Disclaimer: Moving Health Care Upstream is a collaborative effort co-led by Nemours Children’s Health System (Nemours) and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.
In health care and in life, we need to match incentives and expectations. When I was younger, one of my chores was to help empty the dishwasher – I was responsible for the bottom and my sister for the top. The chore was not complete – and the allowance was not received – until both of us completed our parts. It was actually pretty ingenious on my parents’ part; I learned it is not only important to complete my key function of emptying the bottom rack, but also that it made sense to support my sister in completing her key function because it led to a better outcome for both of us.
This is where payment in health care is failing. The incentives are not aligned with the desired outcomes. We continue to pay for volume when what we really want are outcomes – care when and where we need and want it. And, for children, this is even more critical. We want to ensure that children have access to systems of care that are rewarded for optimizing children’s health and development, not only being there for them when they are sick, but innovating on ways to keep them healthy.
Children’s health systems inherently understand this value proposition, and many are challenging their traditional care processes and roles and designing new systems of care that account for the fact that health happens in all the places that children live, learn and play. I’m lucky enough to work for one of those pediatric systems, Nemours Children’s Health System, with leadership that understands that in order to achieve the desired outcome – healthy kids – we need to not only perform our essential function of providing health care, but also support other systems (e.g. early care and education, schools, housing, food security, juvenile justice) in doing theirs. To do so, we need payment to align and support this new model.
Dr. David Bailey, CEO of Nemours, recently published a column in the Harvard Business Review entitled, “Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes,” where he shares an example related to asthma. In the Nemours Delaware Valley pilot, there was a “60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child.” The health system had increased outpatient costs because of the expanded care team, but it also saw a reduction in hospital service utilization and associated costs. The health system did the work; the payer reaped the benefit. That is not a sustainable model for producing health outcomes in the long-run. It is a clear case of the incentives not aligning to support the integrated work necessary to keep kids healthy.
With Moving Health Care Upstream, I know that there are other examples from health systems that are thinking the same way and creating innovative partnerships in support of health. You can find write-ups about them across the website. I would love to hear from others about innovative systems you know about.