s are pioneering a new model – the Special Needs Initiative – which focuses on patients with complex needs. This endeavor served as a best-practices blueprint, which has expanded to include three additional complex care pediatric health systems nationwide to date.
- Medicaid Collaboration: Roughly 40-50% of pediatric patients rely on Medicaid to fund their care, while this figure is 10-15% within the adult population. It goes without saying that pediatric health systems must foster a collaborative working relationship with their state Medicaid agency. At the same time, providers must not ignore the importance of their commercial payer partners in their funding framework.
- Costs of Pharmaceuticals: Pharmaceutical costs are a major driver of overall healthcare costs. Researchers are developing lifesaving cures and therapeutics, but they can be expensive. Recently, a one-dose prescription surpassed the $5 million mark. Health systems and insurers need to design payment models that ensure patients can access these critical treatments.
- Social Determinants of Health: Understanding the social determinants of health – like access to safe housing, food, public safety, social support and economic opportunities – is an important component in meeting the needs of today’s children and delivering world-class healthcare.
- Behavioral Health: According to U.S. Dept. of Health and Human Services pre-pandemic data, one in five adolescents has a diagnosable mental health disorder, and nearly one in three show signs of depression. The COVID-19 pandemic is compounding mental health issues in children. Behavioral health services are becoming an even more important part of the pediatric continuum of care.
The Pediatric Leadership Forum can be seen in its entirety on-demand.