Editor’s note: Voting for AAP president-elect will take place from Aug. 17 through Aug. 31. The president-elect winner will serve as AAP president in 2024.
How do we preserve the medical home model and position of pediatricians as the child expert in the transformation of health care delivery, e.g., telemedicine, minute clinics, team-based care, etc.?
Warren M. Seigel, M.D., M.B.A., FSAHM, FAAP
Kew Gardens, N.Y.
The AAP began promoting the concept of a patient-centered medical home (PCMH) 50 years ago to coordinate care between primary care, specialists, families and community resources. This model is committed to providing safe, quality, evidence-based care through shared decision-making with performance measurement and population health management. Careful planning and management are necessary to meet the needs of patients and families and be financially viable. Practices need to adopt anti-racist practices and policies to address and achieve health equity.
The popularity of minute clinics, urgent care centers and telemedicine highlights the need of pediatric practices to improve the timely access to care. This would be a simple and actionable strategy to better position the PCMH model in the current environment.
The AAP must advocate for payment models that support primary care services delivered by pediatricians in a PCMH model over alternative services. We need to use our collective influence to advocate for financial support for a pediatrician-led team that takes responsibility for a child’s physical, mental and psychosocial needs. The pediatric practice must coordinate care with pediatric subspecialists in order to position themselves favorably when negotiating with insurers.
Pediatricians are uniquely positioned to intervene early enough to prevent and address developmental delays, trauma and mental health issues and to decrease the risk of the consequences of chronic disease. Providing an anti-racist and strength-based approach to pediatric health care in partnership with families and communities, pediatricians can ensure that all children achieve their fullest potential.
Benjamin D. Hoffman, M.D., FAAP
Portland, Ore.
Pediatricians invented the medical home concept, and our ability to provide comprehensive, continuous and high-quality care to children and families is the model for how health care should be delivered to all. As the epidemiology of child health and well-being has shifted over time, we have shown tremendous ability to adapt, while preserving the ideals and promise of the medical home. While challenges may seem daunting, we are well-prepared to meet them.
The rise of retail clinics, urgent cares and third-party tele-docs has led to fragmented and episodic care. While they may offer convenience, they cannot deliver the high-quality, comprehensive care offered in the pediatric medical home. We must preserve those essential aspects, while evolving to meet the needs of our patients. Telemedicine provides promise in increasing access while preserving the primacy of the medical home, but only if payment is equitable and appropriate.
Payment parity is essential, and we must continue to fight against a status quo that values a child’s health at a fraction of that of an adult. The AAP and state chapters must continue to lead innovation in health care financing for children through pediatric-specific alternative payment models and approaches that acknowledge the unique aspects of child health and the practice of pediatrics.
