Investing in Child Health Through Alternative Payment Models: Lessons From North Carolina Integrated Care for Kids

Area of Science:

• Health Services Research
• Pediatric Health Policy
• Value-Based Healthcare

Background:

• Pediatric value-based payment reform faces challenges due to limited ROI for child-specific measures and benefits accruing outside healthcare.
• Federally funded Integrated Care for Kids (InCK) models mandate child-centered alternative payment models (APMs) for Medicaid-enrolled children.

Purpose of the Study:

• To assess the design process of the North Carolina Integrated Care for Kids (NC InCK) pediatric APM.
• To develop strategies for future child-focused value-based payment reform by interviewing experts.

Main Methods:

• Qualitative study involving interviews with experts from NC Medicaid managed care organizations, NC Medicaid, and actuaries.
• Focused on assessing the NC InCK APM design process and identifying key principles for reform.

Main Results:

• Key principles identified include aligning with payer priorities, addressing data uncertainty's impact on investment, and reconciling short-term ROI with whole child health.
• State levers such as mandates and financial incentives are crucial for promoting the implementation of novel pediatric measures.

Conclusions:

• Successful child-focused value-based payment reform necessitates a strategic approach that considers payer readiness, data infrastructure, and long-term investment horizons.
• Future reforms should leverage state-specific mechanisms to encourage the adoption of comprehensive, child-centered payment models.