Effective Value-Based Payment for Children Requires Different Quality Measures than Those for Adults, Says UHF Report
A new United Hospital Fund report focuses on the quality measures to consider as part of value-based payment arrangements for children’s health care. Rolling children’s care into broader reform efforts rooted in value-based payment requires close consideration of how value in children’s health care is defined and how it is measured.
The report presents four central lessons for New York as the State considers quality measures for value-based payment for children: (1) Government and public programs, particularly Medicaid, have good reason to continue leading the development and use of children’s health quality measures; (2) Establishing a process that creates incentives that go beyond what is currently measured can help the State incorporate increasingly ambitious goals; (3) Ensuring that children with special needs receive high-quality care under a value-based payment arrangement is critically important and potentially complex; and (4) Value-based payment quality measures could encourage child primary care providers to integrate or coordinate oral and behavioral health services and address social determinants of health.
You Get What You Pay for: Measuring Quality in Value-Based Payment for Children’s Health Care examines the key features of children’s health care that might have implications for measure selection in value-based payment arrangements. One such feature is that children’s health care is primarily prevention-oriented. Not only is the impact of prevention in children hard to measure, but its benefits are often realized in the long term and outside the health care system. For the relatively small number of high-cost, high-need child patients—many of whom are particularly vulnerable—specific care needs should be safeguarded in value-based payment arrangements. Further complicating the measurement question for children, standards for appropriate and high-quality care can differ across developmental stages.
The report also examines three case studies (from Oregon, Ohio, and Colorado) as examples of what other innovative payers and providers have used in their child-focused value-based payment arrangements. Each is presented with a summary of the arrangement, an articulation of the value or goal that was sought, and a discussion of the measures selected. Among the challenges identified in these case studies were the limited opportunities for cost reduction within primary care, an expectation that savings may be accrued for only a few years, and questions about whether the measures to ensure better outcomes for children have “gone far enough.”
“Common sense tells us that promoting a solid foundation of good health in children will yield enormous benefits for decades to come,” says Suzanne Brundage, senior health policy analyst and the report’s author. “But finding the right metrics to promote that good health requires more than common sense. Because of the growing importance of value-based payment as a key pillar of health reform efforts, now is the time and opportunity to get these metrics right.”
“A lot of discussions around value-based payment focus first on cost and second on quality of care,” said Andrea G. Cohen, senior vice president for program. “As this report makes clear, a focus on quality is especially important in the case of children, and value-based payment is one place where child-appropriate quality measures need to be embedded.”
“As health reform moves New York toward more innovative models of care, we must pay attention to important differences in patient populations, including children,” said Jim Tallon, president of United Hospital Fund. “As this report suggests, the particular solutions and metrics with children’s care will often need to look different, and children need to be an important part of the discussion as New York’s health care system continues to evolve.”
You Get What You Pay for: Measuring Quality in Value-Based Payment for Children’s Health Care is available from the UHF website at https://www.uhfnyc.org/publications/881134.
Support for this work was provided by the New York State Health Foundation.
About United Hospital Fund: United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care.