Advancing Value-Based Population Health Management Through Payer–Provider Partnerships: Improving Outcomes for Children With Complex Conditions

Abstract

Population health management (PHM) approaches to improve cost and quality remain limited. To address this gap, stakeholders within an integrated delivery and financing system in Western Pennsylvania designed, implemented, and tested a value-based care model for children with medically complex conditions that could be scaled across the broader pediatric population. The model included: (1) a multilevel, interdisciplinary infrastructure; (2) actionable analytics reports to guide continuous quality improvement; (3) alternative provider payments; (4) consumer-directed spending accounts; and (5) shared savings with practices. Four practices caring for 215 children (<age 21) with medically complex conditions participated in the demonstration. Quality and cost outcomes were compared between the intervention group and a comparison group using propensity scores. The program generated cost savings over a 2-year performance period, although the difference between the intervention and comparison groups was not significant, likely because of the small N. Quality of care was maintained or improved for the intervention group from baseline to the end of the performance period. This model is an example of how real-world laboratories that leverage strong payer-provider partnerships can be a useful platform for testing value-based PHM models with the potential to reduce healthcare costs while maintaining or improving care quality.