When a teenager has acne, a pediatrician has a wide range of options for treatment. The physician could prescribe benzoyl peroxide, antibiotics or retin-A. If those medications are unsuccessful, the physician can then refer the teen to a dermatologist.
Nevertheless, many pediatricians refer patients to specialists early in the process of treating acne, a practice that increases healthcare costs.
To address this and other areas of inefficiency and to improve the overall quality of care, the Children's Hospital of Orange County, in a partnership with Rady Children's Hospital-San Diego, started a population health initiative in mid-2016. It aimed to lower the cost of care for asthma, bronchiolitis, community-acquired pneumonia, headaches, acute gastroenteritis and acne—six common conditions among children and adolescents.
The initiative created evidence-based guidelines for those conditions, established patient registries so that providers could share clinical data and enhanced medical record systems to improve communication and cut duplication. It aimed to reduce unnecessary care and procedures such as emergency department visits, hospitalizations, tests and referrals—including pediatricians unnecessarily handing off teenagers with acne to dermatologists.
“The thought process was, if we could use our experts in various fields to help create applicable, readily usable guidelines to help reduce variation in care, we'd be able to improve quality, reduce cost, improve access and really move into a value-based paradigm for pediatrics,” said Dr. Michael Weiss, head of Orange, Calif.-based CHOC's division of population health, who is leading the initiative.
The full initiative involves 1,450 pediatric primary-care providers and specialists. It received funding through a $17.7 million grant from the CMS.
Previously, a pilot program showed a year-over-year decrease of 18% in visits to the emergency department for asthma. Among patients in one of CHOC's clinics, that amounted to more than $1 million saved every year, Weiss said.