Incentivizing the health of children

The current administration is hoping to make positive moves in healthcare policy that will address increases in chronic illnesses and take on the unique challenges of children’s health needs. One of the primary goals of the “Making America Healthy Again” initiative is improving the health of children. This is inclusive of chronic illness and behavioral health needs. This is not the first administration to be concerned with the health of the nation’s children, nor are federal agencies the only groups worried by current trends. However, the front and center nature of these announcements in recent months, and the fact that grants are being re-evaluated, means states need to review their policies and make sure program goals are in alignment with these initiatives.

The Center for Health Care Strategies (CHCS) suggests that an Alternative Payment Model (APM) addressing children’s health is a good course of action and points out the need for preventative care in children. Discussion points have been made on both sides of the argument regarding the use of a large APM that incorporates adults and children vs. one that uses a separate APM for children. There are benefits to both approaches and similar needs for designing either program. One incentivizes primary care with the recognition that the needs of children with chronic illnesses will be based on different factors than the factors we use to measure adults with chronic illnesses. 

The question that needs to be answered: How can plans and states risk-adjust the needs of children? Using the chronic illnesses that are predominant in an adult population is ineffective. There is also a question of autonomy. Are children more affected by some social determinants than adults? Clinical risk groups (CRGs) are one way to segment children in a way that allows comparison cohorts that bring all these factors together and show how they interact. They can show a full picture of clinical and behavioral health for the entire population, including children. A CRG can also reflect coded social determinants of health, including attributes like foster care that are important for managing a patient. It is important to look at all these parts of a child together because each component contributes to the overall needs and resource burdens they face. 

Of course, knowing the risk of this group is not the whole story nor all that is needed for a policy designed to create a healthier population. It is important to overlay the resource needs based on the clinical severity of the members, and further, decide the proper payment for those services. Are we paying primary care providers enough to offer proper primary care and create enough capacity for primary care in general? By creating alternative payment models with pediatric primary care providers and using policies for fair reimbursement and quality measurement, perhaps payers and states can incentivize services and programs that can put children on a healthy path. 

Shannon Garrison, MBA, MJ, is a health policy manager, clinical and economic research, at Solventum.