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The Pediatric ACO: A New Frontier in Accountable Care
Anthony D. Slonim, MD, DrPH
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The Pediatric ACO: A New Frontier in Accountable Care

Anthony D. Slonim, MD, DrPH
Considerable attention has been devoted to managing populations around the value proposition. Children, as a population, have received little attention in the accountable care organization (ACO) realm. This manuscript contrasts some of the similarities and differences between adult and pediatric ACOs.
The number of accountable care organizations (ACOs) continues to grow, with more than 700 in place across the country, according to Leavitt Partners.1 Although most ACOs are dedicated to providing adult healthcare, only a few are currently focused on pediatric care.

One of the central promises of accountable care is that it will deliver more value—defined simply as better quality at lower costs—than the current fee-for-service model. Today, healthcare leaders have a significant opportunity to leverage the ACO model to improve clinical and financial outcomes among children.

National data demonstrate that the current model of delivering and paying for pediatric healthcare continues to fail one of the most vulnerable populations: young people. For example:
  • More than 17% of children aged 6 to 11 years are obese.2
  • Nearly 4% of those younger than 18 years lack a usual source of healthcare.2
  • Poor children fare worse than their wealthier peers when it comes to health status.3
  • The incidence of depression among teenagers continues to grow.4

How we address these issues today will have a significant impact on health outcomes in the next 10, 20, and 30 years. Forward-thinking healthcare organizations can address many of these issues in their own communities.

In northern Nevada, a health system, a university, a health plan, government agencies, and nonprofit community organizations are all collaborating on one of the country’s first pediatric ACOs. The difference between adult and pediatric ACOs are highlighted in Figure 1. Compared with the rest of the country, this community faces significant health challenges: nearly 1 of every 5 children lives in poverty,5 25,000 children are food insecure, and 300 are homeless.6 By coming together on accountable care and population health management, a diverse group of stakeholders hopes to reverse these trends by piloting new approaches to pediatric care.

Unique Challenges for a Pediatric ACO
To date, population health efforts in adult ACOs have been driven primarily to meet the requirements of CMS and commercial payers, whereas pediatric ACOs, lacking a defined set of priorities, tend to be driven by the specific needs of the communities they serve (Figures 1-3).

The most significant difference between adult ACOs and pediatric ACOs is in the baseline health of the populations they serve. On one hand, healthy patients present a challenge for providers because there is less room for improvement on key quality metrics. Because children tend to be predominantly healthy—only approximately 8% have a chronic disease that limits their activities7—their total cost of care tends to be lower than with an adult population.

On the other hand, working with a pediatric population offers providers a unique opportunity to shift their focus from healthcare to health given that most children are healthy and require mostly preventive and wellness care. Healthcare organizations have an opportunity to invest in strategies that make a significant difference in the quality of care for children, at a fraction of the cost of caring for adults. When caring for children, wellness and prevention programs that hinge on immunizations, nutrition, physical activity, and well-child care become vitally important.

By investing in these strategies early in life, healthcare organizations may also help to reduce some of the disease burden in their communities that result from conditions like diabetes, obesity, and asthma, as these patients grow into adulthood.

Critical Success Factors for a Pediatric ACO
Although there is no proven template for a pediatric ACO, the American Academy of Pediatrics has developed guidelines for healthcare organizations that aim to develop pediatric ACOs.8 In addition, many providers are designing their own strategies based on community needs. The following are some of the factors that will likely determine a pediatric ACO’s success:



 
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