儿科责任医疗保健社区：对所需能力和潜在解决方案的洞察。

Pediatric accountable health communities: Insights on needed capabilities and potential solutions.

机构信息

Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA.

Duke University School of Medicine, Durham, NC, USA; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

出版信息

Healthc (Amst). 2020 Dec;8(4):100481. doi: 10.1016/j.hjdsi.2020.100481. Epub 2020 Oct 7.

DOI:10.1016/j.hjdsi.2020.100481

PMID:33038579

Abstract

BACKGROUND

Pediatric accountable health communities (AHCs) are emerging collaborative models that integrate care across health and social service sectors. We aimed to identify needed capabilities and potential solutions for implementing pediatric AHCs.

METHODS

We conducted a directed content analysis of responses to a Request for Information (RFI) from the Center for Medicare & Medicaid Innovation on the Integrated Care for Kids Model (n = 1550 pages from 202 respondents). We then interviewed pediatric health policy stakeholders (n = 18) to further investigate responses from the RFI. All responses were coded using a consensual qualitative research approach in 2019.

RESULTS

To facilitate service integration, respondents emphasized the need for cross-sector organizational alignment and data sharing. Recommended solutions included designating "Bridge Organizations" to operationalize service integration across sectors and developing integrated data sharing systems. Respondents called for improved validation and collection methods for data relating to school performance, social drivers of health, family well-being, and patient experience. Recommended solutions included aligning health and education data privacy regulations and utilizing metrics with cross-sector relevance. Respondents identified that mechanisms are needed to blend health and social service funding in alternative payment models (APMs). Recommended solutions included guidance on cross-sector care coordination payments, shared savings arrangements, and capitation to maximize spending flexibility.

CONCLUSIONS

Pediatric AHCs could provide more integrated, high-value care for children. Respondents highlighted the need for shared infrastructure and cross-sector alignment of measures and financing.

IMPLICATIONS

Insights and solutions from this study can inform policymakers planning or implementing innovative, child-centered AHC models.

LEVEL OF EVIDENCE

Level V.

摘要

背景

儿科责任医疗社区（AHCs）是一种新兴的协作模式，整合了医疗和社会服务部门的护理。我们旨在确定实施儿科 AHC 所需的能力和潜在解决方案。

方法

我们对医疗保险和医疗补助创新中心（Center for Medicare & Medicaid Innovation）关于儿童综合护理模式（Kids Model）的信息请求（RFI）的回复进行了定向内容分析（n=202 名受访者的 1550 页）。然后，我们采访了儿科卫生政策利益相关者（n=18），以进一步调查 RFI 的回复。所有回复均于 2019 年采用共识定性研究方法进行编码。

结果

为了促进服务整合，受访者强调需要跨部门组织协调和数据共享。建议的解决方案包括指定“桥梁组织”以在各部门之间实施服务整合和开发综合数据共享系统。受访者呼吁改进与学校表现、健康的社会驱动因素、家庭福祉和患者体验相关数据的验证和收集方法。建议的解决方案包括协调卫生和教育数据隐私法规并利用具有跨部门相关性的指标。受访者认为需要在替代支付模式（APM）中融合健康和社会服务资金的机制。建议的解决方案包括关于跨部门护理协调支付、共享储蓄安排和人头费的指导，以最大限度地提高支出灵活性。