Dr. Patricia Hayes Discusses Relieving The Pediatric Care Crunch

Patricia Hayes, MD, Chief Medical Officer at Imagine Pediatrics, shares her insights on how new partnerships between payers, providers, and virtual care teams are expanding access to care, which is becoming harder to deliver as pediatric inpatient centers shutter.

Summary:

Dr. Patricia Hayes, Chief Medical Officer at Imagine Pediatrics, discussed the challenges posed by pediatric inpatient care closures, highlighting the impact on children with special needs, who account for 50% of pediatric care costs. She emphasized the need for specialized care and coordination, noting the financial strain due to low Medicaid reimbursement rates. Virtual care is seen as an augmentation, not a replacement, for in-person care, with robust protocols ensuring timely escalation. Imagine Pediatrics tracks preventable visits and admissions, showing a 80% reduction in ER visits within 30 days. The value-based care model aligns incentives with keeping children healthy, making the approach sustainable.

Highlights:

Dr. Patricia Hayes' Background and Role at Imagine Pediatrics

• Dr. Hayes serves as the Chief Medical Officer at Imagine Pediatrics, overseeing clinical delivery teams, strategy, and quality.
• She is a double board-certified internist and pediatrician with extensive experience in both inpatient and outpatient settings.
• Dr. Hayes focuses on vulnerable patient populations, particularly those with special health care needs.
• The conversation shifts to the current pediatric inpatient landscape and the challenges faced by pediatric care centers.

Impact of Pediatric Inpatient Closures

• Dr. Hayes describes the significant closure of pediatric inpatient units, limiting access to specialized care.
• Children with special health care needs account for a disproportionate share of pediatric medical care costs.
• The loss of access to care leads to increased emergency room use and unnecessary care in the wrong settings.
• The fragmented and uncoordinated system becomes even more challenging without access to specialized care.

Clinical Gaps and Specialty Care Access

• Dr. Hayes highlights the difficulty in finding specialty care for medically complex children.
• Lack of specialty care leads to longer inpatient stays and poor coordination upon discharge.
• The healthcare system is near its breaking point, and the loss of inpatient units exacerbates the problem.
• The loss of support services, such as social workers, therapy, and dietitians, further complicates care for children.

Reimbursement Challenges and Virtual Care Augmentation

• Dr. Hayes explains the financial challenges of maintaining pediatric inpatient units due to low reimbursement rates.
• Virtual care is not a replacement for in-person care but an augmentation that can provide early intervention.
• Robust protocols are in place to ensure virtual care is used appropriately and can be escalated to in-person care when necessary.
• Virtual care helps families navigate the system and maintain care plans with their specialists.

Access to Care in Rural and Under-resourced Areas

• Dr. Hayes discusses the challenges of accessing pediatric care in rural and under-resourced areas.
• Community hospitals lack the resources and expertise to treat children with medical complexity.
• Children often require transport to specialty hospitals, adding to the burden on families.
• Virtual care can help bridge care gaps and support families in these areas.

Coordination with Traditional Pediatricians and Specialists

• Dr. Hayes emphasizes the importance of coordination with traditional pediatricians and specialists.
• Constant communication and the sharing of information through electronic health records are crucial.
• The goal is to augment, not replace, the work of pediatricians and specialists.
• Virtual care can serve as bridge care and support for families who may not have easy access to specialists.

Mobile In-Home Care Services

• Dr. Hayes describes the mobile in-home care services provided by Imagine Pediatrics.
• The team includes pediatric emergency medicine physicians, paramedics, nurses, and nurse practitioners.
• Services include IV fluids, IV antibiotics, X-rays, and lab samples in the home.
• Transition of care services ensure children have the necessary equipment and medications post-discharge.

Clinical Protocols and Outcomes Data

• Dr. Hayes outlines the evidence-based protocols for triaging acuity and ensuring timely escalation.
• Virtual care has prevented over 5000 potentially preventable events, including emergency department visits and admissions.
• The approach has shown a dramatic reduction in emergency department and inpatient utilization.
• Longitudinal preventative strategies keep children at home and healthy.

Sustainability of Value-Based Care Models

• Dr. Hayes explains the sustainability of value-based care models, which align with keeping kids healthy.
• The model allows clinicians to spend more time with patients, providing better care.
• Recruitment is not a challenge as clinicians find the model fulfilling and patient-centric.
• The reimbursement model incentivizes keeping people healthy and out of the hospital.

Managed Care Partnerships and the Future of Pediatric Medicine

• Dr. Hayes emphasizes the importance of supporting value-based care models in managed care partnerships.
• The approach has shown positive results, including decreases in total cost of care and utilization.
• Medical directors at health plans play a crucial role in advocating for these models.
• The future of pediatric medicine involves earlier intervention and more time with patients through virtual care.