On January 6, high -level leaders in The children’s health health -based in Wilmington, Delaware They were able to make public the announcement of something that had been in the planning stages for numerous months, and whose achievement represented a great advance in the medical care policy around the health of children. The press release announcing development It began like this: “Nemours Children’s Health and the state of Delaware today announced an agreement to create a new transformative effort to make children in Delaware the healthiest in the nation. The new Medical Care Payment model focuses on the 120,000 children covered by the MEDICAID program of Delaware. The new payer agreement aligns financial incentives that pay for medical care with Nemours’s objective to keep healthy children. This association marks the first pediatric global income budget model in the United States. Unlike the traditional arrangements in which suppliers earn more money for providing more medical services, Nemours Children were encouraged to address medical and non -medical promoters of children’s health in an effort to avoid unnecessary medical expenses, «he said The press release.
As Nemours leaders emphasized, “this program is a next bold step in the Nemours Whole Children’s Health model, which considers both the medical needs of a child and the social and community problems that affect their health. Integrates the excellent primary, specialty and hospitable care of Nemours with health initiatives that affect all children in Delaware, including many that come from historically unattended communities. This agreement is based on the long -standing commitment of Nemours to serve the children of Delaware and further establishes the first state as a child health leader. «
And the press release quoted R. Lawrence Moss, MD, president and CEO of Nemours Children’s Health, as stating that «we know what happens at home, school and community of a child is essential to establish them for health All life, however, the United States medical care institutions are mainly paid for providing medical care. They grow to become healthier adults. «
And he summoned the governor of Delaware John Carney, who declared that «ensuring that our children are healthy and capable of being successful is as important as anything we do. I am grateful for the hard work that the Department of Health and Social Services and Nemours Children’s health was dedicated to this effort to better support children throughout our state through innovative care, ”said Governor Carney.
The press release said: “Working in association with community support systems and local and state government agencies, Nemours will coordinate access to the widest range of services necessary to help children prosper and achieve optimal health. The unique position of Nemours as the only multi-hospital multi-hospital pediatric system in the country will provide widely applicable lessons in how different financing systems can improve general children’s welfare and health in the United States. «
In addition, the press release quoted Kara Odom Walker, MD, MPH, health director of the population of Nemours Children’s, as stating that «this innovative global budget model will demonstrate how the change to a» Payment for Health «model» You can create the healthiest generations of Delaware’s’s’s.
And he summoned the Secretary of Social and Health Services of Delaware, Josette Manning, as stating that «I am proud that the first state is first, this time, this time bringing an innovative model to our state that will guarantee the best health results For Delaware children.
Shortly after the announcement was made, Health innovation Chief editor Mark Hagland interviewed Dr. Moss to deepen the ad and obtain his perspective on what is being achieved by launching this new payment model. Then there are extracts from that interview.
How did the trip to this new payment model begin?
It begins in the center of who we are as an organization and our purpose in the world. Nemours is in the health creation business, not just the treatment of diseases. Our children are all children in our service area, and we must be responsible for creating health for each child. And so we approach the State with that aspirational concept. And fortunately, they were very willing to listen, and therefore, several years later, we could sign this Mou [memorandum of understanding.] And, by the way, I want to point out that our colleagues and partners in the state of Delaware have also worked extremely hard on this. People talk about the government move at a slow pace, but that was not my experience in this.
How will the model work in practice?
It is based on the model of a global budget, where we and the State reach an agreement on the value that we decide to put in an annual expense of medical care. And then we are responsible for providing medical care; And if that ends up being a financial victory for Nemours, and if it ends up costing more, it is actually a financial loss for us. In the first three years, we are learning with the State, during that period of three -year learning models.
Conceptually, our vision is that this is not Nemours and the state sitting on opposite sides of a negotiating table driving for money; We are all sitting on the same side of the table asking, how can we create the best health for each child in Delaware? And that is not just a plaque. This is the first Pediatric Global Budget model in the United States that we learn a lot from the State of Maryland in particular. But by children, the scope of the disease is different, and the total expenditure per person is different in childhood than in adulthood. And most importantly, interventions outside the hospital to create health in childhood can have a deep impact. Therefore, investing in food security, freedom of violence and literacy and other problems is totally different. This model really focuses on that. Integrated in that model is health.
And now that we have agreed to do the model, we are sitting with our partners in the state to discover how the funds are seen. Health includes more than just medical care, and we need to make investments. And we are working now those dollars will flow. And they are complicated to marry those problems with medical care in children, in a way that makes sense.
What is the deadline to solve the details of the model? Several months?
Yes, I think they will spend several months, in the context of the three -year initiation phase. The intention is not to keep the feet in the fire to obtain results, because we are learning how the results will be seen. We are really in learning mode during those first three years. And it really will be an association. But the State and the Nemurs have extended a considerable amount of confidence for this to happen. And if we both believed that we were really mutual partners, this would never work. The global budget of Marland’s state is only medical costs, and that is a laudable objective. But we are much broader. The fundamental and primary basis of our model is child health.
You must have done some analysis of this before moving forward with the plan, correct?
Yes, that is correct, and we have hired some very sophisticated actuarial companies. And together with the State, we had a very open data exchange format, and requires trust.
It will invest very early in the life of a child in terms of preventive health and well -being, so correct?
Exactly. Above all, we are trying to treat the disease with compassion, quality and effectiveness; Here, we are really building the way ahead of us. For more concrete, how do we appear the return on investment? Much of the performance is a healthy long -term population. That is outside a budget cycle or a political electoral cycle. So I could ask, how do you invest now? My response to that is that there are enough modest short -term financial victories in terms of reducing acute care stays and emergency visits, there is enough blow early there, to demonstrate that this is financially viable. But these short -term victories pale compared to a long -term reduction in the incidence of cancer, diabetes, heart disease, Alzheimer’s. We first need short -term victories.
I still remember that you have told me the vivid story a few years ago from a patient named Wendell, who, due to the lack of access to a safe space in the playground, ended up seriously injuring his leg, with a resulting gain and necrosis, and more of one million of the value of the medical care of the dollars, including an amputation, while, as he pointed out, providing a safe game space near his public home, It would have been so economical and so effective.
His care cost several million dollars, really. And he endured a nightmare experience due to the injury.
Then, in solving this new payment model with the state of Delaware, I was thinking of Wendell and other children like him, right?
Absolutely. Obviously, when we have a child full of children, we have to take care of them and do everything possible for them. At the same time, we try to apply a broader lens to ask what the real problem was; And often, as with Wendell, the real problem was a child who grew up without resources for the supervision of the game. Or a child who obtained the worst case of RSV in the city and ended at the ICU. Therefore, we want to create health in the first place, which, of course, will mean less necessary medical attention in the future. There will always be children who need heart and chemotherapy transplants, and we will always be there for them; We are there on both sides of the equation.
In other words, aren’t you trying to get rid of yourself?
We would love to get rid of ourselves, but there will always be diseases, and we will always be there to take care of children with illness.
We need to create greater health to isolate people of things like Medicaid rollbacks, right?
Yes, and our payment system has many defects. But what we are talking about today is even a level above that. Regardless of its health insurance coverage, the medical care economy in the United States encourages the opposite of health; Incentives the maximum amount of attention care as possible, in the most expensive forms possible. We should fix the whims of payment systems; But what we really have to do is change the financial incentives of suppliers.
Medicare program analysts have just announced last month that The health system experienced hospital inflation of 10.4 percent during the last yearA great jump. Right there, we have a flame platform, right?
Yes, and a risk of sounding like a broken album, they are incentives, incentives, incentives. Each fiber of our system encourages volume and complexity. The system is driven by incentives, and my belief is that, until we change those incentives, we will not be able to stop that tide. And this model we are talking about today, in my opinion, is transformative. We have said, we move on and encourage health, not volume.
Is there anything else you would like to add?
Three things that I want people to understand about this model. Number one, the news here is about child health, not a payment model. This is an agreement to make the children of our state the healthiest in the country. Secondly, we are focusing on each child in our service area. And third, it is very significant that this is a true association between our health system and the State.
