A Collaborative Practice Model for Improving Pediatric Mental Health Value

In the current health care climate, where access is still a challenge even as health care expenditures come under attack, it is increasingly necessary to understand how best to determine and improve healthcare value. One important area that has received little attention is pediatric expense for children with mental health needs. Historically, studies of medical expense have focused on adults; most children were thought to be healthy and most pediatric illness was time-limited, with little need for medication. However, as cost-containment policy debates extend to decisions about funding Medicaid, a program where the majority of insured are under 21, the determinants of pediatric expense become more significant. Also, in the past decade, clinical trends for children have changed dramatically, with chronic conditions, including asthma, diabetes, obesity and mental illness, now the drivers of service expenditures. Nowhere is this shift more evident than in the escalating psychiatric medication use trends for youth, which have raised questions about both quality and expense. It is timely to seek ways to reduce unnecessary health care expense for children, while improving care. With this context in mind, our paper will present methodologies to help providers and payers identify and engage children and families whose service-use patterns,including psychotropic medication use, offer opportunities for improved quality and better cost-containment. This includes description of: 1) our population-based quantitative EMR data analysis, 2) our practice-based qualitative work with providers and families, and 3) the use of both to develop effectiveness measures related to pediatric expense and clinical quality.