TOP 46 - Integration of Payor-Segregated Pediatric Clinics at an Urban Academic Institution in New York City: The Providers’ Perspective

Publication Number: 3775.TOP 46

Katelyn Jackson, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Beemnet Neway, Weill Cornell Medicine, Burtonsville, MD, United States; Samuel Abramson, Weill Cornell Medicine, Rye Brook, NY, United States; Marianne Sharko, Weill Cornell Medicine, New York, NY, United States

Background: Commonly used payor-segregated outpatient pediatric care models lead to disparities in care, contribute to systemic racism, and can negatively impact outcomes. Children with public insurance experience barriers to equitable care, including lower appointment accessibility and longer wait times for subspeciality care. American academic healthcare institutions often provide care in different clinic settings based on patient insurance type. Publicly insured patients are often seen by different junior providers supervised by attending physicians and privately insured patients are often seen by a consistent attending. Given persisting inequities in care, there has been a general moral call to desegregate outpatient care models. This has led to speculation about the potential benefits and challenges in this process.

At our urban academic institution, general and subspecialty pediatric clinics had been historically divided by insurance type, leading to disparities in care provision, including less availability of subspecialty appointments and less continuity of care providers. (Figure 1) An in-house Health Equity Taskforce formed in 2020 recommended desegregating care, leading to the merger of payor-segregated pediatric clinics in January 2022.

Objective: This study explores pediatric care providers' experiences and attitudes surrounding the integration of payor-segregated outpatient clinical care at our institution. We aim to identify the benefits, challenges, and unintended consequences of this integration process.

Design/Methods: This is a qualitative IRB-approved interview study of pediatric providers who have provided care prior and subsequent to the merger of payor-segregated clinics. We developed a semi-structured interview guide to explore topics related to the merger, including visit scheduling, wait times, space and resource allocation, visit experience, and trainee education. We interviewed general and subspecialty pediatricians and nurse practitioners. (Table 1) The interviews have been professionally transcribed and our research team is currently conducting thematic analysis. Our analysis process consists of pair-wise coding based on a developed codebook, with meetings of our research team to resolve any coding conflicts and to identify emerging themes. The interview guide has been iteratively developed to include themes that emerge during analysis. (Table 2) Upon completion of our thematic analysis, we plan to disseminate our findings through conference presentations and publications to help encourage and guide other institutions through similar desegregation processes.

Appointment availability by insurance type
This is a sample schedule of appointment availability for subspecialty pediatric care by insurance type prior to desegregation of the outpatient care model. Orange shading indicates blocks of appointment availability for subspecialty care patient appointments.

Participant composition by provider type
*Subspecialty areas include adolescent, endocrinology, infectious disease, and pulmonology.

Emerging themes from provider interviews