Managed care plans for children should follow guiding principles to be most efficient

Care plans should be utilized in intentional, specific instances to suit individual needs, according to the American Academy of Pediatrics (AAP).

The AAP designed a set of principals which, when followed, will allow care arrangements to more effectively meet the needs of patients. Ambitious goals were set to improve population health, while also supporting the safety and experience of patients.

Improved networking was recommended for pediatricians who value quality care and specialist providers with niche focuses. Focus on unique needs was stressed for better treatment within communities.

Guidelines to support children with unique and complex needs when compared to adults were also discussed. Dedicated care manger services and partnerships with home health services were among the examples of methods through which this could be accomplished.

The APP suggested giving pediatricians a panel of primary care pediatricians (PCPs) from payer physician networks, with a willingness to broaden treatment teams in order to provide proper assistance. Further increased capacity and specialization would be needed for children who come from vulnerable populations.

When PCPs are not enough for a particular situation, pediatric specialist services were recommended. Preferably, these specialists would be certified by medical and surgical boards within their specialty.

All these care policies should be transparent, according to the APP. The clinicians’ participation should be made known to both the families and pediatricians, and families should be educated on the plan upon enrolling. Health insurance payment policies should also be made clear to providers.

Quality improvement was a key factor in the APP’s outline. Pediatricians, pediatric specialists, patients, and families would all participate in the process. Keeping in mind the previously outlined principles, managed care plans should help with research toward improved results and patient registry development. In order to support patients with health problems, early identification and treatment was recommended, alongside the promotion of preventative services.

To ensure quality during this process, the fundamentals of quality listed by the National Academy of Medicine should be followed. With attention given to early prevention, chronic diseases will be less burdening to children as they grow into adults. The APP concluded by saying, “Pediatricians need the tools and support of the health care delivery system to ensure the health and readiness of tomorrow’s adult population.”

Reference

Carlson KM, Berman SK, Price J. Guiding Principles for Managed Care Arrangements for the Health of Newborns, Infants, Children, Adolescents and Young Adults. Pediatrics. 2022; 150 (2). doi:10.1542/peds.2022-058396