Contributors: Lisa Soroka and Wren Keber
To learn more about Lisa and Wren, click here.
As the third article in our series, we are going to focus on pediatric care and children’s hospitals. If you have followed our series so far (Part 1 and Part 2), you already know we are covering tactics for healthcare organizations of all kinds to recover and thrive as the pandemic recedes. We will touch on issues unique to the pediatric arena, as well as tactics to support financial and operational recovery.
Children and Adolescents at Risk of Becoming Uninsured
In our last article, we noted the dramatic shift in payer coverage which impacted every corner of our country. As dependents of parents/caregivers who suffered job change and/or loss, children and adolescents were not immune to this shift. Employees and their families lost employer-based coverage and became enrolled in Medicaid or exchange plans. While taking advantage of safety-net programs has had a short-term positive impact, an enrollment cliff impacting an estimated 15 million Medicaid enrollees is forthcoming, as programs enacted through COVID-era legislation come to an end in 2022. Of those children and adolescents estimated to lose coverage, only ~ 60% will be eligible for the Children’s Health Insurance Program (CHIP) – providing health insurance coverage to eligible children, and the others are at risk of losing coverage altogether.1
Recovery Tactic: As part of a successful financial recovery plan, it is important for pediatric providers (i.e., children’s hospitals and pediatric primary care and specialist physicians) to protect both the continuity and the continuation of key primary and specialty care services by helping to ensure access to sufficiently insured pediatric populations. If not sufficiently insured, parents/caregivers may delay necessary care for their children and adolescents leading to eroding provider revenue. Additionally, an unfortunate impact of delaying care is also potentially raising the risk of future catastrophic cases, adverse care outcomes and/or complex, comorbid patients – who may also be obtaining care while uninsured. Therefore, children’s hospitals and pediatric care providers should help head off coverage issues through hands-on education to parents/caregivers regarding the changes in eligibility criteria under Medicaid. Additionally, steering them to any alternative programs that may be available to obtain and retain coverage will help. These alternative programs, which vary by state, could include local/county/regional programs that offer premium assistance, vouchers, etc.
Issues and Recovery Tactics for Children’s Hospitals
Early in the pandemic, in certain parts of the country, children’s hospitals were used as surge locations where pediatric beds were temporarily converted to adult beds.
Recovery Tactic: While obvious, facilities should quickly return converted beds to serve pediatric cases to reach full census capacity. Also impacting children’s hospitals is the larger than normal fluctuation in elective cases, correlated to the ebb and flow of cases in particular regions of the country. Even as vaccinations started to impact the trajectory of the pandemic throughout 2021 due to Delta and other variants, many concerned parents/caregivers chose to delay hospital-based and ambulatory care, testing, procedures, or other care that did not have a threatening impact on life or limb. However, as we all know, research has shown that delays in care often lead to more complicated interventions – and can potentially result in a lifelong decrease in quality of life affecting younger patients for a longer period during their lifetimes.
Recovery Tactic: Educating parents/caregivers and making them aware that children’s hospitals are open and safe to enter needs to be implemented if not being done already. In addition, emphasizing again that delaying care can result in permanent adverse outcomes as described above needs to occur. Pediatric specialists can engage with their primary care referring physicians to help convey these key messages when discussing care options with parents/caregivers and to encourage decisions to help result in better outcomes overall.
Issues and Recovery for Pediatric Primary Care and Specialists
In the overall realm of pediatric physicians, both primary care and specialists have each had their share of challenges during the pandemic. As with children’s hospitals, the pandemic has disrupted the flow of patients engaging with primary care physicians (pediatricians and family practice physicians alike) for well-baby, well-child, sick visits, and immunizations, as well as for specialty care referrals and surgical procedures. While these disruptions should begin to return to normal as the pandemic subsides, they have not yet returned even to baseline.
Recovery Tactic: Pediatric physician offices/medical groups should build an outreach program to realign pediatric primary and specialty care as capacity and safety protocols allow. Ensuring parents/caregivers understand that pediatric offices, practices, and clinics are safe, and that delaying care can impact the long-term health of their children and adolescents, can help re-establish care relationships.
Virtual care and telehealth have had a different set of impacts/implications for children and adolescents when compared to adults. While telehealth deployments have had varying success in pediatric population health management (particularly medication management and monitoring), the adoption rate has not been as robust as with the adult population. This is especially true in the Medicaid population, where technology barriers (the digital divide) have further impacted the ability for telehealth to take hold.
Recovery Tactic: Pediatric provider organizations that have an existing/deployed telehealth program should build an optimization program to gather intelligence from parents/caregivers with a high utilization rate and use these insights to optimize programs. Organizations that have not yet deployed telehealth should consider whether technology investments make sense operationally and financially.
As we have said in previous articles, recovering in a post-pandemic world will take many forms, so organizations will have to employ a number and combination of different tactics to fit each current and possibly unique situation. That said, we believe pediatric providers have the ability to recover and thrive as well as their adult provider counterparts.
Contact Lisa at: [email protected]
Contact Wren at: [email protected]
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