Children's join forces with insurers to accelerate transformation of pediatric care
November 4, 2009
Boston, Mass. -- Children's Hospital Boston and its physicians are creating a unique partnership with the state's major health plans to accelerate the transformation of the pediatric care delivery system by expanding innovative approaches and models of care. The approaches and models currently being piloted at Children's are designed to improve health outcomes and reduce costs by eliminating care that is not effective and over utilized. The health plans--including Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care and Tufts Health Plan--have agreed to an advisory role and to target funds toward the effort. The Massachusetts Medicaid Program has also agreed to participate.
To work with insurers to develop a common approach and standards toward improving care and reducing costs, Children's and its physicians have volunteered a cut in fiscal year 2010 payment rates; in some cases reopening contracts to cut rates of increase, and in others agreeing to reduce rates of increase during current contract negotiations. Children's and the health plans have agreed that a portion of these savings will be targeted to support these promising and novel approaches and models. Investments will support SCAMPS (a revolutionary way to provide clinicians with immediate feedback on the success of their treatments), new models and systems for pediatricians to work with specialists in coordinating care, and the most advanced pediatric information technology underpinning these efforts.
"Over the past several years, we've made patient quality and safety our top priority, invested in our clinical health information systems and tackled hospital-wide operational improvement," said Sandra Fenwick, President and COO at Children's.
"Those efforts have provided the confidence and platform on which to launch this next generation of clinical effectiveness tools and models, which the hospital and its physicians believe hold promise for transforming the health care system nationally," added Paul Hickey, MD, president of the Physicians' Organization at Children's.
A 10-member advisory panel, with equal representation from Children's and the participating insurers, will provide valuable insight and strategic guidance for these and future efforts. While insurers have broad experience with clinical quality metrics and appropriateness of care guidelines, few of those measures are specific to pediatrics. It is believed that bringing together the broader experience of the insurers with the pediatric expertise of Children's and its physicians will help to standardize the approach to high quality, effective and efficient pediatric care.
New approaches, models and technologies for additional investment include:
SCAMPs (Standardized Clinical Assessment and Management Plans)
Although everyone's goal is to deliver the optimal tests, procedures and treatments for each patient, as every physician knows, in most cases this has never been defined. Physicians in the Cardiovascular Program at Children's have created a broad-based framework to not only address this problem, but to deliver better care at the same time. The framework, known as SCAMPS, or Standardized Clinical Assessment and Management Plans, uses the best evidence to guide testing and treatment decisions, and the best judgment of practicing cardiologists to standardize care plans for many common clinical situations and to capture data to continually refine the process.
"Children's and its doctors believe that the new framework will become the standard for quality improvement processes - how to create in real time widespread, continuous, data-driven quality improvement, including appropriate utilization and potential cost savings, and will quickly spread to other pediatric and adult care delivery," says James Lock, MD, chief of Cardiology and one of the architects of the pioneering approach.
Integrated Care Models
Currently, efforts to improve collaboration between pediatricians and pediatric subspecialists are underway. This is a crucial element of the primary care model known as the family-centered Medical Home, in which a primary care provider typically works in partnership with families to coordinate care for their children. The fund will expand and accelerate implementation pilots to improve access, communication, and optimal utilization of resources across an integrated system which includes primary care physicians, specialists and hospital, with a particular focus on coordinating care for children and youth with complex and chronic conditions.
Next Generation Information Technology
Advanced information systems are essential to the health care delivery system and are a critical component of Children's strategy moving forward. In addition to the complicated systems needed for SCAMPs, the hospital has developed the first patient-controlled health record fed by two separate health care providers (pediatricians and specialists) giving patients a more complete and comprehensive view of their medical information.
"The complexity and uniqueness of pediatric care compared to adult care require an extra level of effort to measure and improve quality," said Kathy Jenkins, MD, chief quality and safety officer at Children's. "By creating a common platform for discussion in Massachusetts with all major payers, we should make significant progress in improving quality and effectiveness of care while contributing to the state's position as a health care 'learning laboratory' for the rest of the nation."
Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is one of the nation's leading pediatric medical centers, the primary pediatric teaching hospital of Harvard Medical School, and the largest provider of health care to Massachusetts children. In addition to 396 pediatric and adolescent inpatient beds and more than 100 outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: www.childrenshospital.org/newsroom.