Stories about: Cost of healthcare

Children’s and Blue Cross Blue Shield usher in new age of quality-based benchmarks in pediatrics

Sandra Fenwick, president and COO

I’ve worked at Children’s Hospital Boston for more than a decade, and I’m still inspired every day by the hope and strength I see on the faces of our patients and their families. As Children’s navigates a challenging and evolving health care landscape, I draw on that inspiration and determination, especially when many in our industry seem to imply that cost is the only measure of a hospital’s worth.

At Children’s, our worth—our value—is so much more than just dollars and cents. It means being treated by pediatric experts—doctors, nurses and support staff—who understand that children are not small adults and their care needs to reflect that fact. It’s a commitment to care and innovation that produces programs like our Community Asthma Initiative, which helps children with asthma have fewer attacks so they miss less school and their parents miss fewer days of work.

And it’s about a commitment to constantly improving the quality of the care we deliver. To that end, I am pleased to announce that we have signed an innovative new contract with the state’s largest health insurance provider, Blue Cross Blue Shield of Massachusetts (BCBSMA).

This agreement, known as an Alternative Quality Contract (AQC), calls for us to reach quality targets based on national pediatric quality benchmarks—the first such contract in the country—and keeps the contract value well below medical inflation

The AQC has specific quality measures in the areas of primary care (prevention and treatment), effectiveness of treatment for patients with certain conditions or needs (cystic fibrosis, dialysis or general surgery needs) and safety (central line infections). In addition, we have agreed to accept a 0 percent rate increase in the first year and an average 1.5 percent annual increase over the three years of the contract.

Since 2009, Children’s has taken more than $125 million out of the health care system to benefit insurers, employers and consumers

This contract is aligned with our efforts over the last three years to improve quality  while slowing the rising cost of care delivery. Since 2009, Children’s has taken more than $125 million out of the health care system to benefit insurers, employers and consumers. We have reduced insurers’ rates and prices, become more efficient and have innovated new ways to deliver care that improve quality while lowering costs. In addition, we have moved care to lower-cost settings within the hospital and to our less expensive suburban satellites and community hospital partners, and have improved care integration between primary care physicians and hospital subspecialists.

As far as I’m concerned, the greatest indication of Children’s value is the trust of the parents who place more than 170,000 children in our care each year. Whether they come to us from around the block, or the other side of the world, Children’s takes great pride in knowing that every patient who comes through our doors will receive the same level of world-class care that has made Children’s a leader in pediatrics for more than 140 years.

For more on the Blue Cross Blue Shield deal, read Sandra Fenwick’s interview with WBUR.

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Children’s legal eagles

As an attorney, Kristin Small, Esq., specializes in cases where the legal and health care needs of her clients cross paths. She recently worked with the parents of a 5-year-old child with autism.

The father had lost his job and the mother couldn’t work because of the time she needed to devote to her son’s care. Though the Social Security Administration (SSA) agreed that their son qualified for benefits medically, the family was deemed ineligible because they had “too many resources.” With both parents out of work and no means of income, legal counsel was the last option they thought was available to them.

Their pediatrician referred them to Small, a staff attorney for the Medical Legal Partnership | Boston (MLP) and liaison to Children’s for the newest MLP site in the Children’s Hospital Primary Care Center (CHPCC). Providing care for more than 13,000 children—65 percent of whom are covered by Medicaid—the CHPCC is well suited to host the MLP at CHB. “Our medical and social work staff already spend a lot of time advocating for our patients,” says Joanne Cox, MD, medical director for the CHPCC. “They’re writing letters to utility companies, helping families access food stamps and communicating with landlords about poor housing conditions.” Chronic illnesses such as asthma, cerebral palsy and diabetes are often exacerbated by environmental factors like lack of food, housing, education and employment. A child my be falling behind in school due to chronic illness, or a family may be forced to choose between medicine and food. By teaming with the MLP, the CHPCC can now offer their patients direct access to legal information and support to help them make sure their needs are being met.

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Finding unique value in the medical home model

Ari Brown, MD, FAAP

By Ari Brown, MD, FAAP. Dr. Brown is a pediatrician, author of the Baby 411 book series and has offered her expertise to several media outlets including the Today show, CNN and the Wall Street Journal. Dr. Brown completed her residency at Children’s Hospital Boston in 1995 and will be joining her peers at an upcoming alumni reception at the Institute of Contemporary Arts on October 15. For more information visit, Children’s event website.

You are as old as you feel, right? Most days, I feel like I’m still a kid—probably because I hang out with kids all day long. But the other day, I received an invitation to my 20-year medical school reunion. Admittedly, I felt just a little old…and a bit reflective.

The last time I saw many of my med school classmates was when I was 26, and heading off to my pediatrics residency at Children’s Hospital Boston. So much has happened since then. Marriage. Kids. Career. But unlike some of my peers, I wouldn’t change a thing.

I’ve loved pediatrics for twenty years. I am truly happy going to work every day. I have a special relationship with my patients and their families—a relationship that they will never have with the practitioner working in the minute clinic around the corner. I am the one who examines my patients when they are first born. I perform the well child visits, encourage breastfeeding, answer the worried parent phone calls, identify developmental delays, offer parenting advice, and diagnose the colds, flus, ear infections and occasionally things a bit more serious. And I love every minute of it (okay, almost every minute of it). I love it because I can help future generations develop healthy lifestyles and I genuinely enjoy watching my patients grow up.

But, the current trends in healthcare—particularly in pediatrics—are troubling to me. More parents are heading to that minute clinic around the corner to get their child a quick Strep test after school and work, choosing convenience over quality and continuity of a medical home. Are pediatricians going to become the next Borders or Netflix? Are we being shoved out of the marketplace because we haven’t kept up with consumer demand?

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Planet Health: How adding preventative care can subtract from healthcare costs

When a child suffers from nutrition related health problems, it can cause a good deal of emotional and financial strain on her family. Obesity-related medical conditions like diabetes, sleep apnea, high blood pressure and cholesterol often lead to pricey medications and doctor visits, and are sometimes tied to emotional issues that can be costly to treat.

On the flip side, eating disorders can have a devastating affect on a person’s health and usually take years of regular therapy to treat successfully.

Treating these conditions in a single child is expensive; when you add together the cumulative costs of treating them on national level, the numbers are astronomical. But researchers from Children’s Hospital Boston and the Centers for Disease Control and Prevention (CDC), have found that a fairly inexpensive health promotion initiative could reduce both obesity and bulimia nervosa in adolescents, potentially saving millions in would-be healthcare costs.

Their study, recently published in the Archives of Pediatrics & Adolescent Medicine, shows that by adopting an educational initiative called Planet Health, five Boston area schools successfully reduced the prevalence of obesity and behaviors linked to bulimia. If these Boston schools are any indication, a nationwide adoption of the program could lead to less obesity and eating disorders on a national level, thereby saving millions in healthcare dollars usually allotted to treating these conditions.

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