Health Promotion

A Pound of Cure… How Might We Pay For an Ounce of Prevention?

By: Jesse Chandna and Scott Orsey

Social determinants of health, the circumstances in which people live and work, have a profound impact on the overall outcomes of children and their families. That is why Connecticut Children’s places a priority not only on addressing the medical and surgical needs of young patients, but also on prevention by addressing factors, such as healthy housing, transportation, and adverse childhood experiences, that impact children and youth outside of our hospital walls. As society increasingly recognizes this same connection, we will be able to further develop the means to embed social determinants of health and innovative interventions in everything we do.

We are encouraged by an annual report recently published by the PwC Health Research Institute that identifies key topics that will have the most impact on the health care industry in 2018. This year’s report focuses on how health care providers and insurers can increase enterprise resilience, which is the ability for organizations to adapt to short- and long-term change, in an industry that’s undergoing considerable transformation from a variety of factors including, but not limited to: political uncertainty; business model uncertainty due to efforts to reform how providers are reimbursed for care; new entrants into the industry, such as the Amazon-Berkshire Hathaway-JP Morgan Chase joint venture to improve health care for their employees; and the consumerization of health care.

In these uncertain times, we are pleased to see that the report identified prevention through addressing social determinants of health as a risk-mitigation strategy for health care providers. This is significant because treating social determinants of health like other risk mitigation strategies, such as infection prevention and emergency preparedness, allows the sector to place a value on upstream interventions and thus offers an impetus to fund them. The report also identified social determinants of health as an important strategy that health systems can leverage to create efficiencies that will facilitate adaptation to an uncertain environment as payment reform efforts escalate. We are excited that insurers and providers appear increasingly ready to embrace shared-risk payment models that reward providers for the value of care they provide to patients, and the extent to which they keep patients healthy, rather than paying them simply for the volume of patient care they provide.

On our journey to be at the forefront of population health management, Connecticut Children’s has incorporated social determinants of health into its operations for many years. This stems from a realization by care providers and hospital leadership that many of the delays and disorders treated at our facility could have been more efficiently addressed through early identification and intervention, as well and by connecting families to community-based resources at the earliest opportunity.

In 2012, Connecticut Children’s formed Connecticut Children’s Office for Community Child Health (Office) to promote children’s optimal healthy development. One way the Office does that is through addressing the social determinants of health by increasing partnerships and collaboration between internal community-oriented programs and external community-based efforts across all sectors influencing child health and well-being. Now, Office programs and initiatives are being implemented across Connecticut and in more than 28 states, with targeted support from public and private sources including federal and state agencies, corporations, and foundations.

Now that the Office’s infrastructure is established, we are working to quantify the cost savings and associated return on investment, and the impact of our work on children and families in order to strengthen our competitive position as conversations regarding pediatric payment reform intensify. There is much work to be done to pinpoint these metrics, largely because the long-term outcomes we seek are difficult to measure since the benefits of our work often fall in sectors outside child health services. For example, helping a young, at-risk child obtain early intervention for mild developmental or behavioral concerns likely yields significant future savings not only in the child health services sector, but also in special education expenses or even juvenile justice. Similarly, early intervention with public safety, food insecurity, housing and other social factors yields savings across a multitude of sectors.

As we work to calculate the specific return on investment for our work through Connecticut Children’s Office for Community Child Health, we will continue to build the programs that will successfully deliver the outcomes we seek.

Both Connecticut Children’s and Connecticut Children’s Office for Community Child Health are excited to embrace pediatric payment reform models that support a shift towards value-based care and prevention. We are confident our work to address social determinants of health in a cross-sector manner will be the standard of care to achieve population health for generations of children to come.

Jesse Chandna is a strategic finance manager for Connecticut Children’s Medical Center.

Scott Orsey is the associate director for operations, business strategy and institutional engagement for Connecticut Children’s Office for Community Child Health.

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