Nemours and Delaware agree on new payment model to address children’s health

R. Lawrence Moss, MD, the president and CEO of Nemours Children’s Health, often says his organization’s mission isn’t simply to treat children who are sick, but to keep them healthy.

R. Lawrence Moss, MD, the president and CEO of Nemours Children’s Health, is excited about a new payment model with the state of Delaware for kids in the state's Medicaid program.

Now, Nemours and the state of Delaware are putting that approach to the test.

The state of Delaware and Nemours are moving forward on a new payment model involving the 120,000 kids in the state’s Medicaid program.

Rather than simply reimbursing Nemours for treating kids, the payment incentives are based upon the pediatric health system’s success in helping children stay healthy and avoid hospital treatment. The state of Delaware and Nemours are touting it as the nation’s first pediatric global budget model.

In an interview with Chief Healthcare Executive®, Moss says he’s excited about the initiative, even as he acknowledges the challenges of moving away from a fee-for-service model.

“We think of our patients, not just as kids who come to the hospital needing medical care, but every child trying to grow up healthy. And we want to take accountability and be involved in the health creation of all those kids, and this model is a great exemplification of that,” Moss says.

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Going against the tide

With the program, Nemours will be working to address the medical needs of children in the Medicaid program, as well as social factors that can impact the health of kids, including food insecurity and housing.

Nemours and the state of Delaware have been working on the arrangement for years.

Moss acknowledges that the effort won’t be easy.

“We’ve got 10,000 very special people that work for us and with us, and we have a board of directors who is visionary and forward thinking and is aligned with us going on this journey,” Moss says. “This is not for the faint of heart, and it's not for everybody. But we think it's for us, and we think we're going to be successful.”

When asked about the most challenging aspect of the new global payment model, Moss says it’s going against “the tide of healthcare.”

“Four and a half trillion dollars a year is going in one direction, and we're going in the opposite direction, and we think that's important,” Moss says. “But you know, if you want to picture swimming against the tide, that's what we're doing. There's a lot of economic forces that line up that would say, don't do this, but we believe it's the right thing to do, because it's the way to get to optimal health for children.”

Moss says he’s excited that Nemours and the state of Delaware have managed to get on the same side of the table with the state’s Medicaid program.

“This is a historic agreement about children's health,” Moss says. “The headline isn't, this is a new payment model. The payment mechanism is the lever to help us do some of this work. But the news is, we're partnering around child health.”

Addressing social needs

Moss says he’s anxious to try and make an impact in some of the social drivers of health among children.

“Literacy is hugely and directly related to health. The biggest predictor of whether a person will graduate from high school is their third grade reading level, and graduating from high school has a 12-year life expectancy advantage versus not graduating from high school. So literacy is health,” Moss says.

“Food security is another critical area that is super important and can make a real difference,” he adds. “Even early health behaviors taught in early childhood are shown to last a lifetime. So investments which are tiny in dollars but massive in terms of impact, is where we're trying to focus.”

In terms of reaching more kids, Nemours aims to tap its primary care network in Delaware to try and help keep kids healthy.

Nemours will also build on its work with Delaware schools, he says.

“We also have one of the largest and most comprehensive, school-based health programs of any health system in any state, and that's been a huge resource. Because if you want to reach kids, go where the kids are, and where are the kids all day long? They're in school.”

“The Delaware school districts have been really wonderful partners, and those relationships just continue to grow,” he adds.

In a project with the Department of Education, Nemours has been able to link children’s absences from school with their electronic health record in the pediatrician’s office.

“We know a child that misses a certain number of days of school consecutively, there's a high likelihood of a health problem, where we can intervene and turn things in the right direction,” Moss says.

‘A holistic approach’

Moss also says the new model should allow Nemours to offer more care for children with disabilities and complex medical needs, to keep them healthy.

“We as a health system need to do a lot better in coordinating that care and having a holistic approach to that care, so it isn't a game of Whack-a-Mole, but it's really comprehensive care,” Moss says. “Nemours is very committed to that. I think we do that very well, and I'm proud of how well we do that, but we can do it better. And this model, this agreement and partnership with the state that we're talking about today, is going to allow us even more levers to do even better.”

Hospitals have seen a surge of children showing up in emergency rooms due to mental health issues. Moss has said the pediatric mental health crisis has been building for years.

He hopes the new model will help address the mental health needs of some kids before they end up coming to the hospital for treatment.

“Our commitment to health outside the hospital very much plays into the root causes of behavioral health problems, and fits with my strong opinion that the answer to the behavioral health crisis in kids is not to build more and more inpatient behavioral health beds. It's to go at those root causes,” Moss says.

In terms of tackling issues like food insecurity, housing or literacy, Moss says he understands that Nemours isn’t the leading expert in those areas.

But that doesn’t mean Nemours can’t play a part in addressing those critical needs.

“We are the experts in medical care, but we believe we can and should be the conveners of all those other experts for a holistic approach,” Moss says. “So as a health system CEO, I'm not going to tell you I'm bringing expertise to the table about how to address housing costs. But we can bring the right partners to the table with us with a focus on child health, and the impact that housing changes can make on child health, and that's where we have standing.”

Moss credited former Delaware John Carney for his support in developing the new payment model. Carney’s tenure as governor, spanning two terms, ended last week.

"Making sure our children are healthy and able to be successful is as important as anything we do," Carney said in a statement. "I'm grateful for the hard work that the Department of Health and Social Services and Nemours Children's Health put into this effort to better support children across our state through innovative care."

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