COVID can force changes to deliver health equity for children


COVID-19 has underscored what we have known for a long time: We need a new definition of health in this country.

This novel disease has exposed long-standing, underlying health disparities that strongly impact communities of color, putting them at higher risk for severe disease from the virus. This is primarily because they experience higher rates of social and environmental factors, which lead to chronic medical conditions. These inequities, which can impact a child’s health even before they are born, are tied to barriers to accessing essential resources such as food, transportation and housing, otherwise known as the social determinants of health.

How do we change our model of care to systematically address these social determinants to create better health?

Change the reimbursement model

We can only achieve health when we summon the will to create a healthcare system that gets paid for health, rather than for volume and complexity of medical services delivered. The best place to begin this transformation is with our children. They will eventually become 100% of our adult population. As CEO of a multistate children’s health system, I see the enormous potential of changing the reimbursement model so that the financial responsibility and risk of delivering health to our patients lies with health systems, rather than with government or insurance companies. In this type of system, investments in the social determinants of health, along with superb medical care, will not only be in the best interest of patients but also in the financial interest of health systems.

Spending on child health is the single largest lever to impact future generations. In the current system, which focuses on delivery of medical care, instead of more widely addressing health, 7% of our spend is on children. If we were to spend wisely on the many social factors affecting health in children, our overall medical spend would plummet and our society would be healthier. Addressing the social determinants of health in children is absolutely critical to improve the health of future generations and to support the viability of our economy.

Invest in developing the core competencies necessary to deliver health rather than volume of medical care

At Nemours, we’ve seen how the pandemic has further compounded the economic, racial and health disparities that exist in our healthcare system for children and their families, and how these heightened needs have created greater urgency around our commitment to prioritize value over volume. We’ve begun to transform the way we deliver health, starting in Delaware, by investing in a value-based services organization tasked with transitioning us from a fee-for-service system to a value-based model in which Nemours is paid for health.

We’ve created tools—such as a population health platform—that allow us to categorize patients based on clinical risk scores; measure medical expenses; integrate patients’ clinical data with their social needs; create registries and care-management plans; and monitor various clinical and quality metrics. Our teams are working toward a model that would seamlessly connect patients with social services and community-based partners every day.

Innovate to develop new care models
The pandemic has forced us to innovate in ways that have clearly improved how we deliver care. For example, we harnessed the potential of telemedicine to meet the needs of our families in new ways. We created outdoor clinics to safely accelerate immunizations and complement the telemedicine visits. Some payers agreed to reimburse these tele-well visits, and preliminary data indicates this has improved “show rates” for appointments, particularly for our population covered by Medicaid. Beyond the pandemic, we will explore whether tele-well visits can continue as an option for families with transportation challenges.

The health of our nation will not primarily come from new treatments and technologies designed to manage chronic diseases after they develop. Instead, health will mostly come from preventing these diseases before they occur. As leaders of our nation’s health system, we must summon the courage and the will to lead the change to create a health system that optimally serves all Americans. This vision means total disruption for an industry that for decades has benefited by maximizing the volume and cost of medical care. We know we need to change. Let’s start turning around this gigantic $3.5 trillion aircraft carrier that is American healthcare. Let’s start by focusing on children’s health.



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