Reshaping Pediatric Practice

When pediatrician Donald Berwick became Administrator of the Centers for Medicare and Medicaid Services, he brought with him a simple framework to reorganize that agency and through it the US health care system.1 The “Triple Aim” sets 3 goals: (1) reducing per capita costs of health care, (2) improving the experience of care by addressing quality and satisfaction, and (3) improving the health of populations. Combined, these aims redefined the role of the Centers for Medicare and Medicaid Services from financier of health care services to public fiduciary and change agent. They also are likely to reshape the role and organization of pediatrics in the United States. Despite its reputation as a low-cost service, child health care will be examined for overuse and inefficiencies. Preventive care will be scrutinized. Interventions will target the small group of children who account for the majority of health care expenditures,2 and there will be greater interest in modifiable social factors that ramp up the costs of care for many children. And despite their low incomes relative to other specialists, pediatricians in the United States will not be immune from payment reform and possibly reduced reimbursement. Pediatricians will experience increasing pressure to reduce variations in the quality of care among neonates and children with chronic and complex health problems who are at heightened risk for poor outcomes.3 Recent shifts in the prevalence of a number of pediatric morbidities are placing new demands on child health care providers for which they may be … Address correspondence to Edward Schor, MD, Lucile Packard Foundation for Children's Health, 400 Hamilton Ave, Suite 340, Palo Alto, CA 94301. E-mail: edward.schor{at}lpfch.org