Insights for Change

Divine Inspiration for Connecticut’s Health Care Transformation

By: Paul H. Dworkin, MD

The Old Testament seems an unlikely source for inspiration on healthcare reform.  Nonetheless, the admittedly commonplace quote, “….a little child shall lead them,” (Isaiah 11:6) may be regarded as applicable to our state’s notable efforts to transform healthcare delivery through a series of ambitious strategies.  If successful, Connecticut will defy its “land of steady habits” moniker and leapfrog to the forefront of states’ health reform efforts that include an emphasis on children.

The signing into law by President Obama of to the Affordable Care Act (ACA) in 2010 triggered a wide range of delivery system reforms to improve the quality of care, enhance population health outcomes, and constrain healthcare costs.  The pursuit of the so-called “triple aim” has, perhaps understandably, focused most heavily on reducing the per capita cost of health care. Because children are relatively healthy and comparatively inexpensive to treat, delivery system and payment reform efforts have not prioritized children. In contrast, most reform efforts to date address the elderly with such complex and chronic conditions as diabetes.

Recent federal and state efforts have defied past trends and increasingly include child health services. Medicaid’s Integrated Care for Kids initiative encourages development of a new payment service and delivery model that supports state- and locally-driven innovation to improve the health of children and youth.  Several states, such as Ohio, Massachusetts, New York, and Washington, have promoted health care reforms that include new pediatric payment models. Connecticut has been a national model in controlling Medicaid cost trends by committing to a person-centered medical home model of primary care and was the first state in the country to implement early expansion of Medicaid eligibility under the ACA. While the State’s self-insured, fee-for-service Medicaid program has not specifically prioritized child health services transformation, recent collaborations with the State’s Office of Health Strategy are bringing child health to the forefront of reform efforts.

Read more of Dr. Dworkin’s blogs here.

The State of Connecticut’s Population Health Council recently released the Connecticut State Innovation Model Health Enhancement Community (HEC) Framework, which emphasizes that improving the health and well-being of all residents in Connecticut and reducing the rising trends of Connecticut’s health care costs depends on improving community health and health equity.  In concert with primary care modernization, the HEC initiative has four ambitious but achievable goals. Notably, one is to make Connecticut the best state for children to grow up.  Furthermore, the State’s Population Health Council recommends that the HEC initiative focus on two health priority aims: improving child well-being in Connecticut, pre-birth to age 8 years, to assure all children are in safe, stable, and nurturing environments; and improving healthy weight and physical fitness for all Connecticut residents.

The State’s HEC strategy is an initiative of the Connecticut State Innovation Model (SIM), which is jointly implemented by the Office of Health Strategy and the Department of Public Health. We are proud that the Council has declared its commitment to promoting children’s optimal health, development, and well-being as a central tenet of its healthcare transformation efforts. The SIM, as noted in our recently published, “A Framework for Child Health Services,” offers opportunities to improve the health and development of the State’s children beyond its focus on payment reform. These efforts should serve as an important and impactful example of how child health services transformation can inform and inspire healthcare reform strategies across the lifespan.  We commit to supporting the State’s efforts to the very best of our capacity and ability. We are confident that Connecticut can, and indeed should, be a national model for the strategy of child health services transformation first.

Paul H. Dworkin, MD is executive vice president for community child health at Connecticut Children’s, director of Connecticut Children’s Office for Community Child Health and founding director of Help Me Grow® National Center. Dr. Dworkin is also a professor of pediatrics at UConn School of Medicine.  Learn more »

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