Advancing Value-Based Population Health Management Through Payer-Provider Partnerships: Improving Outcomes for...

Area of Science:

• Healthcare Management
• Pediatric Care
• Value-Based Healthcare

Background:

• Existing population health management (PHM) strategies have limitations in improving healthcare cost and quality.
• Integrated delivery and financing systems face challenges in managing care for pediatric populations with complex conditions.

Purpose of the Study:

• To design, implement, and test a scalable value-based care model for children with medically complex conditions.
• To evaluate the impact of the model on healthcare costs and quality of care within a real-world setting.

Main Methods:

• A value-based care model incorporating interdisciplinary infrastructure, analytics, alternative payments, consumer spending accounts, and shared savings was implemented.
• Four practices enrolled 215 children (
• Propensity score matching was used to compare outcomes between intervention and comparison groups over a 2-year period.

Main Results:

• The intervention group demonstrated cost savings over the 2-year performance period, though not statistically significant compared to the control group due to small sample size.
• Quality of care metrics were maintained or improved from baseline to the end of the performance period for the intervention group.
• The model highlighted the utility of real-world laboratories and payer-provider partnerships in testing PHM initiatives.

Conclusions:

• The tested value-based care model shows promise for reducing healthcare costs while maintaining or improving care quality for children with medically complex conditions.
• Real-world laboratories leveraging payer-provider collaborations are effective platforms for evaluating innovative PHM models.
• Further research with larger sample sizes is warranted to confirm cost-saving impacts.