IN AN INDUSTRY CHARACTERIZED BY COMPLEXITY, VISION AND STRATEGY RULE
The Children’s Hospital and Pediatric Care Ecosystem (as illustrated in figure 1) is perhaps the most complex in the healthcare industry, with pediatric providers facing all the same pressures adult health systems face, including an intense regulatory environment, declining inpatient utilization, cost escalation exceeding payment rate growth, inadequacy of electronic records and data analytics, aging physical plants and access to capital, difficulties of managing at-risk populations, and alignment challenges between hospitals and providers. Other unique aspects of children’s healthcare are that pediatric specialty services are among those experiencing the greatest workforce shortage and that children’s providers generally have a much higher dependency on government payers via Medicaid and the Children’s Health Insurance Program (CHIP) (and in turn a greater dependency on philanthropy and support from community service organizations). Further complicating the situation are the dynamics of children being especially affected by social determinants of health (SDOH) such as poverty, violence, housing, malnutrition, and access to even basic preventive care and wellness services.
This environment has led children’s hospitals, pediatric providers, and academics and researchers across the US to develop an expertise-focused delivery system characterized by superregional and nationally focused children’s hospitals and what is arguably the best pediatric care delivery model in the world, yet at the same time, these environmental circumstances are a call to action for this model to continue to advance and improve across multiple facets for the benefit of all stakeholders.
In the following pages we lay out the market context for children’s healthcare in the recent past and looking forward. From this joint understanding, we will dissect the four imperatives for children’s healthcare in the next decade.