Few topics in healthcare today trigger intense discussion as quickly as value-based care. From the argument about when it actually started (estimates range from the early 1990s to the mid-2000s), to the measure specifications and weights, to the ultimate value of value-based care itself. But one thing is constant: value-based care isn’t going anywhere. In fact, emerging trends in pediatrics show it’s becoming a mainstream operational reality that closely aligns with population health itself.
Is your network ready for this industry shift? If you didn’t answer a resounding “yes,” start with these five actions that every pediatric network should take to prepare for mainstream value-based care.
1. Create stronger protocols for preventing childhood heath issues
An ounce of prevention is not only worth a pound of cure, it’s actually the most critical aspect of population health in the value-based setting (and everywhere else, too). Developing, deploying, hardwiring, and improving your standardized protocols for promotion and screening for childhood disease are the single most important thing you can do to foundationally improve the health of your pediatric population — and meet the underlying value-based measures. To really achieve this, you’ll need to go far beyond just having a good protocol on paper. It means integrating it into day-to-day workflows, your electronic health records, your physician practices, and your onboarding procedures, all of which take time, effort, and a multidisciplinary approach.
2. Become experts in segmentation measurement of process
In the world of population health and value-based care, it’s the oversimplified global execution that counts, even where we all know that execution is the result of dozens or even hundreds of caregivers' efforts. Because, like a hole in Swiss cheese, any step in the process that isn’t completed can fail a patient and cause a “fallout” in the value-based measures. To prevent this, organizations need to focus their efforts on measuring the success of each step of the process to pinpoint issues and allow targeted and rapid improvements when things aren’t working. Partner with your analytics resources to identify and build dashboards that measure actual segmented performance.
3. Bolster and develop your care management staff
Few departments are as “mission-critical” to population health as care management. In addition to ensuring your inpatient team is ready to begin discharge planning at the front door of the emergency department (ED), outpatient care management elements should be embedded in every aspect of your nonhospital presence. This includes leveraging electronic health record information to automate contact, follow-up, and transition of care. Outpatient care management will be even more critical to pediatric populations because, while childhood disease may promote enhanced utilization, that utilization may not primarily be as an ED or inpatient. It will take outpatient care managers to recognize trends and help these vulnerable pediatric patients navigate to the right level of care at the right time.
4. Master your protocols to address childhood chronicity
While prevention is essential, so is evidence-based treatment of chronic disease in a respectful and cost-effective way. Tightening your care pathways and protocols, as well as measuring each element can reveal where you need to improve treatment and handling of chronic childhood diseases. While this element is, in concept, a rollup of Nos. 1 and 2 above, it’s the crux of population health and must be carried out reliably with every patient affected. Many hospitals are operating with protocols that were developed several years ago or even several medical records ago. Taking the time to analyze, update, and integrate your chronic care protocols with your current electronic health record will net large dividends for pediatric patients and remove unnecessary work left over from older practices.
5. Train your staff for continuous improvement
No element lends more to ongoing success than your team’s ability to navigate continuous change while still moving “the improvement needle.” Implementing a well-developed and objective improvement approach for creating a culture of continuous improvers will ensure that your team is well prepared for whatever comes next. We’ve all heard that culture beats strategy every time, but the truth is that culture makes strategy unstoppable. Investing in your team’s ability to develop, deploy, and improve processes at every level will make your population health and value-based care strategy, along with everything else, as strong as it can be.
In its most foundational sense, value-based care is the building block to true population health. As this system of reimbursement becomes mainstream, pediatric networks will have to drive fundamental change at the operational, administrative, and patient care level in order to adapt. The multidisciplinary approach to these elements, while a necessity, can be challenging for organizations. What will make the most difference, above all else, is taking steps now to understand the scale, scope, and impact of value-based care on your organization — a measured starting point for significant transformation begins with clarity.
