Improving the Care and Experience of Children with Health Needs: Imagine Pediatrics’ Mission

Delivering the best care and the best care management for children with special healthcare needs can be challenging in any context; but when those children receive their health insurance through the Medicaid program, additional issues and challenges arise. Yet the opportunity to improve that care delivery and that care management, has led the leaders of the Nashville-based Imagine Pediatrics to develop a unique and innovative service that brings physicians, nurses, and other clinicians to children either virtually or in person in their homes.

Imagine Pediatrics, which was founded in 2022, currently serves patients in three different geographical areas in Texas, Florida, and the Washington, D.C. metro area, and involves a staff of 350, half of whom are clinicians (a mix of physicians, advanced-practice nurses, and others).

As the organization explains on its website, “We are a pediatrician-led team committed to creating a world where every child with special health care needs gets the care and support they deserve. With deep understanding of the unique challenges these kids face, our team works around the clock to give them, their families, and other caregivers the help and relief they need, right from home.”

Further, the organization emphasizes, "We partner with health plans using a value-based population health payment model, so we can often offer our services at no cost if they are part of a child's existing benefits."

The organization’s website also notes that “We prioritize care modalities that are most convenient for caregivers. Anytime of the day or night they can call or message us using the Imagine PediatricsTM Mobile App. We will answer their questions, hold a virtual care visit, address their child’s acute needs, and when appropriate, provide in-home diagnostics and treatment.” And it provides “multidisciplinary, whole-child care that is comprehensive and designed to meet the specific needs of the children we serve. All of our patients receive Core Care Services, including unlimited access to 24/7 virtual and in-home multidisciplinary pediatric care”; as well as providing care coordination and support throughout the patient journey.

As Taylor Beery, Imagine Pediatrics’ co-founder and chief innovation and administrative officer explains it, the creation of the physician organization has its roots in the experience of his young son, who succumbed from cancer at an early age. The experience that the entire family went through in terms of having to rely on rushing to the emergency department for care when virtual or home-based interventions so often could have delivered the care needed without the disruption of ED visits, helped to inform Beery and his colleagues as they founded and architected Imagine Pediatrics.

Recently, Beery spoke with Healthcare Innovation Editor-in-Chief Mark Hagland about Imagine Pediatrics’ founding, mission, guiding values, and organizational model, and the advances that he and his colleagues are making in delivering care to pediatric patients and improving the healthcare system’s interaction with them and their families. Below are excerpts from that interview.

So, can you describe the basic premise on which Imagine Pediatrics operates?

Yes, we are a medical group, pediatrician-led, and deliver 24/7 virtual and in-home care. We are currently contracted with six Medicaid health plans in the regions in which we operate. The bulk of our interaction with Medicaid families is through virtual and digital interactions, but we also have home care specialists who work in the home. We’re 100-percent Medicaid in our reimbursement.

With regard to a business model predicated on Medicaid reimbursement, would you say that there are challenges right now, as the future of the contours around Medicaid reimbursement, remains uncertain in the current Congress?

The presumption going in was that it would be challenging to work in a Medicaid reimbursement-based business model. Some might have felt that it would be easier to work under the Medicare/Medicare Advantage umbrella. But we’re now serving 35,000 kids and have been taking care of kids since January 2022 in Texas. In the value-based space we have incredibly increased our reach. We do not replace PCPs or specialists; we’re more of a wraparound-care model. We’re seeing super-happy parents. An 87-percent plus caregiver score. Our goal is safe days at home for these kids. And we’ve seen a 10-percent MLR [medical-loss ratio] reduction right out of the gates. The kids are able to spend more safe days at home. So we’re there to support them 24/7.

To what do you attribute the success of your operations and business model so far?

When my son was sick, it was inevitable that at 2 PM on a Saturday afternoon, my son would have a medical issue, and so often, that meant a trip to the emergency department. And when I was there, it was remarkable how often I was sitting side by side with other parents who would have preferred staying at home. I remember flushing central lines by myself, and not feeling confident about that. And these are hardworking people doing their best to balance almost an impossible situation. And what they need is resources and tools. They need this network. And the situation is ripe for value-based opportunities. Also, when we hung out our shingle, we were impressed the unbelievable quality of physicians, nurses, APPs, who would work with us. And the people who’ve been attracted to this work have really been extraordinary. The complex-care expertise combined with the empathy, to increase the number of safe days at home for the kids. Also, the heterogeneity of the population probably was daunting to people. But through data analysis, we’re able to provide longitudinal care for these kids in a way that I think people couldn’t have anticipated. I think that’s why we’ve seen the result we’re seeing.

What have been the biggest challenges so far?

I spend a lot of my time right now worrying about what public policy could mean for these children and families; everything we do is families-first. And as long as a model like this is allowed to move forward—you write a lot about reimbursement rates—these children need that support. I really think if we’re allowed to do what we do in an open space that isn’t threatened by external forces, we can dramatically improve patient outcomes and lower costs on the pediatric spend.

How are you managing the moment around the uncertainty over Medicaid reimbursement in Congress?

We’re preventing distraction from the clinical work that our teams are involved in. And I spend time in D.C. trying to communicate about this. One in five kids have special healthcare needs, and nearly 50 percent of them are on Medicaid, and that’s who we serve. And our objective is to make sure that policy leaders acknowledge that there’s an extraordinary activity to focus programs around these children. I believe that the most vulnerable population on the earth are children with special healthcare needs. And we assume the best intent among policymakers. Our job is to inform them with data. This model works, and we need to make sure that all providers caring for children are considered.

What does the next couple of years look like for you?

We’re going to continue to expand in the states where we’re already operating, but we’re also looking to expand beyond those geographies. There’s really nothing stopping us from continuing to expand geographically. So we’re working to expand the lives that we’re honored to serve, wherever they are.