Children’s health care CDA overview
A care delivery area (CDA) is an innovative value-based payment (VBP) arrangement. See the VBP Roadmap for Coordinated Care Organizations.
Innovative payment models for children’s health care should focus on the healthy growth and development of children specific to each developmental stage and provide the unique opportunity to improve health and life trajectories. Further, because children depend on caregivers for much of their well-being, payment reforms should encourage care that addresses needs within families. Finally, to meet children’s unique health needs, payment models may account for both disease prevention and the rare chronic conditions treated in children’s health care.
There is no limitation on the specific types of providers who may be included in the children’s health care VBP, but payment models may only be applied to providers caring for members 0–18 or a subpopulation of members within. Providers include but are not limited to pediatricians, primary care, specialists and psychiatrists.
Alternative Payment Models for Healthy Steps
Healthy Steps Zero to Three
- A framework for states, health plans, health systems and pediatric primary care providers developing a VBP model based on the Healthy Steps model.
Key points: Healthy Steps is a population-based, risk-stratified model that helps to operationalize and enhance the American Academy of Pediatrics Bright Futures recommendations.
Alternative Payment Models to Support Child Health & Development: How to Design and Implement New Models
Duke University, Margolis Center for Health Policy
- Outlines a series of considerations organizations should include in implementing VBPs for children's health and development.
Key points: Identifies opportunities to encourage coordination across health care and social services, and identifies opportunities to provide greater local flexibility for child-focused VBPs.
Oregon Integrated Care for Kids (InCK) Model
Oregon Health Authority/CMS Center for Medicare and Medicaid Innovation (CMMI)
- Oregon is one of eight states with InCK initiatives from CMMI. The Oregon Health Authority and the Oregon Pediatric Improvement Partnership lead the initiative to be implemented in partnership with regional core child service partners and CCOs in Oregon.
Key points: The InCK initiative requires the development and implementation of VBPs to align payment with care quality and accountability for improved child health outcomes starting in 2023.
Payment for Progress: Investing to Catalyze Child and Family Well-Being Using Personalized and Integrated Strategies to Address Social and Emotional Determinants of Health
The Child and Adolescent Health Measurement Initiative/Academy Health
- Strategies and recommendations on VBP payment approaches and policies to promote positive social and emotional determinants of health and address risks like adverse childhood experiences and the stress and trauma that can result from adverse family and community experiences.
- Payments to improve child and family well-being
- Support enhanced and personalized well-child care
- Build sustainable capacity for transformation
Pediatric Value-Base Care Models
Moving Health Care Upstream Initiative Issue Briefs
- Nemours Children's Health System and the Duke-Margolis Center for Health Policy partnered on issue briefs that provide recommendations on pediatric VBP and integrated care models that address social drivers and promote health equity.
Key points: Emerging examples of pediatric VBP with recommendations.
Recommendations for Value-Based Transition Payment for Pediatric and Adult Health Care Systems: A Leadership Roundtable Report
The National Alliance to Advance Adolescent Health
- The results and recommendations on VBP from a roundtable of child/adolescent health experts, providers, payers and other stakeholders with a review of VBP initiatives and findings.
Key points: Recommendations with rating for six VBP options and selected quality measures in the triple aim domains of population health, experience, and costs of care.
Value-based Payment Models for Medicaid Child Health Services
- Supported by New York's United Hospital Fund, this report proposes a child-centered approach to value-based payment in Medicaid based on review of children's services, literature on children's health and health care, and expert interviews.
- Differences in children’s health care utilization compared to adults and the value of children's health point to a different approach to VBP.
- Payment models need to address screening and effective interventions to address psychosocial risks and scioeconomic risk and consider approaches that address parental health and well-being.
- Separate payment strategies are needed for very high-need children where service needs generate high costs and are generally addressed by specialists.
- The value for children is unlikely to generate short-term savings and may require an upward adjustment in capitated payments for primary care.
Value-based Payment to Support Children's Health and Wellness: Shifting the Focus from Short-term to Life Course Impact
Center for Health Care Strategies
- Key points: Examples of Medicaid VBP models serving children, key themes, and policy considerations to help Massachusetts better meet children’s needs. The lessons can inform payers and providers in other states.
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