THE VALUE EQUATION

“Cost” may be the first thing that comes to mind when thinking about the value of care. Yet, like value, cost can be defined in many ways: What are the costs when families miss work or school because of a child’s illness? What are the costs for unnecessary emergency services? What are the costs when a patient misses an appointment because they don’t have reliable transportation? The truth is, there is a cost to our communities when these factors compound. What we can no longer afford is inaction — our children’s future depends on it.

SHIFTING TOWARD VALUE-BASED CARE

Nemours’ commitment — in communities where it has a physical presence and beyond — is to be an important leader in designing the future of caring for children. To create and sustain a future of systematic value, Nemours will dig even deeper into its work to:

  • improve health outcomes;
  • advance quality of care;
  • increase accessibility of care;
  • address social determinants of health;
  • enhance quality of life; and
  • reduce health care costs.

VALUE-BASED SERVICES ORGANIZATION LAUNCHES IN DELAWARE

Conceptualized in 2017 and finalized in 2018, infrastructure has been solidified by Nemours to support its move toward value-based care. The Nemours Value-Based Services Organization (VBSO) combines both new and existing competencies for the medical home, analytics, medical management, population health and clinically integrated networks.

The VBSO is built on Nemours’ successful practices. This includes mastery of the medical home throughout its primary care network; the extensive data capabilities of Nemours’ fully integrated electronic health record system; and more than a decade of promising practices in population health. This is all combined with the collaborative spirit among pediatric and adult providers, community health workers, school districts and other partners.

The state of Delaware is a unique environment with increasing readiness to move in more progressive ways toward value-based care. With 200,000 children, half of whom are covered by Medicaid, Delaware is indicative of many states across the U.S. Nemours will share its learnings — both pitfalls and best practices — as the shift to value becomes a reality.

Listen to the Radio interview on Delaware Public Media with Jamie Clark, Executive Director, Nemours VBSO.

Increasing Value

  • Health Outcomes
  • Quality of Care
  • Accessibility of Care
  • Social Determinants of Health
  • Quality of Life
  • Reduction in Cost

Medical care represents less than 20 percent of the TOTALITY of a CHILD’S HEALTH. Complete health DEPENDS on a NUMBER OF FACTORS such as good NUTRITION, LITERACY, optimal EDUCATION, freedom from poverty, EQUITY and other factors.

CREATING GREATER VALUE FOR FAMILIES

Nemours VBSO team members, along with collaborators from the Nemours Office of Health Equity & Inclusion and operations areas across the enterprise, kicked off a project focused on the development of a standard Social Determinants of Health Screening Tool that could be used to gather information on non-medical patient needs across Nemours. The goal of the tool is to assess areas known to be critical to patient success and healthy living but often overlooked in the health care visit. This pilot project consisted of identifying stakeholders across Nemours currently engaged in work addressing patients’ social needs; identifying the domains of interest for a screening tool and selecting questions; administering 400 screeners (in English or Spanish) to patients in a variety of settings (emergency, specialty clinic, primary care and PICU); and conducting analysis on the results. In addition to the questions on the screener, families were asked how they felt about these questions — were they intrusive or personal? Did the role of the person asking the questions impact their level of comfort? The VBSO team is finalizing analysis of the pilot data and working on a system-wide rollout for the screener and a repository of resources to which families can be referred, as needed.

Disparities Solution Center

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Nemours’ work to develop and pilot the pediatric-focused Social Determinants of Health Screening Tool was recognized with an “Excellence” award by The Disparities Solutions Center of Massachusetts General Hospital.

Medical Neighborhood

Informed by the 2017 assessment of the West Center City neighborhood in downtown Wilmington, Del., the Nemours Medical Neighborhood initiative kicked off across the state in 2018. The primary goal is to develop consistently documented profiles of each Nemours practice, its structure, and patient and neighborhood population demographics — ultimately, integrating both assets and needs. During 2018, members of the VBSO, primary care practices and data analytics teams designed and completed data collection for all 12 Nemours primary care practices in Delaware. These and other data sources will help inform decision-making to help Nemours hyper-localize efforts to improve total health.

SCHOOL-BASED WELLNESS EXPANDS

With a year under its belt, Delaware’s first elementary school-based health center has now become the state’s first Elementary Wellness Center system. At the start of the 2018-2019 school year, the partnership among Colonial School District’s Eisenberg Elementary School, The Life Health Center and Nemours expanded to four additional neighboring elementary schools (Pleasantville, Carrie Downie, New Castle and Wilmington Manor).

As a district composed of a largely underserved population, many families are uninsured, underinsured or have significant gaps in their health care coverage. All three partner organizations have deep ties to the community and are passionate about providing access to high- quality services to maximize the children’s opportunity for success. Approximately 25 percent of the Center enrollees report that they do not have a primary care provider. The most critical objective of the Wellness Center system is connecting students with primary care providers in the community to help them establish a medical home. Other objectives include acting as a source for referrals to outside medical care, specialty care or other comprehensive health services.

Eisenberg Wellness Center Video

During the 2017-2018 school year, The Life Health Center’s dedicated social worker, child psychologist and therapist served 187 Eisenberg students during 3,290 behavioral health encounters. Early results indicate the model of prevention and early intervention is working. Compared to four years ago, there has been an increase in early identification of behavioral health concerns, and instances of student discipline issues have dropped dramatically at Eisenberg. The number of children with six or more referrals dropped from 37 to nine.

The Value Equation

Optimizing Health for All Children

The Nemours National Office of Policy & Prevention influences national policies and catalyzes practice changes that help children grow up healthy. The National Office has successfully competed for $35 million in grants over the last seven years to accelerate pediatric population health improvement and health system transformation. Most recently:

  • Nemours was awarded a two-year, $500,000 grant from the Kresge Foundation to highlight effective networks for population health and clarify the roles and functions that hospitals and health systems play as integrator partners within such networks. Integrator Learning Labs will build upon the Successful Policy Learning Lab model Nemours developed as part of its Moving Health Care Upstream initiative.
  • Under the leadership of Nemours and Mental Health America, the Collaborative on Accountable Communities for Health for Children and Families (ACHCF) was launched in 2018. ACHCF was organized by the National Academies of Sciences, Engineering and Medicine’s Forum for Children’s Well-Being. Collaborative membership is comprised of individuals from health systems, funders, innovative community leaders and other child health experts, who recognize the role of social determinants of health in impacting a child’s overall health trajectory. Accountable Communities for Health (ACH), structured collaborations among multi-sector partners and residents to improve health in a community, are an emerging model being tested and catalyzed through public and private investments. To date, with some exceptions, the model has primarily been focused on the adult population. To promote optimal health and development for children, members of the ACHCF Collaborative identify factors that accelerate ACH models that will nurture healthy and resilient children and families.
  • Released several papers including a brief that explores elements of technology applications emerging to “close the referral loop” between clinical and community services and presents accelerators and challenges to their adoption.
Community Care Coordination Systems: Technology Supports

View PDF to learn more about the emerging technologies and how they are helping.