Better wellness visits, healthier kids: Minnesota pediatricians try a new approach

Tens of thousands of kids come through the Children’s Minnesota clinic in Minneapolis each year for their monthly or biannual well-child visits. As a result, pediatrician Patricia Hickey sees a lot of patients for only short periods of time. 

Doctors, she said, may only get about 20 minutes to assess a child’s physical growth, illnesses, medication and vaccine needs, developmental, behavioral and mental health.

“We definitely can’t get to everything we want to get to — everything that we know is important for the health of the child,” she said. “We wish we had more time, and that’s just not the reality of the world these days.”

While doctors may not have the power to lengthen the day, Hickey and other pediatricians have been experimenting with a program that’s effectively letting them add more expert hours around those vital kid checkups.

The hospital’s been partnering with HealthySteps, an effort by the national nonprofit Zero to Three, to pair child developmental specialists with pediatricians so that families can get more out of their routine checkups. 

In 2023, nearly 9,000 children ages 3 and younger were served across the two sites in Minnesota. The feedback has been promising enough that state officials are talking with HealthySteps and local pediatricians now about letting HealthySteps bill the state’s Medicaid program for services.

Hickey and other doctors say teaming up with HealthySteps specialists makes it easier to identify health and developmental concerns in the youngest patients and also help struggling parents navigate the health system.

“We see kids here in clinic, and they might not be making it to other resources in the community,” Hickey said. “So we wanted to bring some of those resources to them and help bridge those gaps.”

‘Talk to families about what they’re seeing’

HealthySteps operates at two sites now in Minnesota, at Children’s Minneapolis and at St. Cloud CentraCare Health.

At Children’s, HealthySteps specialist Kim Zack meets with parents before their child’s pediatrician visit to answer initial questions and allay concerns about the process.

“I want to talk to the families about what are they seeing from their child,” she said. “What do they see that is really going very well that they want to brag about? And what are some of the resources that exist out in the community that could make it easier for them to parent.”

Part of the job includes helping parents understand normal early childhood development and relieve some of their fears.

“Their examples might be that they have a child who’s throwing really big tantrums, and they’re biting and hitting and kicking. They don’t like to be told no, and the parents are struggling to set limits,” Zack said. “All of those are really developmentally normal behaviors for a two or three year old. And sometimes it’s just helping to frame that for the family to say this is actually super normal.”

When parents meet the doctor, they come in with less anxiety, she added. 

Worth the cost?

Zack gets families connected with community resources that can improve kids development and help families struggling with housing and food instability. More than 60 percent of the families who use HealthySteps nationwide are also eligible for Medicaid.

She’s hoping to see the effort spread, but that will take some work and some effort to get state Medicaid programs to defray the expense. 

HealthySteps analyses provide proof of low costs and high return on investments. It says it can employ one full-time specialist for a clinical practice for as little as $50 per child, per year and that it can show its work pays off with states needing to spend less money on care for kids down the line. 

The nonprofit estimates that every dollar spent on HealthySteps yields state Medicaid agencies $2.63 in savings.

The program is not yet billable through Minnesota’s Medicaid program, known as Medical Assistance. But the state Department of Human Services has been in contact with the nonprofit and local pediatricians.

“Our job is to really try to share the innovations across states and get more and more of those codes and more and more of those innovative pathways open so that state Medicaid agencies can take them up and they can feel comfortable that they aren’t the first ones doing it,” said Jennifer Tracey, senior director of growth and sustainability with the HealthySteps national office. “They can actually follow a framework of what another state has done.”

Officials with Minnesota’s Human Services Department say they’re looking at how other states are implementing new insurance billing models before making a decision in Minnesota.

“I would strongly recommend other clinics develop this program in their clinic if they have the opportunity,” Hickey said. “It really has the ability to benefit the family and the clinician, and can be a win-win. Bringing in more resources for families and helping bridge those inequities.”

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