The American Academy of Pediatrics has long been focused on improving the systems of healthcare that stand to benefit children and their families. Throughout their history, the AAP and its lineup of Presidents and distinguished members have taken stances to pioneer environmental health, expand access to healthcare for all children, invest in the science of pediatric medicine, and advocate for policy at the state and national level. Today, the AAP stands poised to speak louder and more clearly than ever before on a subject that many pediatricians put second only to the care of their patients: getting paid fairly and appropriately for their work.
The COVID-19 pandemic shook the world, and the pediatric healthcare system is no exception. Practices continue to recover from the enormous changes that the pandemic required of families and healthcare systems. Physicians are focused on getting children caught up on vaccinations after “the largest backslide in routine immunizations in 30 years,” according to a 2022 report by UNICEF. Practices are striving to increase recall rates to recover their finances. Staffing shortages are causing a storm in private practices who cannot seem to keep staff from jumping ship to hospitals with attractive pay and benefits.
In the wake of the turmoil in which pediatricians, alongside other healthcare workers and teachers, helped the world recover, the American Academy of Pediatrics is taking its loudest stance to date on the need for Congress to reevaluate pediatric healthcare payment models. Alongside other organizations, it’s possible that the AAP’s advocacy means that the tide is shifting in favor of true healthcare reform, and that children, families, and independent practices alike stand to benefit.
The AAP and other organizations like the Primary Care Collaborative are speaking up for pediatric healthcare payment reform.
In a landmark policy statement, the AAP is laying out exactly the reasons why – and how – payment reforms are necessary for the future health and wellbeing of children, families, and the American healthcare system. The policy marks an assertive change in the way that the AAP voices its desires to Congress and state Medicaid organizations.
“Society benefits from having a physically and emotionally healthy … population of young adults who can strengthen the economy … in an increasingly complex economic environment,” the policy statement reads in part. As the current healthcare system is built around the needs of adults, its foundations must be challenged and changes implemented to ensure long term healthcare value.
In a world where healthcare value is defined as outcomes relative to costs, the AAP describes why investment in pediatrics is different than generalized healthcare: the pediatric population has diverse needs that shift as children grow; the population is more ethnically diverse than any other age group; children are most likely to live in poverty than any other age group. These circumstances dictate specific and diverse healthcare needs that stand to benefit children all their lives. They also outline the need for specific healthcare infrastructure in policy and in disaster relief, so that all communities are prepared for the needs of children as well as adults.
The policy goes on to describe the needs of an improved healthcare system as one that would embrace value-based payment models, a model in which insurance companies, state and federal governments, and families benefit from long-term investment in pediatric healthcare. As the largest payor for children, the AAP identifies Medicaid as a prime opportunity for innovation and study over the long term for value-based payments. The AAP emphasizes the need for value-based services to include focuses on healthcare collaboration, mental and behavioral health services, prevention and early intervention, and payment for technologies that don’t require a doctor to be in person (suchThe Primary Care Collaborative aims to “secure policy change that improves the health and well-being of patients… by increasing investment in primary care and promoting primary care payment models”.
In its Better Health Now initiative, the Primary Care Collaborative aims to bring goals of primary care payment models to other key stakeholders to invoke healthcare system reform that would refocus primary care on communities and whole-person health.
The Collaborative’s perspective is that payment reform and primary care focus is a critical target for healthcare reform because primary care providers are uniquely poised to contribute the most good towards communities and long-term healthcare investments. “COVID-19 has laid bare the deadly consequences of persistent inequities in access to care across racial, social, and economic groups,” their campaign website states, “Yet structural economic forces and institutional racism were ravaging communities before the virus arrived.”
The AAP and Primary Care Collaborative align on their mission: to improve payment models for primary care to improve community health via the powerful vehicles of Medicare and Medicaid. The Primary Care Collaborative operates on 7 principles that dictate that primary care should be patient-centered, coordinated, continuous, equitable, high value, collaborative, and accessible. The AAP has signed on to both these principles and to the Better Health Now campaign.
What do pediatricians stand to gain? How can my practice get involved?
Pediatricians, as primary care providers, deserve to be paid appropriately for their work. The AAP’s policy statement and the work of the Primary Care Collaborative’s Better Health Now campaign go far beyond making sure to bill individual visits and phone calls appropriately – it is a long-term shift in the way that doctors and nurses are paid for their work, so that they may reinvest in their communities in ways that improve the lives of children and families.
Some of the proposed reforms include a shift towards community-based care in which a child has equitable access not only to their pediatrician, but to relevant specialists. The patient and family would have key decision-making powers in the child’s healthcare journey, helping healthcare teams to better understand the health of the “whole child” – the patient’s physical, emotional, and mental health, as well as their social context. The collaboration of integrated healthcare teams would allow pediatricians to better understand and identify inequities that prevent all children from reaching their potential.
Payment reforms that focus on value-based care and community-focused healthcare stand to benefit independent pediatricians as cornerstones of communities. When physicians have access to integrated care networks as well as a payment model that allows them to remain in business, more children in more communities have access to reliable, trusting physician-patient relationships that improve their healthcare overall.
Practices can sign on to the Primary Care Collaborative’s Better Health Now campaign to indicate support for the campaign and bring more weight to conversations around healthcare policy. Pediatricians can support the AAP by becoming members, and members can participate in their state’s AAP branch to show support for payment reform.
How long it will take for the American healthcare system to recover from the pandemic and embark on an unprecedented overhaul, it’s impossible to say. The work of pediatricians, policymakers, and organizations such as the Primary Care Collaborative ensure, however, that children’s voices and needs are heard in high places, and that no matter how long change may take, pediatricians are prepared for the challenge.