Can redesigning pediatric primary care improve child and adult health?

February 05, 2019

A new report and accompanying policy brief make the case for redesigning pediatric primary care to play a broader role in the health and well-­being of families and their children and outline the principles for changing how the care is funded. The report, Transforming Pediatrics to Support Population Health: Recommendations for Practice Changes and How to Pay for It, was released by the Child Health and Development Institute of Connecticut and the Connecticut Health Foundation, with recommendations that emerged from a study group they convened of experts, including providers, payers, foundations, policymakers, and parent advocates. Robert W. Seifert, MPA, executive director, Health Law & Policy, and Hilary Deignan, JD, MEd, policy analyst, Health Law & Policy, of Commonwealth Medicine at UMass Medical School prepared the report.

The study group proposes that pediatricians and other primary care providers who treat children take on a more holistic approach to their patients’ lives. In addition to providing guidance on development, well-­child visits, and medical care when children are sick, as they do now, pediatric primary care providers would also expand their practices to include family support services and connect families to community services – such as behavioral health care, assistance with food or housing, help with school issues, and treatment for maternal depression.

“Nearly every child sees a primary care provider who serves as a trusted family resource but often these providers can only provide traditional services that are covered by health insurance,” said Lisa Honigfeld, vice president for health initiatives at the Child Health and Development Institute of Connecticut (CHDI). “These services are important, but a new payment system could take advantage of pediatrics’ universal access to children and families and provide health promotion services that are not traditionally reimbursed by insurance. Some examples include home visits, breastfeeding support, parenting groups, and connections to other community supports for children and families.”

While children in Connecticut are relatively healthy overall compared to children in other states, there are significant racial and ethnic health disparities, which start early and carry through education, employment, and adult health. Supporting pediatric primary care providers to address families’ needs more broadly and connect them to social services or other supports that could improve their well-­being could lead to better long-­term outcomes, including improved school performance, a healthier workforce, and reduced adult health care costs.

CHDI and the Connecticut Health Foundation convened the team of experts in health care, children’s health, policy, and insurance to develop strategies for redesigning pediatric primary care to support practices in adopting innovations in child health services and targeting outcomes beyond what have traditionally been part of health care, including ensuring children enter kindergarten ready to learn.

“Pediatrics is changing to promote better health and life outcomes for children, but clinicians are often held back by a payment system that only rewards them for the number of office visits and procedures they can complete in a day,” said Patricia Baker, president and CEO of the Connecticut Health Foundation. “If pediatric primary care providers are going to take on a larger role in supporting the well-­being of families, they need a payment system that will support them in doing so. These changes, while ambitious, are achievable. They are also necessary for the long-­term health of our kids and our state.”

The study group recommends several changes, including:

  • Payment that supports and rewards effective health promotion and prevention – not just treatment for illness – for all children.
  • Up-­front payments for services that improve long-­term population health, health equity, and quality.
  • Improving measurement and data sharing that connects effective pediatric primary care to adult health and well-­being and to children’s success in school.
  • Universal participation from all payers, public and private.
  • Payment methods that recognize the variety of service sectors’ overlapping encounters with and responsibilities with children.
  • On-­going public-­sector commitment to improving pediatric primary care.

Next steps include pilot testing innovations recommended in the report in pediatric primary care offices and integrating the report’s recommendations into the state’s ongoing work to redesign health care to improve population health. The Connecticut Health Foundation and Children’s Fund of Connecticut have jointly dedicated $163,250 to support the next phase of this work and convening of the study group.

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