Focus on Children’s Health Care Often Missing in Transition to Value-Based Payment

Reports find payment reform requires greater focus on children, provides guide for closer collaboration between Medicaid agencies and children’s organizations

NEW YORK, NEW YORK March 11, 2019—Overhauling payments for children’s health care so that quality and outcomes are rewarded—rather than the quantity of care delivered—could have a profoundly positive impact on children’s health. But implementing such highly complex payment reform requires close collaboration between state Medicaid agencies and children’s organizations, according to companion reports released today by United Hospital Fund (UHF).

The reports—Achieving Payment Reform for Children Through Medicaid and Stakeholder Collaboration and its companion Guide for Action—outline rationales and specific steps that can help children’s health champions and state Medicaid programs work together to refocus health care payments, which in turn can improve the health and well-being of children. The reports also provide a framework that can form the basis for collaborative efforts between non-governmental organizations and public agencies.

“To date, most payment reform efforts focused on improving health care for adults, missing the opportunity to help children be healthier,” said co-author Suzanne Brundage, director of UHF’s Children’s Health Initiative and Patricia S. Levinson Fellow. “Designing a child-centered payment approach will be difficult, but with considerable collaboration between Medicaid agencies and children’s organizations, it can be done.”

Because children under age 18 make up 50.6 percent of enrollees in Medicaid and the associated Children’s Health Insurance Program (CHIP), the reports focus on Medicaid payment reform. Also, state Medicaid agencies are already being pushed by the U.S. Centers for Medicare and Medicaid Services (CMS) to move to payment systems that reward value rather than quantity.

“It’s not just Medicaid that stands to gain, however,” said Chad Shearer, UHF vice-president for policy and director of UHF’s Medicaid Institute. “Research has shown the importance of a child’s first years to their lifelong health. Reforming the payment system in a way that will improve maternal and child health can reduce special education needs, child neglect and mistreatment, problem behaviors, and adult illnesses.”

The report recommends that health care providers familiar with children’s needs and education and social services organizations that work with children help Medicaid agencies by setting goals, identifying specific areas where payment reform can improve health outcomes, and providing parameters that protect children’s unique needs.

“The only way payment reform will be a powerful force for improvement in children’s health is through collective, thoughtful action by Medicaid leaders and children’s organizations dedicated to making it happen,” said UHF president Anthony Shih MD, MPH. “None of the suggestions in these reports are easy to undertake or master, but the effort is worthwhile.”

The reports are based on interviews with experts on New York State’s own efforts to reform Medicaid payments, additional interviews with individuals in four other states, and UHF staff research. The publications are supported by a Cooperative Agreement awarded to ChangeLab Solutions and funded by the Centers for Disease Control and Prevention.

Both the main report and the guide for action can be downloaded from UHF’s website here.

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. For more on our initiatives and programs please visit our website at and follow us on Twitter.