Nemours Children’s Health has achieved a significant milestone in its journey toward redefining children’s health and moving to a “pay-for health” or value-based care reimbursement model. In Nemours Children’s first year of a new collaboration with Florida Blue, the state’s Blue Cross Blue Shield plan, the pediatric health system increased immunizations, preventative screenings, and wellness visits, while also reducing costs.
An analysis of care provided to 6,500 patients in the first year of the collaboration with Florida Blue shows that in 2021, the pediatric system reduced costs while simultaneously taking preventative steps to keep children healthy and out of the hospital. The amount of preventative care Nemours provided to patients increased by 15.7% and was higher than comparable health providers, showing how access to care is essential to improving wellness.
Nemours also decreased hospitalization re-admissions by 24%, compared to a 5.6% increase among similar providers, thanks to its investment in comprehensive care management services to provide personalized support to patients.
“Nemours Children’s is committed to making a positive impact on children’s health in Florida, and these new results demonstrate that our approach has done just that,” said Karen Marie Wilding, Chief Value Officer, Nemours Children’s Health. “We are excited to achieve our goal while ensuring that Florida’s children get the right care, at the right time from the right provider. We are demonstrating how children’s health care organizations can successfully transition from fee-for-serve to pay-for-health and value-based care.”
Value-based care, an alternative payment model that promotes wellness and prevention for a specific patient population, coordinates services for medically complex cases and encourages investment in high-quality and efficient care across the continuum – in essence, insurers pay health care providers for patients’ good health.
“Our primary care providers focused on addressing gaps in care, including wellness visits, immunizations, and other preventative screening,” said Tom Lacy, MD, Primary Care, Nemours Children’s Health, Florida. “Our physicians care for some of the sickest children in Central Florida. We have worked diligently to improve patient care through initiatives that have resulted in fewer emergency room visits and increased prevention and quality.”
The average risk score – data that reflects a patient’s risk for disease – for Nemours’ patients also increased, which illustrates the medical complexity of the children served by the Nemours primary care practices.
Nemours focus on patient care and wellness also resulted in slowing costs to only 3.6% vs. 7% for comparable health providers. The Nemours network achieved a reduction in health care costs, specifically pharmacy expenses. Use of expensive brand-name medications was reduced by over 15%, while still preserving the therapeutic goals and outcomes for patients.
“Florida Blue values health care organizations like Nemours Children’s Health that share our commitment to addressing affordability by prioritizing our patients’ health and well-being,” said Phil Lee, Florida Blue’s Vice President, Strategic Provider Partnerships. “Their work proves that hospitals and physician practices can work together to achieve the quadruple aim of improved patient experience, lower costs, better outcomes, and improved clinician experience.”
Nemours will continue to pursue opportunities to replicate the success of this program with larger populations of Florida’s children. To learn more about how Nemours Children’s is transforming the definition of children’s health, visit https://www.nemours.org/about/sdoh.html.