Payment Reform Series
Statement of Problem
Advancing health equity for children and families requires changing how health care services are paid for and what is paid for, particularly within public programs like Medicaid and the Children’s Health Insurance Program (CHIP). Reimbursement policy—or how health care providers are paid for the services they deliver—enables and guides health care delivery, creating incentives for treatment and services that can entrench or act against disparities.
For instance, without Medicaid reimbursement for screening and interventions that identify and address unmet social needs, many pediatric providers will not have the resources to assist families who struggle with unsafe housing, unhealthy foods, and unaffordable transportation to medical appointments, resulting in worse health outcomes for patients living in under-resourced communities. Reforms to health care payment policy can be challenging but can structurally transform how health care is delivered and must be done with a focus on scaling and sustaining evidence-based best practice and advancing equity.
Description
PolicyLab’s research highlights the effectiveness of delivery system reform and innovations designed to improve health outcomes and promote health equity for children and families. Our work on payment reform recognizes that sustainable financing models are often necessary to implement and scale the best practices identified by this research.
Payment reform can also be a powerful policy lever for driving the pediatric health system to better address health equity and the adverse health effects caused by poverty and systemic racism. Therefore, PolicyLab’s work on payment reform is cross-cutting to its five research portfolios and focuses on sustainable payment models for interventions that address needs—health and social—disproportionately affecting low-income communities, communities of color and other vulnerable populations.
PolicyLab's policy team leads this project to highlight policy innovation and flexibility that exists or should be explored, and barriers that need to be overcome.
In a series of briefs, as well as through ongoing engagement with policymakers, payers, and advocates, PolicyLab will compile the evidence and explore levers for sustainably financing pediatric delivery system innovations that advance health equity, with a particular goal of informing and shaping Medicaid policy.
The first brief in the series focuses on addressing postpartum depression in pediatric settings. While evidence-based treatments for postpartum depression exist, treatment rates are low, with birthing individuals from under-resourced communities facing significant barriers to accessing care. The brief lays out the policy levers that state policymakers can leverage to raise treatment rates, advancing health equity by improving the health of all birthing individuals and their children.
The second brief highlights opportunities for Medicaid and CHIP to support early literacy promotion in pediatric primary care, with a spotlight on Reach Out and Read. Reach Out and Read is an evidence-based model that trains medical providers to use children’s books as a tool to connect with families at pediatric well visits. Despite the benefits for families, Reach Out and Read is not consistently or equitably funded in pediatric care. Opportunities exist to leverage Medicaid and CHIP for further investment in this model. This policy brief, released in partnership with Reach Out and Read, provides recommendations on how Medicaid and CHIP could be utilized to improve equitable access to Reach Out and Read.
Next Steps
PolicyLab is continuing work on this payment reform series and plans to leverage our work to support policy changes that promote a more equitable and innovative health care financing system. For example, we are currently evaluating and exploring sustainable implementation of HealthySteps, which utilizes the pediatric primary care setting to support healthy early childhood development and effective parenting.
This project page was last updated in March 2023.
Suggested Citation
Children's Hospital of Philadelphia, PolicyLab. Payment Reform Series [Online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here].