Aligning Incentives for Kids’ Health

What kind of change could occur if advocates for kids’ health shared similar incentives? Today, partnerships between key stakeholders – health systems, providers, community organizations, payors – are complicated because of the distinct, contradictory incentives that shape their work.

For example:

• Hospitals are largely paid on case rates, while physicians are often reimbursed on a fee-for-service basis.
• Health insurers are still designed to limit medical spending, rather than promote the utilization of services that improve overall wellness and reduce medical risk, which may not be within the medical field.
• Community organizations, whose work contributes to better health outcomes, are often funded through a mix of public and private dollars, with each funding stream attached to different eligibility criteria, measures of success, and funding horizons.
• Families are taking on greater shares of their healthcare spending through employer-based cost sharing or high deductibles. Though they have an incentive to be discerning consumers of health care services, there is limited transparency and comparability of critical data points like total cost, out-of-pocket share, quality, and safety outcomes.

These financial incentives are so familiar to each stakeholder that they almost become invisible, accepted as beyond change. In truth, these incentives, and the systems that perpetuate them, can change. And, in doing so, can facilitate even more effective partnerships to improve kids’ health.

Where to start:

Today, stakeholders use disparate methods to categorize the children and families they serve, if they record service-delivery data at all. Children may be identified by a medical record number, a Medicaid identification number, a Social Security number, a child welfare case number, a student identification number, or so on. These identifiers do not translate across different systems, nor do they consistently roll up to a family unit. Research clearly shows that, particularly for pediatric populations, understanding and engaging the family unit is critical to achieving long-term, positive results in health and stability.

One way to facilitate this work is to endorse a shared, unique indicator to identify children, coordinate care, and measure outcomes. If organizations can illustrate the real journey a family takes through different social, medical, and community programs, they will be better able to articulate opportunities for alignment, the potential for improved outcomes, and shared measures of success.

No silver bullet can address the complex and conflicting incentives in the broader health care community. These incentives have taken years to evolve, and will take years to organize and align. However, if organizations have support to begin understanding and communicating about the populations they serve in a consistent, shared language, one major barrier to the ultimate outcome has been reduced.

Learn more about how Genesis Health Consulting can support your organization’s goals by contacting us at [email protected].