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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Pediatrics Perspective

The Need for New Cost Measures in Pediatric Value-Based Payment

Nathaniel Z. Counts, Kamila B. Mistry and Charlene A. Wong
Pediatrics February 2021, 147 (2) e20194037; DOI: https://doi.org/10.1542/peds.2019-4037
Nathaniel Z. Counts
aCare Management Organization, Montefiore Medical Center, Bronx, New York;
aCare Management Organization, Montefiore Medical Center, Bronx, New York;
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Kamila B. Mistry
dDepartment of Pediatrics, School of Medicine, John Hopkins University, Baltimore, Maryland; and
dDepartment of Pediatrics, School of Medicine, John Hopkins University, Baltimore, Maryland; and
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Charlene A. Wong
eChildren’s Health & Discovery Initiative, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina; and
fDuke-Margolis Center for Health Policy, Washington, District of Columbia
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  • Abbreviations:
    APM —
    alternative payment model
    InCK —
    Integrated Care for Kids
    TCOC —
    total cost of care
  • Value-based payment reform is gaining momentum as health care stakeholders seek to reduce costs and improve quality. Reforms have not been evenly distributed, with most alternative payment models (APMs) being focused on adults. The relative lack of child-focused APMs represents a missed opportunity. Early life interventions can improve children’s cognitive and behavioral development, resulting in reduced costs over a lifetime; however, such interventions require new financing models to be sustainable.1

    The Center for Medicare and Medicaid Innovation’s recent Integrated Care for Kids (InCK) Model, which requires APM development to support the integration of health care and other family-serving sectors, offers new momentum for child-focused payment reform.2 To capitalize on the reform opportunities, new cost measures for APMs are needed that better capture the value of children’s healthy development and promote greater investment for preventive interventions during this critical life stage.

    Cost Measures in Use Today

    Cost measures play a vital role alongside quality measures in shaping the incentives within an APM. Cost-of-care measures capture the total spending on health care services for a specific duration of time, population, or care setting. APMs use cost measures to ensure that the total amount paid out is not more than what would otherwise be spent absent the APM. For example, the total cost of care (TCOC) captures the total spending for a patient population over a certain duration …

    Address correspondence to Nathaniel Z. Counts, JD, Mental Health America, 500 Montgomery St, Suite 820, Alexandria, VA 22314. E-mail: ncounts{at}mhanational.org

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    Pediatrics
    Vol. 147, Issue 2
    1 Feb 2021
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    The Need for New Cost Measures in Pediatric Value-Based Payment
    Nathaniel Z. Counts, Kamila B. Mistry, Charlene A. Wong
    Pediatrics Feb 2021, 147 (2) e20194037; DOI: 10.1542/peds.2019-4037

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    The Need for New Cost Measures in Pediatric Value-Based Payment
    Nathaniel Z. Counts, Kamila B. Mistry, Charlene A. Wong
    Pediatrics Feb 2021, 147 (2) e20194037; DOI: 10.1542/peds.2019-4037
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