A Pediatrician’s Perspective: Value-Based Care, Consumerism, and the Practice of Pediatrics: A Glimpse of the Future

For patients and families, value is in the eye of the beholder. Consumerism has arisen as a determinate of what patients find valuable about health care. An abundance of choices and the ability to make or change those choices at any time for any reason is the driving factor. Cost continues to be a concern for many families. Additionally, convenience, access, personal outcomes, prevention, relationships, safety, and quality may all influence decisions patients and families make about when, where, what kind, and how much health care they consume.

For those who pay for health care, value has a more concrete meaning. Given limited resources, patients, governments, and employers are all asking, “Am I getting what I pay for given the high cost?” All are demanding reductions in waste, improvements in outcomes, and increases in the value of the care they are purchasing. In response, physicians, health systems, and other providers are taking more responsibility for the entire spectrum of care, becoming accountable for both patient and population outcomes and being compensated on the basis of value.

How will these forces of value and consumerism shape the practice of pediatrics? No one knows for certain. However, 1 thing seems to be clear; the lens has shifted. What’s important and valuable is no longer determined solely by those providing care. Like the majority of US industries, value is determined by the consumer and purchaser. How will pediatricians and pediatric organizations respond? This fictitious press release could be released in your community soon.

The Children’s Network, a leading provider of pediatric health care in hospitals and independent pediatrician offices, and the RxCO Pharmacies are partnering to offer Children’s Care: convenient, high-quality medical care for children that exceeds the expectations of today’s busy families. Customers will experience easy access via mobile devices, multiple convenient locations should an in-person visit be necessary, on-site laboratory and pharmacy, and seamless coordination of care, all backed by the expert pediatricians, surgeons, and subspecialists of the Children’s Network.

“Providing high-quality care, when and where children and families need it, is the most important thing we do,” said Dr Tim Johnson, Medical Director of Children’s Care. “Modern families are busy, have multiple time constraints, and work really hard at keeping it all together. A sudden illness, a sports physical form that needs to be filled out, or even getting a well-child exam and immunizations can really throw a wrench in the works. Recently, many families have turned to retail clinics and urgent care centers for these types of needs, forgoing the relationship and expert care of their primary care pediatrician,” explained Dr Johnson. “At Children’s Care, we provide the expert pediatric care children need in the way that works best for their family.”

A typical visit might start when 11-year-old Cole wakes in the morning with itchy red eyes. Mom is running late for work and needs to know what to do: keep him home and call in sick to work or send him to school. Mom contacts Children’s Care by going to the Web site, signing into the secure site, and answering a few basic questions about what is happening. Within minutes she is connected with a provider/nurse team by secure video conference. The provider reviews Cole’s medical history, on file from previous visits in the Children’s Care system, asks some detailed questions about Cole’s red eyes, and performs an exam via Webcam. Cole has allergic conjunctivitis, which is not contagious. The provider recommends an antihistamine. Minutes later, mom receives a summary of the visit, instructions for care, and information for the school, all via secure text message.

Sometimes an in-person examination and testing are required. In Cole’s case, an alternate scenario could evolve when the Children’s Care telemedicine provider’s questions and exam indicate that he has had a fever for several days and his lips appear cracked. The provider explains to mom that Cole needs to be examined in-person and some laboratory testing needs to be done. Mom selects the visit location that is most convenient from the Children’s Care Network of Pediatrician Offices, RxCO locations, or Urgent Care Centers. When Cole and his mom arrive at the location, the visit starts right up at the point where the telemedicine provider left off. All of the information the provider needs is presented in the Children’s Care system. Cole is examined and has on-site laboratory testing completed by using on-site rapid testing. Less than 1 hour later, the diagnosis is made. Cole has a serious illness and needs to be admitted to the hospital. The Children’s Care staff arranges the admission, reviews the information with the inpatient specialists, and directs Cole and his mom to the Children’s Hospital.

Children’s Care offers flexible preventive and primary care options as well. Parents can choose to schedule appointments with the same pediatrician or group of pediatricians to enjoy the benefit of a long-standing personal relationship with their doctor. Alternatively, parents can schedule same-day visits for physicals, follow-up, and even many chronic conditions at any Children’s Care location. Select Children’s Care locations can even bring in pediatric specialists for consultation during the visit or as scheduled visits for specialty care. Either way, Children’s Care provides the well-coordinated, expert pediatric care children deserve in a way that works for today’s busy families.

For children with serious or chronic medical conditions, the Children’s Care team coordinates all medical, behavioral health, and other services necessary to help these children and their families live life to the fullest. “Traditionally, parents or family members have had to play care coordinator, patient advocate, and caregiver for their chronically ill children while trying to be a parent at the same time,” said Dr Johnson. “At Children’s Care, dedicated care coordinators relieve parents of the burden of appointment tracking, insurance authorizations, information transfer, and monitoring of the plan of care so they can focus on being parents.” By taking financial responsibility for the care provided to whole populations of patients, Children’s Care has eliminated many of the redundancies of typical health insurance activities like case management and lengthy approval processes.

Services at Children’s Care are covered by Medicaid, most major health plans, and employer-sponsored health insurance. Prices for all services are available on the Children’s Care Web site, and any amounts not covered by insurance, including copays and deductibles, are clearly presented to families at the time of service.

Many employers, Medicaid agencies, and insurance companies have chosen Children’s Care as their exclusive provider of pediatric care services. Children’s Care is responsible for the quality and total cost of the care provided and uses the latest population health tools to ensure that all children receive the right care, at the right time, in the right setting, at the right cost.

This fictitious description of a comprehensive provider system describes a significant change from how pediatric care has been provided in the past. Improvements in technology and the transition to value-based payment systems make most of this possible today in communities across the country. So far, the pediatric provider community has been reluctant to stray from our traditional model of care. Now consumerism and the demand for value are in the driver's seat. Pediatricians, health systems, and all who provide health care for children must work together to develop novel solutions that get patients, families, and purchasers where they want to go or risk being left behind.

• Copyright © 2017 by the American Academy of Pediatrics