An unprecedented partnership with the state’s largest health plans

by James Mandell, MD, CEO on November 4, 2009

 

James Mandell, MD

As Washington works toward national health reform, we’re pleased to announce that Children’s has established an unprecedented partnership with the state’s largest health plans to help accelerate the transformation of the pediatric care delivery system by expanding innovative approaches and models of care. Working with Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care and Tufts Health Plan, Children’s and its physicians volunteered to cut its fiscal year 2010 payment rates. A portion of these savings will be targeted to support such efforts as:

  • SCAMPs (Standardized Clinical Assessment and Management Plans) – a revolutionary way to provide clinicians with immediate feedback on the success of their treatments. It uses the best evidence to guide testing and treatment decisions, and the best judgment of practicing physicians to standardize care plans for clinical situations. Most important, the approach allows clinicians to continually refine treatment approaches to deliver the best outcome.
  • Integrated Care Models – a crucial element of the primary care model known as the family-centered Medical Home, in which a primary care provider works in partnership with families to coordinate care for their children. The fund will expand and accelerate implementation pilots to more efficiently coordinate care of chronically ill patients with diabetes, asthma and other conditions.
  • Next Generation Information Technology – are vital to our role as innovators of models of care and the patient experience. In addition to the technology behind SCAMPs, Children’s developed “MyChildren’s,” the first pediatric patient and family controlled medical records fed by both pediatric and specialist health care providers.

It’s our belief that these efforts will help improve health outcomes and reduce costs by eliminating care that is not effective and over utilized.

The health plans, along with the State’s Medicaid Program and Children’s representatives will form an advisory panel to provide strategic guidance. By bringing together insurers’ broad experience with clinical quality metrics and appropriateness of care and the pediatric expertise of Children’s and its clinicians, we’ll be better able to standardize the approach to high quality, effective and efficient pediatric care.

As a cautionary note – efficiency for efficiency sake has its own problems. If hospitals become more efficient so that they can put more volume through the system, that potentially opens up the pipeline for more overtreatment. We must not avoid a comprehensive approach that looks at models of care, quality through evidence-based care, transparency, benchmarking and sharing of data, service improvements through re-engineering, information systems innovation and rapid translation of research findings to the bedside. All these efforts ultimately serve the same purpose – bringing the best outcome and experience to patients and their families, while maximizing efficiency and minimizing costs.

Much like how Massachusetts has served as a model for national health reform, this partnership, and the innovative models and approaches being developed may serve as a ‘learning laboratory’ for the rest of the nation.

3 comments

  • http://tuftshealthplan.com Jim Roosevelt

    On behalf of Tufts Health Plan, we are excited about Children’s Hospital’s innovative thinking, and are glad to partner in this initiative. Opportunities to collaborate in this way hold real promise for improving quality care while reducing premium cost–good news for all of us.

  • Andrew Dreyfus

    Congratulations to Children’s. This is a bold action that again puts them at the forefront of pediatric medicine. We will all closely follow the progress of SCAMPS – it has the potential to be a model for others struggling to achieve the goal of improved safety and reduced costs in a pediatric setting.

    Andrew Dreyfus
    Blue Cross Blue Shield of Massachusetts

  • Pingback: Top pediatric health stories of 2009()

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