Pediatric Falls
fee for service has passed by the medical home and is headed for a fall...

Pediatric Falls

Transformative discussions in pediatric care persist as a constant thread in healthcare narratives. The "Triple Aim" framework, championed by pediatrician Donald Berwick and reinforced by the American Academy of Pediatrics, stands as a comprehensive roadmap for this transformation. It articulates three fundamental objectives: reducing healthcare costs, enhancing care quality and satisfaction, and improving population health. This initiative propels the Centers for Medicare and Medicaid Services from mere financiers to proactive agents of change, fostering a cost-effective, quality-driven, and population-focused future.

The Triple Aim advocates for a paradigm shift from an individual-centric to a public health model, emphasizing preventive services and healthy behaviors over reactive treatments. It prescribes six strategic practices essential to realizing its objectives: the adoption of family-centered medical homes, the redesign of practices, the development of care plans, the support of self-management, the formation of organized health systems, and the sharing of resources. These strategies are not just about revolutionizing pediatric care practices; they are about empowering pediatricians to become leaders in an evolving healthcare environment.

In line with the Triple Aim, the medical home is envisioned as a cornerstone of pediatric care, characterized by its:

  • Accessibility: Ensuring care is readily available, overcoming both geographical and insurance-related barriers.
  • Family-centeredness: Engaging families as partners in the decision-making process.
  • Continuity: Providing consistent care throughout every stage of a child's development.
  • Comprehensiveness: Offering a full suite of health services, ranging from preventive to specialty care.
  • Coordination: Developing and communicating care plans in collaboration.
  • Compassion: Guaranteeing that every care aspect deeply considers the child's and family's well-being.
  • Cultural Effectiveness: Incorporating the child's and family's cultural identity into their care.

However, despite the aspirational nature of these strategies, the reality of current practice often falls short. The financial strain and clinician burnout are leading to a decline in both patient and clinician satisfaction, resulting in an unsustainable cycle of service addition without addressing root issues.

Faced with these challenges, we must ask: Can we deliver the value that aligns with the medical home's principles? Are we ready to take the necessary risks for transformation, or will we continue down a path of service addition, burnout, and declining satisfaction? How can we reconcile our economic realities with the noble vision of a medical home? Is it not feasible to restructure our practices to be both financially viable and true to these core values?

The path forward involves embracing a value-centric approach, where we pivot toward being rewarded for the quality and outcomes of our care, rather than the volume. We must demand more—more resources, more support, more recognition—and in turn, deliver true value to our patients.

This is an invitation to recommit to the principles of a medical home. It is a vision that includes providing better prenatal care to reduce NICU admissions, enhancing early intervention screenings, taking ownership of care coordination, and finding cost-effective solutions for ancillary services without sacrificing quality.

Yet, confronting the current reality, which starkly deviates from our intended direction, requires us to dare to dream. Dreaming is not a form of escapism but an essential step toward crafting a better reality—a reality where pediatric care aligns with the medical home model, where every child and family experiences the highest standard of care.

At this critical juncture in pediatric healthcare, reimagining our approach is more than an aspiration; it is a necessity. We must navigate the challenges of modern practice, guided by the "Triple Aim" and the medical home's principles. To align with this ethos, we propose a suite of transformative practices:

  • Population Health: Utilizing advanced analytics to segment patient populations and deliver personalized care.
  • Integrated Interdisciplinary Teams: Assembling tailored teams to meet specific patient needs.
  • Physician Time Alignment: Concentrating primary care physicians on complex and preventive care.
  • Diverse Care Modalities: Adapting care delivery to meet families where they are, including virtual and in-home visits.
  • Integrated Data for Measuring Outcomes: Using robust data analytics for continuous patient outcome improvement.
  • EMR Support: Streamlining care coordination through optimized electronic medical records.
  • Aligning Provider Compensation: Incentivizing quality and outcomes over volume.
  • Integrating Specialty Care in Primary Care: Creating a unified team around each child for seamless care.

These are not mere incremental changes but radical reconfigurations of pediatric care delivery. They are the tangible steps toward actualizing the medical home model—a patient-centered, integrated approach that anticipates and responds to the evolving needs of our populations.

As we stand ready to embark on this transformative journey, we must decide: Will we deliver the value consistent with the medical home's principles and take the necessary risks? Or will we settle for adding services, accepting burnout and declining satisfaction? The time for action is now. By committing to these principles and practices, we can move beyond a system strained by financial pressures and professional exhaustion. We will forge a path where pediatric care is synonymous with the medical home, and every child and family receives the full spectrum of care they truly deserve.

This vision is not an unattainable dream but a practical blueprint for the future—a future where the pediatric medical home is not just an ideal but a lived experience, and the value we provide is evident in every aspect of our care. It is within this framework that we discover the seeds of true transformation in pediatric care—a transformation that starts with us, today.

Howard A Green, MD

Dermatology & Dermatology Mobile Apps

9 个月

J. Michael Connors MD Germany, Japan, Switzerland, Metherlands and other capitalistic democracies ensure access for all their citizens to quality affordable private insured and private FFS manufactured preventive, medical, surgical and palliative care with more private hospitals per capita and better outcomes and costs than AMERICA simply by making their health insurers profit neutralized utilities instead of luxuries. It’s called the Bismarck healthcare model and it works, read about it here; https://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php

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Robert Bowman

Basic Health Access

9 个月

Berwick is down for half as much micromanagement and the termination of Medicare Advantage or at least curtailment.

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Avram Kaplan

Faculty member UCLA Fielding School of Public Health : Health, Policy and Management

9 个月

Well said and fits within my course at UCLA; Integrated Health Systems using the Triple Aim as the true north, adding the quadruple and quintuple aim in my lectures

Jason Taylor

Healthcare Junkie - Making Digital Health Easier! - Transformational Leader - 30+ years "wiser" -Trusted Advisor to C-Suite

9 个月

Great post - and there's an amplified effect on health equity. We are not succeeding at the triple aim in the US, and some metrics are going backwards, especially in marginalized communities, where fee for services is just plainly a barrier to access.

James H. Wesp, MPH MBA

Principal at Oasis, LLC

9 个月

Wow!! Thank you, Dr. Connors. Our healthcare system has evolved from the Flexner Report in 1910 to focus upon and reimburse "care-to-cure" instead of a prevention and wellness incentive. The propagation of specialties and subspecialties; chasing the cure dollars to the dilution of primary care providers, like pediatricians and family medicine docs, is clear and convincing proof that the medical community is chasing the dollars for cure, instead of prevention. RVUs and DRGs exacerbated this trend. Turning the healthcare aircraft carrier will require political will to overcome K Street and, most probably, a disaster caused by lack of access!!

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