As managed care organizations (MCOs) and accountable care organizations (ACOs) begin to invest in population health improvement, they are faced with significant and diverse challenges. This is especially true in pediatric care; without the leverage of a national payment system and standard-setting authority like Medicare, those providing and paying for pediatric care must navigate complex political, cultural, and financial environments that are unique to each state and local community. Though many MCOs and ACOs already engage in population health and prevention work, not all invest in upstream interventions that address the root social determinants of health. These social determinants of health contribute to long-term wellness—or sickness—and play a large role in chronic disease development. A key question remains: what are the factors that influence leadership in MCOs and ACOs to move upstream and invest in the social determinants of health?
In an effort to aid MCOs and ACOs in the early stages of population health strategy development, the Nemours Foundation has set out to spotlight outstanding systems that provide examples of success and demonstrate the flexibility that may be available under existing Medicaid managed care authorities. One such system is Nationwide Children’s Hospital (NCH); by further understanding NCH’s experience in upstream investment, we hope to illuminate pathways for other MCOs and ACOs to focus on social determinants in their population health strategy.
NCH is a large academic medical center in Columbus, Ohio, with more than 1 million patient visits per year and 25,000 inpatient admissions. NCH also co-owns a pediatric ACO called Partners for Kids (PFK) and carries full financial risk for about 330,000 children in the Medicaid program. While not focused on obesity prevention, PFK implements an upstream population health strategy using predominantly Medicaid funding that may be widely applicable to many disease prevention efforts including childhood obesity.
This paper provides a brief history of NCH and the context in which its population health strategy was developed, an analysis of the accelerators of and barriers to success, and concludes with a review of lessons learned.