Source: Authors’ calculation of patient health data extracted from Epic health record software at the University of Maryland School of Medicine
The most common barriers to code use were practitioners forgetting or being in a rush (particularly during follow-up or acute visits), followed by not knowing when to use the code. Providers suggested that an automated application of the code in the electronic medical record for all eligible encounters could be more effective than relying on the provider to manually apply the code. Residents also suggested additional provider education about code use.
Enhanced payment helps cover the cost of HealthySteps, but supplemental funding is still needed.
In Maryland, one urban hospital center’s primary care practice had 2,500 to 2,700 encounters per year that were eligible for enhanced payment, translating to over $52,000 per year of revenue if applied to all eligible encounters. This figure does not account for potential cost savings from reduced emergency department and other costly encounters demonstrated in previous studies of HealthySteps and in large studies of adult patients. Depending on the qualifications and experience of an individual integrated HealthySteps specialist, the enhanced payment revenue could currently cover most—but not all—of the position’s full-time salary and benefits. Because of providers’ satisfaction with the program and existing studies demonstrating return on investment, two pediatric primary care practices within the state hospital system committed to a shared cost model with Maryland Medicaid to partially cover funding for the HealthySteps specialist position without significant reliance on external funding support. In the absence of adequate reimbursement, integrated care programs rely heavily on less predictable funding sources such as short-term grants, philanthropy, or state dollars to provide services. Underinvestment in early childhood integrated primary care is a missed opportunity to improve child health and wellness outcomes.
Conclusion
Integrated pediatric primary care has a growing evidence base for promoting child health while reducing overall health care costs, primarily by incorporating specialists into medical settings focused on child development, psychosocial needs, and SDOH for children and families. Our youngest children and their families benefit from early investments in high-quality health programs like HealthySteps, but our health care system is not designed to incentivize long-term health outcomes that are driven by SDOH. Maryland’s successful development of a novel enhanced payment system for HealthySteps was the result of relationship-building among state agencies, health and mental health providers, and technical assistance providers, along with gubernatorial investment in maternal and child health. HealthySteps still requires additional braided or matched funding, in addition to enhanced payment by insurers to sustain its implementation. HealthySteps and other programs like it have demonstrated the business case and public health argument for expanding investments in the future health of our youngest children.
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