Pediatric Primary Care Payment Reform

TRANSFORMING PEDIATRICS TO SUPPORT POPULATION HEALTH

CHDI is working to develop and test strategies for redesigning pediatric primary care to play a broader role in the health and well-being children and outline principles for changing how care is funded.

While health care is not the only sphere that can influence a child's life course, it represents a near-universal way to reach children and has potential to serve as a hub to connect families to services that can help them thrive. 

Statewide Study Group and Report

In 2018, CHDI and the Connecticut Health Foundation convened a statewide study group of payers, providers, policymakers, and parent advocates to develop recommendations for a pediatric primary care delivery system that would increase the value of pediatric primary care to:

• support long term health and population health,
• mitigate health disparities, and
• better integrate health care with other services that children and families use.

The study group’s final report, Transforming Pediatrics to Support Population Health: Recommendations for Practice Changes and How to Pay for Them, included the following recommendations, several of which have been included in proposals from the Office of Health Strategy for inclusion in statewide reform efforts. 

1. Begin with health promotion and prevention, recognizing that the key to creating a healthier population begins early.
   
2. Make flexible payments to pediatric providers to allow them to broaden their scope of services to include ones that are not currently paid for by public and private insurance.
3. Develop outcomes that all providers, health and community, can contribute to and maintain data across health and community services.
4. Ensure that Medicaid and private insurers participate in new payment methods to allow universal application of services within practices.
5. Blend and braid funding from sectors that provide services to improve children’s health, development, and well being.
6. Recognize the role that the public sector needs to play in ensuring population health, beginning in childhood. 

Webinar Series

A series of three webinars sponsored by the CHDI and designed by Commonwealth Medicine health policy experts shared experiences from other states in addressing children within health reform efforts. The webinars explored outcomes for reformed pediatric primary care, cross sector collaboration and new payment methodologies.

Pilot Testing Payment Innovations

Next steps include pilot testing innovations recommended in the report in pediatric primary care offices. The Connecticut Health Foundation and Children’s Fund of Connecticut have jointly dedicated $163,250 to support the next phase of this work and re-convening of the study group.