Closing the Pediatric Care Gap Through Primary Care Reimbursement Reform: Chris Johnson, MBA

Chris Johnson, MBA, founder and CEO of Bluebird Kids Health, identifies the emergence of "pediatric care deserts" as a primary driver of health care inequality. In some communities, the ratio of clinicians to patients is as low as 1 pediatrician for every 6000 to 7000 children. Because local pediatricians cannot handle this volume, families frequently turn to emergency departments (EDs) for routine needs like earaches or strep throat.

This creates a significant disparity in care utilization where children on Medicaid use emergency medicine at 4 to 5 times the rate of children with commercial insurance in the same community. Johnson argues this is not because Medicaid recipients are sicker but because they lack access to primary care. This reliance on EDs is inefficient, expensive, and fails to address the root causes of chronic conditions such as asthma or behavioral health issues, which require longitudinal care planning rather than acute interventions.

A significant barrier to care is the financial structure of pediatric practices. In many states, he explains, Medicaid reimbursement rates do not cover the full operating costs of even a small practice. Consequently, many pediatricians face a difficult dilemma: they must either refuse Medicaid patients entirely or strictly limit their volume to ensure that higher-paying commercial insurance covers their overhead.

From a policy standpoint, Johnson suggests a shift in how resources are allocated. Currently, significant funding is directed toward expensive acute care and emergency procedures. He argues that by increasing reimbursement for primary care, policymakers could incentivize pediatricians to open up access. While this would increase utilization of primary care services, it would likely result in a dramatic decrease in high-cost downstream utilization of emergency departments and inpatient care, ultimately creating a more sustainable and effective health care ecosystem for families.

Watch part 1 of Johnson’s conversation with The American Journal of Managed Care^® here.