The Value Equation in Pediatric Health Care

Opinion Statement One of the biggest buzzwords in healthcare today is “value.”. However, the definition of value in healthcare has gone through evolution since the 1960’s and has largely been defined by the healthcare industry rather than consumers. Today, the framework from which healthcare experts largely define value is the Triple Aim. First described by an economist rather than a clinician, the Triple Aim can be translated into a value equation: Value = outcome/cost. Skeptics may assume this is code for cost reduction alone. But it is the numerator that tends to resonate more with pediatricians because outcomes are dependent upon the condition of the patient and defined by improved health. Yet, there remains poor agreement about what the indicators of children’s health are or the timeframe in which those outcomes should be measured. Pediatric outcomes studies that also include cost are numerous but favor constrictions within service lines, specific disease processes, or outpatient or inpatient settings. This often limits true measurement of value because accounting for all the variables that influence the value equation are is not adequately captured. Acquiring all the data requires defining the population and aligning the providers within an agreed upon care model. Currently, there is no standard way to do this, but several models have become more prevalent including the patient- centered medical home, clinically integrated networks, and accountable care organizations. Unfortunately, published pediatric studies regarding the success or failure of these models are virtually non-existent. Efforts abound locally, regionally, and nationally to increase value in pediatric healthcare delivery. For example, pediatricians in Phoenix are putting compensation at risk to improve quality. Arkansas Children’s Hospital is establishing the country’s first statewide pediatric clinically integrated network. Congress is considering bipartisan action with The Advancing Care for Exceptional Kids Act. Time will tell which models are successful.