Early Childhood Pediatric Care

Fellowship Year 2015-2016

Background

A growing body of evidence in health policy, neuroscience, and child development suggests that early childhood is the key window of opportunity to optimize lifetime trajectories for the population with the potential to improve physical and behavioral health, productivity, and well- being in adulthood. The United States performs poorly across child health indicators when compared to other developed nations.

The United States spent $285 billion annually in pediatric care in 2014. However, only 60% of children receive quality well child care. Moreover, the majority of pediatric health care spending has been spent primarily on a minority of children with lifelong chronic illnesses, a population that continues to grow rapidly. Even these children face poor quality care in spite of consuming the majority of resources in pediatrics.

Safely reducing per capita spending in pediatric care while improving lifelong health and well-being

CERC’s early childhood redesign team found three addressable failure points in current care. Team members address these failure points via a new care model with three core elements: (1) screen universally for medical and psychosocial needs; (2) risk-stratify pediatric care; and (3) establish communication hubs for medical and community programs.

Estimated savings 

A conservative estimate of net savings from national implementation of the CERC Early Childhood Care model is $46.5 billion dollars in direct health care spending per year with the majority of savings due to reduced emergency department visits, reduced hospitalizations, and reduced hospital length of stay. Additional downstream savings outside of the health care system includes potential contribution to an anticipated annual savings throughout childhood of $1000 per child who becomes school ready and an anticipated annual savings throughout adulthood until age 65 years old of $3000 per child who becomes school ready. In childhood, these savings are primarily through decreased costs to special education and the child welfare.

Authors

Jody Lin, MD, Maysa DeSousa, PhD, Arnold Milstein, MD, MPH, Paul Wise, MD, MPH