During the COVID-19 public health emergency, family dynamics and routines were flipped on their head. Between school closures, social isolation and unprecedented uncertainty, families were hit particularly hard from a social and emotional standpoint. Now, four years later, many families are still grappling with the aftermath, most notably with a significant increase in pediatric mental health conditions.
“We have all navigated a bizarre couple of years with the pandemic, and that has impacted kids developmentally,” Caitlin Zaner, MD, a pediatrician with Capital Medical Group in Chevy Chase, MD, said during an episode of Privia Health’s “Physician Voices” podcast about pediatric mental health and how it affects value-based care.
There has been “a major uptick in anxiety, depression, obsessive compulsive disorder and eating disorders. It’s a tough time for kids,” Dr. Zaner added.
Capital Medical Group is a member of Privia Medical Group, whose parent company, Privia Health, is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Privia Health’s current podcast series, “Physician Voices”, highlighted Dr. Zaner as she discussed the pediatric mental health crisis, why focusing on mental health sets kids up for a healthier future and pediatric care’s role in a value-based care system.
Families are facing a crisis
When times are tough for kids, things inevitably become tough for families too. Consequently, as pediatric mental health conditions continue to rise, there has also been a significant increase in anxiety, depression and other mental health conditions in parents.
In fact, the challenges parents face today were highlighted in the “Parents Under Pressure: The U.S. Surgeon General Advisory on the Mental Health and Well-Being of Parents.” The advisory highlighted that 33% of parents reported high levels of stress in the past month compared to 20% of other adults. It also provided recommendations to help reduce parents’ stress and better support parents’ mental health and well-being.
“The word crisis is an absolutely accurate description of where we are with mental health in this country right now,” Dr. Zaner said.
With a spike in demand for mental health care, psychologists and psychiatrists are often at capacity—especially for pediatric patients. This has made it increasingly difficult for children to access care where and when they need it, which adds fuel to the crisis.
Dr. Zaner explained that if a pediatric patient is facing a mental health crisis or situation, it doesn’t help them or their families if they get referred to a psychiatrist who can’t see the patient for six months or more.
“More work needs to be done around expanding access for mental health conditions from preschool onward. Particularly for patients who are more complicated, such as very young preschoolers or kids who have compounding medical issues,” said Dr. Zaner.
For example, Dr. Zaner noted that kids who are on the autism spectrum, neuroatypical or going through a gender-identity journey are at a higher risk of anxiety or depression. Yet the resources for these patients are fewer and farther between—and they’re often not covered by insurance.
“Mental health connects all humans together—it connects the whole system together,” said Dr. Zaner. “My hope for Privia is that thought is given to expanding access to mental health to directly create referral networks that allow for patients—particularly our child and adolescent patients—to access psychiatrists or psychologists for individual, group or family therapies.”
Addressing kids’ mental health needs
But with limited access to pediatric well-being services, pediatricians like Dr. Zaner are taking a more prominent role in addressing their patients’ mental health needs through value-based care.
That is because “pediatricians are the frontline to mental health,” said Dr. Zaner. “We have evolved to be better able to understand and manage mental health.”
Of course, this can be challenging within current clinical workflows.
“I need to help families figure out how to navigate a school system, advocate for learning plans that will be tailored to the child’s needs and much more. And somehow all of that has to happen in a 15- to 30-minute visit,” she said. “To do these appointments right, it takes a lot of time.”
This additional work inevitably means pediatricians are doing even more documentation and coordination.
“Somehow that type of complex information collecting, analyzing and management planning also has to work into my day-to-day workflow,” said Dr. Zaner. “That means clinical workflows have to evolve, especially for complicated situations.”
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Recognizing long-term health benefits
Despite these challenges, Dr. Zaner and her pediatric colleagues know that prioritizing pediatric mental health is crucial for improving health overall.
“If you have an underlying mental health condition that is not well-managed, your physical health deteriorates … This is true for kids too,” said Dr. Zaner, noting that all their conditions “become harder to manage if anxiety and depression aren’t treated.”
Therefore, investing is pediatric mental health has long-term benefits for patients—and for the U.S. health care system as a whole.
“Childhood mental health strongly impacts our mental health in adulthood,” Dr. Zaner said. “If I can do a better job helping a family manage their child’s mental health as a preschooler, school-aged kid and teenager, I can set them up to be a healthier adult.”
Pediatric health and value-based care
In fact, treating and managing pediatric mental health conditions can help patients and families avoid more serious health issues down the road, which is a core tenant of today’s value-based care.
“It is tough to measure these things generationally. But if I can do a better job reducing kids’ risk of obesity, prediabetes or high blood pressure and managing or supporting their mental health issues, they’re going to be healthier,” explained Dr. Zaner.
This has a direct effect on supporting the value-based care model by reducing patients’ health care needs and, ultimately, the cost of caring for them.
“My adult [primary care] colleagues will have a more typical time managing the care of these patients [in adulthood]. Their health care outcomes will be better, their chronic illness burden will be reduced, and the cost associated to care for their medical health will go down,” said Dr. Zaner.
But the inability to effectively measure these outcomes throughout a patient’s lifespan is one of the more challenging aspects of providing pediatric care in a value-based system, according to Dr. Zaner.
“The hard work, time and 20-year relationships we have with our pediatric patients impacts the work, time, relationships and medical management of these same patients when they’re adults,” she said. “Yet there is no way to cross-generationally look back and reward pediatricians for that part of it.”
That’s why Zaner believes it is crucial for pediatricians to have a seat at the table to ensure that the value-based care system is working for pediatric patients and physicians. This is particularly needed when contracts are up for renegotiation and quality measures and performance metrics are discussed.
“Some of these measures and metrics are straightforward,” such as giving vaccines on the schedule the American Academy of Pediatrics and Centers for Disease Control and Prevention’s “evidence-based recommendations require. But some are trickier, such as screening for depression and follow-up for that,” said Dr. Zaner.
She believes pediatricians need to weigh in on quality measures and performance metrics, ensuring that they are realistically achievable. In fact, Dr. Zaner is part of Privia Pediatrics, a specialty-specific division of Privia Medical Group, that is looking specifically at what the data means, what it tells them, the limitations of data and how to be sure the work being done to care for their pediatric patients is captured.
Privia is looking at “how we can develop strategies around all those things, communicate those strategies to pediatricians and listen to feedback from them,” she said. “This is why physicians need to be in leadership. We’re one of the stakeholders in the system needing to communicate strategies to other physicians.”
Learn with the AMA about ways to improve value-based care data sharing and advance value-based care with alternative payment models in Medicare.
