Genesis Health Consulting, PO Box 170724, Milwaukee, WI 53217, United States.
Fortify Children's Health, Children's Medical Group, Children's Hospital of the King's Daughters, Norfolk, VI, United States.
Curr Probl Pediatr Adolesc Health Care. 2021 Aug;51(8):101066. doi: 10.1016/j.cppeds.2021.101066. Epub 2021 Aug 25.
Pediatric-specific networks have emerged over the past decade as Medicaid payment models have shifted away from fee-for-service, which rewards volume of service delivery, towards more value-based payments that incentivize improved health outcomes. More recently, growing recognition that health care alone is insufficient to produce health has resulted in the Centers for Medicare and Medicaid Services advancing value-based payment models that allow greater flexibility for networks to address the "social determinants of health" - those social and economic conditions which significantly influence health outcomes. Although pediatricians have long advocated for understanding and addressing social health needs, pediatric networks must now determine their role in managing or mitigating the impact of these complex factors on the health of their attributed populations. Pediatric networks can implement basic screening and referral processes to address social health needs, invest network resources in direct service provision, and/or leverage the network's expertise in child health to influence upstream changes in health policy. This article presents some questions that pediatric networks can use to explore their potential role in managing social health needs.
在过去十年中,随着医疗补助计划的支付模式从按服务收费(按服务量付费,奖励服务交付量)转向更注重价值的支付方式,以激励改善健康结果,儿科特定网络已经出现。最近,越来越多的人认识到,仅仅提供医疗保健不足以促进健康,这导致医疗保险和医疗补助服务中心(Centers for Medicare and Medicaid Services)推进了基于价值的支付模式,为网络提供了更大的灵活性,以解决“健康的社会决定因素”——那些对健康结果有重大影响的社会和经济条件。尽管儿科医生长期以来一直倡导了解和解决社会健康需求,但儿科网络现在必须确定他们在管理或减轻这些复杂因素对其归属人群健康的影响方面的作用。儿科网络可以实施基本的筛查和转介程序来解决社会健康需求,在网络资源上投资于直接服务提供,和/或利用网络在儿童健康方面的专业知识来影响健康政策的上游变化。本文提出了一些问题,儿科网络可以用来探讨他们在管理社会健康需求方面的潜在作用。