Single (Aim)-minded strategies for demonstrating value to payers for youth with medical complexity

Michael Harris, Lena Teplitsky, Harpreet Nagra, Kim Spiro, David V. Wagner

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

In the current financial climate, health care institutions and providers experience substantial challenges in achieving the Triple Aim in health care reform (i.e., reducing costs, improving health, improving care). The present study describes the successes and challenges of garnering payment for a population health program, Novel Interventions in Children's Health care (NICH), for youth with both medical and social vulnerability. Using 4 real patient scenarios, this study provides examples of how to use economic data to demonstrate program value to key stakeholders (i.e., insurance providers, hospital administrators) and obtain authorization and payment for services. Health care utilization and cost data were retrieved through retrospective review of patient medical records and hospital financial records. NICH utilized distinct strategies to overcome systemic barriers, demonstrate value, and show need for intervention to key stakeholders. Strategies included highlighting patients': (a) history of utilization, (b) accumulated medical expenditures, (c) projected costs for anticipated procedures, and (d) social risk linked to poor health and high utilization. We describe each effort using real patient scenarios that feature varied medical conditions including Type 1 diabetes, chronic pain, and failure-to-thrive. Economic data can be a useful tool in garnering support for behavioral health interventions. And while these data offer programs like NICH the opportunity to make the case for investing in an alternative intervention, the strategies utilized by NICH to advocate for services can be applied by pediatric psychologists working with youth with medical complexity and social vulnerability.

Original languageEnglish (US)
Pages (from-to)152-163
Number of pages12
JournalClinical Practice in Pediatric Psychology
Volume6
Issue number2
DOIs
StatePublished - Jun 1 2018

Fingerprint

Child Care
Delivery of Health Care
Health
Patient Acceptance of Health Care
Economics
Hospital Administrators
Costs and Cost Analysis
Failure to Thrive
Health Care Reform
Population Control
Hospital Records
Health Expenditures
Insurance
Climate
Type 1 Diabetes Mellitus
Chronic Pain
Health Personnel
Health Care Costs
Medical Records
Pediatrics

Keywords

  • APMs
  • FFS
  • NICH
  • Triple Aim

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Clinical Psychology
  • Applied Psychology

Cite this

Single (Aim)-minded strategies for demonstrating value to payers for youth with medical complexity. / Harris, Michael; Teplitsky, Lena; Nagra, Harpreet; Spiro, Kim; Wagner, David V.

In: Clinical Practice in Pediatric Psychology, Vol. 6, No. 2, 01.06.2018, p. 152-163.

Research output: Contribution to journalArticle

Harris, Michael ; Teplitsky, Lena ; Nagra, Harpreet ; Spiro, Kim ; Wagner, David V. / Single (Aim)-minded strategies for demonstrating value to payers for youth with medical complexity. In: Clinical Practice in Pediatric Psychology. 2018 ; Vol. 6, No. 2. pp. 152-163.
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