P4 Challenge: Innovations in Pediatric Primary Care to Improve Child Health

If you are not already aware, HRSA (the Health Resources and Services Administration) announced the P4 Challenge - a national contest aimed at improving well-child visits and their accompanying services, namely vaccines, developmental screening, etc. 50 winners will be chosen to receive $10,000 each based on their ideas for promoting well visit care. Then, based on the results from the original round of winners, up to 20 of the original 50 winners will receive an additional $25,000. Real money for a pediatric practice! You have until March 15, 2021 to apply - just 3 weeks away.

You can read the details here, where they outline the goal of the contest, who is allowed to apply, and the application requirements.

Naturally, I was immediately interested in this topic. Is there anyone who has lectured about this specific topic more than I have? Is there a pediatric issue more near and dear to my heart than engaging with patients and getting them in for their well visits? No and no.

The January information webinar quickly showed that independent pediatric offices are at a disadvantage here - the questions were largely from professional grant seekers from various hospital systems, multi-site FQHC programs, school systems, etc. Which is great, we need those players to help improve care for children, especially those in the figurative "last mile" of well-coverage. But PCC still has plenty of clients who serve at-risk populations who may not have the resources to gather all the information to submit a strong application.

And there are even more non-PCC practices in the same boat.

That's what this post is about.

Ultimately, HRSA has promised to share the winning applications as they seek clever and effective solutions for driving well child care. This is as a chance to get 50 new ideas for how to get the 30% of your patients who are overdue into your office right now, especially as we navigate this non-existent flu season.

PCC clients have some distinct advantages applying for this contest. We provide a long list of free tools designed specifically to improve well visit rates. Perhaps the most important tool for this application is our Dashboard, which provides clients with up-to-date benchmarks for state, regional, and national well visit benchmarks. At PCC, we know how important and effective the Dashboard is.  I'm not sure there's another tool with more timely or applicable pediatric data available anywhere.  We know that practice-level, peer-comparative clinical data is very effective at improving clinical results - I've even gone and done some homework for everyone on this particular aspect of the application (see below).

So here's my promise: if your pediatric practice wants to apply to the P4 Challenge, I (and our crew) will help you improve your application.  Specifically, we will provide you with initial benchmark data that you can use to measure your performance.  Just send me a note, tell me what state you are from and what measures you're interested in (see below), and I'll send you the data we have.  If you get chosen, I'll send you monthly data so you can apply in the second round for the $25,000.  I want independent pediatric practices to do this work!

If you're a PCC client, we'll obviously go a lot further.  We'll help proof read and tighten your application.  We will provide one of your two required letters of support.  We will jump through whatever hoops we can do get you the data you need if it's not right there in the Dashboard or our other reports - especially data related to your practice demographics (part of the application).  You still have to come up with the good ideas and prepare the content, but we'll make it as easy as possible.

Below, I'll outline some of the help we can give.  If you're a PCC client, pick up the phone and call.  

PCC Tools

  • Free email and text-based patient recall tools.



  • Clinical Dashboard




Our Pediatric Dashboard Includes the following measures.  PCC clients know where to find this, but if you're a non-PCC client who can use this data to apply, let me know:

  • Well Visit Coverage Rates, broken into 5 age groups
    • HEDIS Comparison Scores
    • Ambulatory Pediatrics Comparison Data
    • Overdue patient lists (exportable)
    • Can be broken down by:
      • Clinician
      • Race
      • Ethnicity
  • Immunization Rates
    • By Vaccine
      • HPV
        • Patient sex, PCP
        • 13 and 13-17yo measures
      • Meningococcal
      • Tdap
    • By Age Group
      • 2 Year HEDIS Grouping (DTaP, IPV, MMR, HiB, HepB, Varicella, PCV, HepA, RV).
      • Adolescent HEDIS Grouping (TdaP, Meningococcal, HPV)
    • Ambulatory Pediatrics Comparison Data
    • HEDIS Comparison Scores
    • Per-Clinician Results
    • Overdue patient lists (exportable)
  • Depression Screening Rates for Adolescents
    • Ambulatory Pediatrics Comparison Data
    • Per-Clinician Results
    • Overdue patient lists (exportable)
  • Developmental Screening Rates for Infants
    • Ambulatory Pediatrics Comparison Data
    • Per-Clinician Results
    • Overdue patient lists (exportable)
  • Guidance from NCQA’s 2017 PCMH standards

Some of our clients have already shared ideas with me that they intend to submit.  I'll share some of them here.

  • Implement professionally developed, age- and sex-specific patient recall content with A/B/C test messaging to determine which messages resonate best with our patient base.
    • Provide "Preventive Care Report Cards" to individual families, indicating their preventive care service utilization.  The goal will be to stimulate a demand for our services based on Bright Futures.
  • Leverage the idea that a tight feedback loop with peer benchmarking leads to behavior change. [see below!]
  • Receive HPV training and education to enable a stronger and more empathetic approach to encouraging HPV vaccination among hesitant families.
    Dempsey AF, Pyrznawoski J, Lockhart S, et al. Effect of a health care professional communication training intervention on adolescent human  papillomavirus vaccination: A cluster randomized clinical trial. JAMA  Pediatr 2018; doi:10.1001/jamapediatrics.2018.0016. [Epub ahead of print].
  • Make the changes required to our workflow and business calendar to schedule more than 3m out.
  • Create a drive-through immunization clinic.
  • Use your computer to flag all overdue patients and “super-size” every possible visit.
  • Incentivize patients somehow.
    • Stark law issues?
    • Gameify?
  • Create a school-based vaccine/well-visit clinic?
  • Help families sign up for Medicaid.

Below, I share a series of published articles that reference the positive relationship between clinical benchmarking and physician performance.

Private “Performance Feedback” Reporting for Physicians: Guidance for Community Quality Collaboratives (https://www.ahrq.gov/sites/default/files/publications/files/privfeedbackgdrpt.pdf)      [great guidelines for building a clinical dashboard!

Providing Performance Feedback to Individual Physicians: Current Practice and Emerging Lessons (https://www.rand.org/content/dam/rand/pubs/working_papers/2006/RAND_WR381.pdf)
“Comparative Performance Information: The literature we reviewed indicates that peer comparisons are an effective way to motivate behavior change and are the comparison type that physicians find most meaningful.[19, 20, 24] And “unblinded” peer comparisons (i.e., those that identify physicians by name) seem to provide greater motivation for behavior change than do “blinded” (confidential) peer comparisons because they leverage the natural competitive instincts of many physicians.[25]”

Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance
(https://www.ahrq.gov/sites/default/files/publications/files/confidreportguide_0.pdf) [more guidelines for dashboard development]

Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial
“Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.”

Audit and feedback: effects on professional practice and healthcare outcomes
“Audit and feedback generally leads to small but potentially important improvements in professional practice.”



Finally - and this is to see if anyone reads this far - what do you think about PCC running it's own contest, open to any pediatric practice?  $500 prizes for good ideas on patient engagement?