According to a 2017 study published in JAMA Pediatrics, pediatric healthcare spending in the U.S. increased from $149.6 billion to $233.5 billion in 2013. Of that colossal level of funding, the most significant expenditure was on well-newborn pediatric care in the outpatient setting. The authors, who were mostly associated with academic health centers, concluded that their findings should “provide policymakers and healthcare professionals with evidence to help guide future spending.”
One such initiative to stage change in the primary care pediatric delivery arena was just announced in June. This project plans to reach children and their families in an environment that already provides half (48.5 percent) of healthcare to children under the age of three: the Children’s Health Insurance Program (CHIP) and Medicaid. The initiative, outlined in a report, is titled “Fostering Social and Emotional; Health though Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change.” Called the Blueprint for short, the plan seeks to control the costs of pediatric healthcare delivery and improve quality outcomes by addressing the Social Detriments of Health (SDoH) through community care coordination and strategies to improve child welfare. For children, SDoH refers to the conditions in which they are born, grow, and live. This influence by the education level, work, and economic factors of their parents.
The call for community care coordination is driven by the truth that many people – especially those of moderate to lower income – are not just medically complicated, but socially complicated. As the primary source of coverage for America’s babies, toddlers, and children, Medicaid and CHIP are in a unique position in both financing and access to drive more effective population, community-based pediatric primary care. One of the main sponsoring organizations of the Blueprint is the Center for the Study of Social Policy (CSSP). With the Blueprint, CSSP aims to create standards for high-performance primary care pediatrics and community care coordination through, four goals are proposed in the Blueprint:
1: Care for the whole child. The provider will offer services that address the child’s physical health, the parent-child relationship, developmental progress, behavioral health, and helps families secure services and supports that help them address social and economic needs.
2: Family-based care. The provider will offer family-based care that focuses on the parent/child relationship and validates the strengths parents bring to that relationship. Since a parent’s health and behaviors have a direct impact on a child’s well-being, the provider screens the adult for conditions such as depression, tobacco or other substance use, and oral health.
3: Attention to social and economic issues. In light of the critical role of stable housing, food, and income security play in the healthy development of children, the provider addresses social and economic issues. As recommended by the AAP, the provider conducts a psychosocial and behavioral health assessment during well-child visits, including an assessment of SDoH.
4: Team-based care. Since no single person will have the expertise and time needed to address all of the relevant needs of children and their families, the provider employs a team approach. Among others, the team may include a community health worker or other similar team members, sometimes called a family support specialist who may deliver services in the clinic, home, or an early childhood setting.
Five strategies and tools are offered to accomplish the above goals:
1: Cover and support a full range of screening, assessment, and treatment services for children and their parents. Medicaid has a longstanding commitment to the health of young children, providing a comprehensive benefits package designed to meet their unique health and developmental needs. Medicaid’s companion program, CHIP, features similar (although sometimes more limited) services.
2: Leverage quality and performance improvement initiatives to spur changes in pediatric practice. States can incorporate a focus on social and emotional development into their statewide quality strategy.
3: Establish payment models that support and incentivize a focus on the social and emotional development of children, ideally as part of a high-performing pediatric medical home.
4: Facilitate investment, including Medicaid funding, in team-based care and training on children’s social and emotional development. States can support the use of team-based care to make it more feasible for pediatric practices to connect families to public benefits and community resources, and offer support to help strengthen parenting and prevent problems with social and emotional development.
5: Leverage a CHIP Health Services Initiative to finance interventions aimed at supporting children’s social and emotional development. Using CHIP administrative funds, states can implement a wide array of interventions to foster children’s social and emotional development.
The key to success will rely on finding ways to amass and express performance data across providers. This can be a challenge. However, overall, there is a precedent for adopting such a community care coordination solution to pediatric healthcare delivery. A 2013 World Health Organization study found that integrating medical services can be ten times more effective than waiting for families with unmet social needs to present to healthcare providers with medical problems due to SDoH. A 2018 report stated that only ten percent of a child’s health derives from access to quality healthcare. Another twenty percent comes from their environment – home, school, and community, with thirty percent of their genetic make-up. The balance – 40 percent – is based on choices that are made for a child, which can include community care coordination and primary pediatric care. Such findings support the goals of the Blueprint and CSSP.