Florida is looking to make major changes to Children’s Medical Services, the state-run health care program for children with complex medical needs.
The Florida Department of Health is issuing an invitation to negotiate, soliciting proposals from outside vendors to run Children’s Medical Services as a value-based plan.
“This will be big,” says Dr. Jeffrey Brosco, deputy secretary for Children’s Medical Services and a pediatrician at the University of Miami. “We hope that it is a change that really makes our health care system work in a direction that helps families experience everyday life value, and not just say, ‘OK, here's the doctor, here's the medicine you need to take.’”
Currently, Children’s Medical Services is tied to state Medicaid rules. Brosco says that limits the kinds of services the state can offer.
“So if I gave you the example of asthma: Right now, I as a physician can get paid for seeing a child in my office. And if that child had to go to the emergency room, we can pay the emergency room doctors and the hospital,” says Brosco. “What we can't do, for example, is pay for someone to go into the home and do a look around and see: Is it allergens that's causing it? Are there certain things in the home that we can fix?”
Brosco hopes that shifting to a value-based model—in which an insurance company is paid a certain amount per patient per month—will allow for more flexibility in spending on preventive services outside a clinical setting. And it would change the incentives to keep a child healthy.
The plan is to keep the same doctors and providers that currently participate in Children’s Medical Services and offer more telemedicine options. Brosco also wants to expand how the state measures a child’s quality of life—like tracking whether a child is going to school, if she’s happy, if her family is able to work.
Children’s Medical Services released a presentation on its website with more details about the changes.
Approximately 60,000 children would be covered by the new version of the program. Brosco expects the new plan to begin in 2019.