From Families USA, July 2020
The COVID-19 pandemic, and its disproportionate impact on low-income people and people of color, has starkly demonstrated the need for long-term investments targeted at social drivers of population health. Although chronic physical and behavioral health problems are not the only source of these disparities, they are among the most important causes. Health inequities often start in childhood. Yet important efforts to re-orient our health care system to focus more on prevention and changing long-term outcomes have largely excluded children. This paper is a call to policymakers to recognize the long term health, social, and economic benefits of upstream investments for children, including those who have experienced trauma, violence or severe adversity, and to fully include children in health care payment and delivery system reform.
Large scale efforts to transform the way we pay for and deliver health care have gained considerable momentum over the last 10 to 15 years. These efforts have stemmed from an acknowledgment that our current system is far too expensive and does not deliver on the promise of high-quality health and health care that our nation’s families deserve. The COVID-19 pandemic has reinforced the urgency behind efforts to move towards value-based care as entire sectors of the health care system – most notably, primary care – are at risk of collapsing. The collapse of primary care is being driven by the failure of the fee-for-service payment model which is the predominant payment model in the U.S. health care system. The failure of fee-for-service economics has been the driving force behind efforts to move towards value-based care and payment. A weakened and reduced primary care infrastructure would be devastating for the health care system and the health and well-being of children and their families.
With the pandemic, we can anticipate a renewed focus on payment and delivery reform and intersections with public health. Unfortunately, because cost is often the starting point for transformational efforts by state and national policymakers, the health care transformation enterprise focuses predominantly on adults, particularly those with chronic conditions and overlooks the importance of making early investments in the health and well-being of children.
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