For the past two years, Children's Hospital Boston has taken a proactive, multidisciplinary approach to improving the quality and value of its pediatric care services.
Children's has partnered with primary care physicians and insurers to better integrate care and develop innovative approaches and care models, piloted programs that have improved health outcomes and reduced costs, and renewed its focus on prevention.
"As health care providers and consumers, we've all been inundated with statistics about the rising cost of health care in Massachusetts and nationwide," says Children's CEO, James Mandell, MD. "At Children's, we're doing something about it."
Dr. Mandell notes that while children don't need health care services as frequently as adults, when they do become ill, they are more fragile and require more resources—including more nursing care, specialized equipment and pharmacists to reformulate medications tested only on adults. On average, children are twice as sick as adults when they are hospitalized. Younger children in particular are especially vulnerable to rapid deterioration because of their small physiological reserves and immature immune systems.
According to President and Chief Operating Officer, Sandra Fenwick, Children's now cares for 90 percent of the sickest children in Massachusetts, nearly a third of whom rely on the state and federal Medicaid program to pay for their care. Children's also serves as the community hospital for children who live in the city of Boston.
"Because of the major role we play, we have a responsibility to tackle the cost issue head on—to ensure that health care remains affordable for families," she says. "That's why Children's and its physicians voluntarily lowered our rates and prices to Massachusetts health insurers by more than $105 million last year and absorbed $26 million in Medicaid cuts—all without cutting services or sacrificing the quality of the life-giving care we offer."
Fenwick cites a number of efforts to increase efficiency, including more productive use of operating rooms, quicker turnover of beds, and shorter emergency room wait times. "All of these initiatives reduce the cost per patient and improve the patient's experience," she says.
Also on the horizon are price reductions for tests and services that are currently offered in the community at lower cost, information technology enhancements that will allow community-based physicians to view information about their patients in the Children's electronic health record system and additional efforts to improve care coordination.
She also points to the following examples of how Children's is eliminating unnecessary care, moving care to lower cost settings and preventing disease:
Through its home hydration program, children undergoing chemotherapy are now able to get their IV hydration at home, saving more than $900,000 a year in hospitalization costs.
Its headache collaborative is bringing together community-based pediatricians and Children's neurologists to better diagnose and treat headaches, one of the most common childhood complaints that result in referral to specialists. The goal is to give pediatricians the support they need to manage more of these cases in their offices and reduce the number of unnecessary brain imaging tests. To date, the pilot program with Harvard Vanguard Medical Associates pediatricians has shown great success, and Children's hopes to expand the program to other referrers in the near future.
As a result of its Community Asthma Initiative, children with severe asthma have had 83 percent fewer admissions and 65 percent fewer ED visits. Nurses visit parents after a child has been discharged to make sure that they have their child's medicine, know how to administer it and have a follow-up appointment with a pediatrician. The program also provides home inspections for mold and pests and vacuum cleaners for parents who don't have them.
An important venue for moving innovative programs forward has been the Provider-Payer Quality Initiative (PPQI), a unique partnership that Children's forged with the state's major health plans and the Massachusetts Medicaid Program in the fall of 2009. The 10-member panel, with equal representation from Children's and the participating insurers, meets on a regular basis to provide strategic insights on proposed new approaches and models of care.
In addition to supporting programs like the headache collaborative, the PPQI had an important role to play in the rollout of SCAMPs (Standardized Clinical Assessment and Management Plans), a framework developed by Children's cardiovascular physicians that uses the best evidence to standardize care plans for many common clinical conditions and then captures data to continually refine the plans.
Another example of how the hospital is improving quality and efficiency is the work it is doing with the Pediatric Physicians' Organization at Children's to implement the Family-Centered Medical Home model across its network of 72 pediatric primary care practices. It uses care management practices to coordinate a patient's care over time, and has gained attention nationally because of its demonstrated ability to lower overall health care expenditures while focusing on prevention and community-based primary care.
"Innovation drives improvements from the research bench to the bedside," says Dr. Mandell. "It has also helped us drive savings for the health care system while ensuring that we can continue to provide world-class care to every child who needs it."
"We believe that the value that we bring to our patients, their families and society is high-quality care, exceptional service and innovation at a reasonable cost," he adds. "We promise to continue to deliver on all components of this important equation."
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