MCH-MRN E-News Update: April 2019
Coordinated by CAHMI
Recommendations for Advancing Payment Strategies to Address Child and Family Well-Being  

The Payment Transformation to Address Social and Emotional Determinants of Health for Children project focuses on redefining goals in child health care and aligning models of care and payment accordingly. Initial work for this project was supported by the Children’s Hospital Association and built upon prior work led by the CAHMI and AcademyHealth to advance a collaboratively developed a national agenda for promoting child and family well-being by addressing the social and emotional determinants of health (SEDH) like adverse childhood experiences (ACEs) and to redesign care to proactively promote positive child and family health in children’s health services.

A recent report from this project Payment for Progress: Investing to Catalyze Child and Family Well-Being Using Personalized and Integrated Strategies to Address Social and Emotional Determinants of Health , prepared by the Child and Adolescent Health Measurement Initiative, Johns Hopkins University, and AcademyHealth, sets out three priority recommendations.

  1. Pay to Improve Child and Family Well-Being: Measure value and return on investment in health services for children to incentivize and build capacity to promote positive social and emotional well-being and prevent and mitigates risks from ACEs and other social determinants.
  2. Support Enhanced and Personalized Well-Child Care: Leverage and align existing payment approaches, federal law and practice innovations to establish an enhanced well-child care services model to promote healthy development that is guideline-based, personalized and systems-oriented (GPS).
  3. Build Sustainable Capacity for Transformation: Invest and collaborate across sectors to build the cross-cutting workforce capacity, systems integration, data and measurement and continuous learning infrastructure to both scale high value primary care and the related services and supports children and families need to thrive.

Overall, we found that experts and stakeholders already embrace the importance of whole-child, whole- family, and whole-population approach to health care ,” said lead author, Christina Bethell, PhD.
The mandate to embed proactive promotion of healthy development and well-being that addresses SEDH and ACEs into systems of care was unanimously supported and shaped the recommendations emerging from this project ."

The report is based upon eight activities, including a “goodness of fit” analysis of existing and emerging payment models, an environmental scan of innovations and identification of key requirements for success and extensive and iterative input from a National Advisory Committee and other experts who convened in a national invitational meeting.

The Payment for Progress report identified four categories of infrastructure needed to effectively finance approaches to address SEDH: (1) workforce and environmental capacity building; (2) strategies that enable effective cross sector collaboration; (3) aligned measurement and data systems; and (4) robust learning and improvement platforms. Attention is needed not only to coordination and integration of services, but also to improved community resources, community engagement, and strategies to advance equity.

A central goal for child health transformation must be to identify concrete payment and care model approaches effective in meeting child and family needs and incentivizing providers, and supporting effective systems of care. The Payment for Progress report affirms that these efforts should be grounded in a GPS—Guideline-based, Personalized, and System-oriented—approach that can guide transformation of well-child care and services for children with special health care needs to optimize healthy development and well-being of the child population. Measures supporting these goals are needed and a focus of the MCH-MRN.
Measurement Priorities for Transforming Well-Child Care
Leaders engaged in the MCH-MRN have opportunities to help shape measurement in states’ efforts to transform pediatric care clinical, system, and payment approaches. The Payment for Progress report and the agenda upon which it builds both emphasize the importance of having metrics related to defining value, assessing social and emotional determinants, ACEs and positive child and family well-being and health outcomes, and protective factors, all of which are tools to engage families in assessment and care .
One key recommendation is to leverage existing data and measures to quickly identify a set of indicators to help innovative efforts assess whole child and family well-being and risk, to monitor individual and community resilience and trauma and formulate measures that define value as avoiding the cost of various types of failures to prevent avoidable developmental delays, health problems early and across life. Another key recommendation is assembling and improving core assessment (e.g. screening) tools and measures in clinical settings. At the clinical, research, and policy levels, there is a need for more and better tools, databases, data sharing agreements, and toolkits to support action. Focusing on both overall improvement in outcomes and return on investment is essential for measuring value in child health.

To read more on this topic, use links to publications below.

Leveraging existing resources to measure well-being, risk and value in child health
  • Optimize existing federal surveys and data systems, including the National Survey of Children’s Health (NSCH) and the Medical Expenditure Panel Survey (MEPS).
  • Optimize state-based surveys and data systems, such as the Behavioral Risk Factor Surveillance Survey (BRFSS), the Youth Risk Behavior Surveillance Survey (YRBS) and the Pregnancy Risk Assessment Monitoring System (PRAMS).
  •  Liberate available data, about ACEs, resilience, social determinants of health, and related data, such as local, state, and national data from the American Community Survey.
  • Build on crowdsourcing, citizen science, and N of 1 methods, taking advantage of newer National Institutes of Health policies to allow data collected through crowdsourcing and citizen science methods that engage individuals and communities in self-led learning and healing around ACEs, resilience and flourishing. Click here to learn more about this topic.
  • Integrate common-element research modules for longitudinal studies, to enable a focus on prevention and mitigation of impact of ACEs and promotion of safe, stable, nurturing relationships, positive health, and well-being.
  • Link existing networks to expedite collaborative learning and innovation, such as the HRSA-supported Research Networks, and Collaborative Innovation and Improvement Networks (e.g., CoIINs on infant mortality, home visiting, early childhood comprehensive systems), and the National Improvement Partnership Network (NIPN).

Click here to read full article on Prioritizing Possibilities for Child and Family Health
Survey word cloud. Adobe Stock
Provide Input on the National Survey of Children’s Health (NSCH)

The NSCH is led by HRSA and is a powerful national and state resource. The CAHMI liberates NSCH data for all states through its HRSA supported Data Resource Center .

The CAHMI is assembling ideas and input from our network related to future iterations of the NSCH.
Click here to provide input on what you wish to see prioritized and maintained in the NSCH, what you may recommend editing or adding, and your other ideas for optimizing this essential national resource.  
Engage with the MCH-MRN
The MCH-MRN provides a platform to: inspire, support, coordinate, and advance efforts related to MCH measurement, promote measurement innovation and shared accountability, and improve outcomes and systems performance on behalf of the nation’s children, youth, and families. 

MCH-MRN members contribute to setting a strategic agenda, collaborate to address MCH measurement gaps and needs, and receive resources and information relevant to MCH measurement.
  • Engage in the network. Please fill out our engagement tool to help us understand how you would like to be engaged in the MCH-MRN and how best to keep you informed about network activities.
  • Use our website and the interactive compendium to quickly browse through over 1000 MCH measures by measure set, data source category, or three levels of topical categories.
  • Download the most recent MCH-MRN Strategic Agenda.
  • Link to an article we’re reading this month on A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences.
The Child and Adolescent Health Measurement Initiative (CAHMI) is a center within the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health