Documenting financial, operational and human challenges
The Seattle Children’s Care Network (SCCN) was formed to anticipate and advance market trends in pediatric care.
The collaboration between Seattle Children’s Hospital, independent primary care providers and Children’s University Medical Group foresaw how changes in the financial and operational landscape would impact patient care.
Since the integrated network was launched, more than a dozen practices have joined.
These market dynamics impacting pediatric care are financial, operational and human. Awareness of these trends and strategies to meet the challenges are paramount as value-based care and alternative payment models are becoming a reality in this specialty, joined by market dynamics around hospital consolidation, workforce limitations and business margins.
While Medicare payment reform has not hit the pediatric specialty directly, Medicaid/CHIP does account for 30 percent of pediatric payer volume. State Medicaid programs are increasingly looking at pediatric care and the overall movement to value-based care, be it through bundled payments, risk structures and capitation.
Already the specialty is addressing this through data and delivery integration.
“We take care of a 60 to 65 percent Medicaid population, and most are complex pediatric cases,” says Paul Holmes, senior director of accountable care at SCCN. “We knew we needed to provide a better longitudinal method of care.”
As many smaller community hospitals and their pediatric service lines consolidate or even close, new patient volumes are driven to general hospitals sometimes not equipped to treat children, which in turn will start transferring patients into larger children’s hospitals.
In accordance, regional centers for excellence will have to factor in a larger referral network that may cross state lines. These higher volumes will place increasing demands on children’s hospitals.
Given the market and business landscape changes around consolidation and payments, the most important reaction of course is patient care.
Social determinants of health are also growing factors into advancing pediatric careToday, more than 25 percent of children combat a chronic condition such as asthma, diabetes and even mental health issues, according to The Child Data Bank.
Social determinants of health are also growing factors into advancing pediatric care.
To deal with all of these dynamics, pediatric facilities are finding that devoted care managers is a successful way to coordinate with parents and facilities to focus on intervention and prevention, early onset care and the creation of a longitudinal patient chart.
By combining resources to meet all of the market dynamics and challenges, the Seattle Children’s Care Network advanced its technology capabilities and established this set of goals:
- Care coordination and transparency between community provider, specialist and hospital
- Improved service for patients, families and referring providers
- Consistent protocols to streamline behavior and better outcomes
- Shared data, analytics and information between patient, provider and payer
- Improved patient safety
- Gains in market, clinical and financial knowledge
- Reduction in cost due to elimination of redundancies
- Mutually beneficial contractual relationships
We have compiled three position papers detailing the trends that need understanding to advance pediatric care. Access them below and tells us how we can further help.
Overcoming daunting operational challenges is tough, but not impossible—as long as you understand the issues pediatric providers face.Download
If you think payment reform isn’t going to play a major role in pediatric care, you’re putting your organization at risk for major financial woes.Download