Value-Based Pediatric Care: The Education Prescription

Value-based models are designed to improve outcomes and reduce costs, but they implicitly rely on patients to understand, follow through, and take charge of their care. In pediatric care especially, success hinges on the ability to educate and engage children and families meaningfully. This is where a platform like Xploro becomes not only relevant, but essential.

By empowering patients with personalized education and emotionally intelligent engagement, hospitals can unlock the behavioral changes that drive lower utilization, better outcomes, and higher quality scores. In an era of rising clinician burnout and workforce shortages, such tools also offer a crucial benefit: providing supportive technology to unburden clinical teams while improving care delivery.

The Untapped Power of Patient Engagement

Value-based payment models, whether Accountable Care Organizations (ACOs), shared savings programs, or pay-for-performance incentives, are predicated on a simple but powerful principle: care should be measured by its results. Yet too often, we focus solely on provider-side transformation, leaving patients as passive recipients rather than active participants.

This is a critical oversight. A disengaged patient is less likely to adhere to care plans, attend follow-up visits, or understand treatment options. In pediatrics, this challenge is magnified. A frightened, confused child or an overwhelmed parent can derail even the most carefully designed care pathway.

Patient engagement isn’t a buzzword; it’s a lever for performance. Research shows that higher patient activation correlates with better chronic condition management, fewer emergency department (ED) visits, and lower hospital readmission rates. In value-based contracts, those outcomes translate directly into financial incentives. Providers that invest in engagement tools that bring the provider and patient together in the care plan and self-management, see returns not only in quality metrics, but also in the bottom line.

As funding for programs like Medicaid face historic reductions, success in value-based care depends in large part on the ability to activate, educate, and support patients and families at every step. By empowering patients — especially children and vulnerable populations — to understand and manage their health, we help bridge the growing gaps in access, outcomes, and cost containment. Patient engagement isn’t just a strategic advantage; it’s rapidly becoming a financial and ethical imperative for all healthcare organizations striving to thrive in this new fiscal reality.

Scott Kent, Kent Health Strategies

Health Literacy as a Performance Strategy

Closely tied to engagement is health literacy – the ability of patients and families to understand healthcare information, navigate options, and make informed decisions. In value-based care, health literacy isn’t just a social good; it’s a financial imperative.

Many VBC quality metrics hinge on the assumption that patients will know when to seek care, where to seek care, how to follow post-discharge instructions, and what symptoms warrant concern. Low health literacy disrupts this cycle, leading to unnecessary procedures, avoidable readmissions, and poor medication adherence.

Pediatric care illustrates this vividly. Many families struggle to understand complex diagnoses, medication instructions, or what to expect during hospitalization. Language barriers and educational disparities exacerbate these gaps, contributing to inequities in care and outcomes.

Improving health literacy supports multiple VBC goals:

•       Shared decision-making

•       Reduced diagnostic overuse

•       Fewer missed appointments

•       Better patient satisfaction and experience ratings

•       Compliance and adherence reduce complications, improving cost of care.

Solutions that translate complex information into accessible, engaging formats help mitigate these challenges. When families understand the “why” and “how” of care, they’re far more likely to follow through.

Xploro as a Value Based Care and Workforce Enabler

Hospitals today face a dual challenge: deliver high-quality care under value-based models, while navigating severe workforce constraints. Nurses, child life specialists, and care coordinators are stretched thin, tasked not only with clinical duties but with educating and emotionally supporting patients.

Xploro offers a powerful solution on both fronts. Built specifically for pediatric patients, Xploro uses avatars, 3D visuals, and gamified education to teach children about procedures, treatments, and recovery in a way they understand and trust.

Here’s how Xploro supports value-based success while unburdening clinical teams:

Scales education efficiently: Instead of repeating the same explanations to each family, clinicians can rely on Xploro to deliver consistent, high-quality content tailored to the child’s developmental stage.

Reduces repeat questions and confusion: Children and families arrive more prepared and leave better informed, lowering the burden on staff to re-explain instructions or calm fears.

Enhances satisfaction metrics: Families who feel informed and confident rate their care more positively, improving CAHPS and Press Ganey scores tied to reimbursement.

Mitigates staff burnout: Xploro offloads part of the cognitive and emotional labor of patient education, especially in emotionally intense pediatric environments.

Supports health equity: Multilingual content and intuitive interfaces help bridge gaps for diverse populations, aligning with Medicaid and ACO goals around disparity reduction.

In short, Xploro is more than a patient education tool, it is a strategic lever for achieving VBC goals and sustaining the healthcare workforce.

Leveraging innovate ways to digitally engage patients and help them learn more about their health condition, determine the right treatment, and get extra support is a key component of a successful population health model.  Success in this area helps members in Value Based Arrangements receive the right care, extends the care team’s impact as resources become more limited, addresses barriers to care, and most importantly helps individuals improve their health.

Nathan T. Hunt, President, Bravo Wellness

Evidence and Case Studies in Medicaid Value Based Care

Across the country, Medicaid ACOs and value-based initiatives are beginning to yield tangible results. States like Oregon, Minnesota, and Massachusetts have demonstrated that when providers are given incentives to manage total care and coordinate effectively, outcomes improve and costs stabilize.

Oregon’s Coordinated Care Organizations (CCOs) saw margins improve and paid over $300 million in quality incentive payments to providers.

Minnesota’s Integrated Health Partnerships saved $210 million over four years, with $8.9 million shared back to providers in a single year.

New Jersey ACO pilots showed dramatic reductions in ED visits among high-utilizer patients.

Each of these programs relied on foundational elements of engagement, coordination, and proactive care. Tools like Xploro plug directly into that infrastructure, equipping patients to become active participants in their care journey.

Strategic Roadmap: Preparing for 2030

By 2030, CMS and many state Medicaid programs aim to have all providers operating under accountable care arrangements. That means taking on risk, managing populations, and delivering whole-person care. Future VBC contracts will increasingly integrate:

•       Behavioral health

•       Social determinants of health (SDOH)

•       Equity benchmarks

•       Longitudinal outcomes for pediatric and adult patients

Hospitals that want to thrive in this environment must move beyond compliance and toward transformation. That includes adopting tools that engage patients outside the four walls of the hospital and empower families with knowledge.

Conclusion: A Call to Reframe Value-Based Care

Too often, value-based care is discussed in terms of contracts and incentives. But its true power lies in enabling better care, not just cheaper care. Engaged, informed patients are more likely to adhere, recover, and thrive, and the hospitals that empower them will win on quality, cost, and satisfaction.

Solutions like Xploro bridge the clinical and emotional gaps that undermine outcomes. They make the invisible work of patient education visible, measurable, and scalable. For hospitals, they offer a double dividend: stronger performance in value-based contracts and a more resilient, supported workforce.

The future of healthcare isn’t just about who delivers the care – it’s about how well patients understand and act on it. And that future is already within reach.