Rachel Wilson, Co-founder and COO of Bluebird Kids Health on pediatric value-based care

The American Academy of Pediatrics published its analysis of Medicaid and CHIP enrollment this past February, which found that 49%, nearly 1 in 2, children in the U.S. were covered by the safety net program.

Briefs from KFF detail staggeringly low measures of access and utilization in this population with this chart in partiuclar showing a year over year decline in Well-Child Visits for Medicaid/CHIP children, falling further from CMS’s goal of 80%.

Reimagining care for children is an incredibly urgent and deeply important task for the United States, as measures of children’s health have declined across the board, according to this recent JAMA article:

Medicaid Managed Care contracts with capitated payments seem like a logical place to start, with ~85.3% of children enrolled in a comprehensive managed care program. But there isn’t much of a playbook for bringing value-based care to pediatric populations, which makes what Bluebird Kids Health is doing so interesting: pioneering taking risk as a pediatric medical group and investing in a model of care that’s historically been the province of older adults in Medicare Advantage or the mass affluent who can afford concierge models like One Medical.

Earlier this year, Bluebird Kids Health announced a $31.5 million Series A to support its expansion. I had the chance to speak with co-founder and COO Rachel Wilson on the challenges and opportunities of Medicaid Managed Care, build versus buy decisions, and the opportunity for generational returns by investing in children’s health.

Q1: Let’s start with the big picture. Children’s health in the U.S. is paradoxical: we spend more per capita than nearly any other country, yet outcomes for kids - especially those on Medicaid - lag behind. Millions of children live in care deserts, and pediatric care is often fragmented, reactive, and poorly aligned with family needs. What do you see as the biggest challenges the U.S. has in pediatric care today, and what’s Bluebird’s theory of the case for solving them?

Q2: How would you describe the Bluebird Kids Health care model to a parent or a particularly precocious teenager interested in finding a new pediatrician? What makes the Bluebird Kids Health model different from a local private practice or hospital-affiliated pediatric group?

Q3: Bluebird Kids Health was founded in Boston, a city with a rich mix of mission-driven and market-driven non-profit health institutions. Unlike philanthropic models like Boston Health Care for the Homeless and Partners In Health, or non-profit systems like Boston Children’s Hospital and Mass General Brigham, you’re building a venture-backed company that serves Medicaid populations. You’re also among the first to bring value-based care to pediatrics. Can you walk us through your strategy - starting with the underserved market opportunity, then your care model, and finally the business model that makes it viable? And as part of that, how are you structuring contracts with Medicaid and commercial payers? Where do you sit on the HCPLAN framework today, and what are your ambitions for value-based care in children’s health? 

Q4: Can you talk about what made Florida an attractive place to test the model? Looking at the Kaiser Family Foundation state fact sheet and data, it has slightly above average percentages of Medicaid Managed Care participation but below average reimbursement rates. Are there physician incentive programs that help offset these lower reimbursement rates that you’re able to participate in that help cover the costs of the community outreach and engagement you’re doing?

Q5: The build versus buy question is notoriously tricky for a novel care delivery model. A de novo build allows you to make design and hiring decisions unburdened by organizational inertia, but is slower and riskier. Buying a practice and its patients means a quicker start but more change management. Bluebird Kids Health opted for buying, and joined forces with Palm Beach Pediatrics in 2024. What was the decision-making behind going that route? Is that going to be the model as you grow? What makes a market attractive to Bluebird Kids for expansion?  

Q6: One way among many that a pediatric population is different from an adult one is that your patients, by and large, can’t drive themselves to a clinic or pay for their own prescriptions because they’re kids and they don’t have cars or jobs. Parents or primary caregivers must play a large role in your model, which imposes an additional layer of complexity on any patient engagement. What does this look like for the Bluebird Kids team? What channels or tactics are most effective?

Q7: How do you think about patient acquisition? Back to the point earlier about your patients’ caregivers being the primary decision makers, what have you found to be the most effective way to build trust and bring patients into the care model?

Q8: In the Fierce Healthcare article about your Series A, Bluebird Kids cites a payer partner’s analysis that your patients see a “42% reduction in emergency room visits and a 69% reduction in inpatient admissions compared to the market average.” It seems like in any value-based arrangement, but especially for Medicaid populations, reducing unnecessary ER and hospital utilization is the key driver of success. How are you able to do this so much better than your peers, and to what degree can those systems and approaches scale without just putting more humans on the problem?

Q9: The Bluebird Kids leadership team has extensive experience operating in value-based care arrangements, including with Atrius Health and Landmark Health. To what degree has that experience translated well to pediatrics, and what challenges have you run into that you didn’t see when you were working with older adults?

Q9: I was listening to the Alignment Healthcare’s talk at the Morgan Stanley Conference, and one thing I latched onto was this idea that as a cohort matures in their model, the MLR for that cohort improves: e.g. a new member has an MLR in the high 80s to low 80s but five years in it’s maybe closer to the high 70s or low 80s. I know it’s still early innings for your company and kids, but I’m curious what, if any, differences you’re starting to see for a new-to-Bluebird kid versus someone who has been in the model for a while.  

Q10: There’s always some tension in a value-based care relationship between documentation and care. Payers want documentation to pay out incentives, and the marginal dollar spent on collecting and sharing this information is a dollar you can’t spend on community health outreach or another Medical Assistant or boosting pay for doctors. Looking at your Insurance page, I count 14 commercial plans, 5 unique Medicaid and CHIP plans, and a couple of VA contracts. That sounds like a lot of complexity to navigate on the quality and reporting front. Is it technological or operational leverage that allows you to be in-network with all these plans? It seems to me like among all the potential use cases for AI, this is one where there's a clear return on investment, but what are you seeing in the day-to-day trenches of operating a medical group?

Q11: Medicaid populations have historically been overlooked when it comes to venture capital financing for a variety of reasons: high churn, low reimbursement, and structural challenges that make it harder to engage. Are you seeing any evidence that this is starting to change? Are there innovations or tooling that you saw for Medicare Advantage that you wish existed for pediatrics?

The biggest gaps in pediatric care stem from systemic underinvestment, fragmented delivery models, and misaligned incentives, especially for children on Medicaid. Despite high national spending, care deserts persist across rural and urban areas, and families face long waits, limited access to specialists, and a lack of culturally competent care.

A major driver is the traditional fee-for-service model, which rewards volume over outcomes. Pediatric Medicaid reimbursement rates are often so low that it’s financially unsustainable for small practices to survive, let alone invest in proactive, whole-family care. That disincentivizes exactly what improves outcomes: preventive care, behavioral health integration, and community engagement.

At Bluebird Kids Health, we’re reimagining that model. We focus on underserved geographies where the need is greatest and have built a pediatric-first, family-centered model that integrates primary care, behavioral health, and social supports. Our value-based contracts reward us for helping kids stay healthy, not just treating them when they’re sick. That means fewer ER visits, fewer hospitalizations, and more time for kids to just be kids, at school, with family, and in their communities. We believe better outcomes and lower costs aren’t in conflict; they reinforce each other. By aligning our business model with what families need, we’re providing pediatric care that is both impactful and sustainable.

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Bluebird Kid Health offers care that fits into your life. Our practices are located close to where you spend your time already - in familiar plazas where you might stop to get your groceries, near schools and parks, and always near public transportation. You don’t need to travel across town to find us. We’re also open when life doesn’t follow a schedule. You don’t have to wait weeks for an appointment. We’re easy to reach and always ready to help. If you twist an ankle at soccer practice or spike a fever at night, you can reach us. We offer same-day visits, weekend hours, and round-the-clock support so parents never feel alone when a child needs care.

What makes us different is how connected we are to you. Our technology helps us stay ahead by reminding us when you are due for a visit or need a follow-up. And, you don’t just have a doctor; you have a team that knows your family. Our providers, nurses, medical assistants, care coordinators, and outreach teams work collaboratively and check-in with you between visits to make sure every care need is followed up on. Most of all, Bluebird feels personal. We hire people from the communities we serve, speak families’ languages, and create spaces that feel warm and familiar. Whether you’re a parent or a teen, you’ll know this right away: we see you, we know you, and we’re in this with you.

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The market opportunity starts with a striking reality: about half of all children in the U.S. are covered by Medicaid, yet many can’t find a pediatrician who will see them. In many areas, families rely on emergency rooms for routine care. This is both a moral and market gap: millions of children who should be receiving preventive care aren’t connected to the healthcare system in any meaningful way. 

We see that as both a public health imperative and a scalable opportunity. By redesigning how pediatric care is delivered and financed, we can improve outcomes for vulnerable children while building a sustainable model that makes serving Medicaid populations viable.

Our care model starts with accessibility and integration. We build practices directly in access-starved neighborhoods and pair them with virtual and 24/7 remote care services, so expert clinical care is available whenever and wherever families need us.   Each practice delivers whole-child care: physical, behavioral, and social services, coordinated by multidisciplinary teams. Behavioral health is not an add-on; it’s built into every visit.  

Our technology platform supports this with AI-driven population health tools that help us identify at-risk children early, proactively reach out, close care gaps, and track progress with developmental milestones. Families can book appointments online, message their care teams, and access care plans in plain language. Our systems are designed to be as intuitive and trustworthy as the best consumer experiences, while still deeply clinical. We’re proving that this approach works. In our early markets, over 90% of Medicaid-enrolled children engaged in our care, received annual wellness visits (almost double regional averages) and we’ve reduced emergency room visits by 42% and hospitalizations by 69%.  

The financial sustainability of our business model comes from efficient, tech-enabled operations, as well as value-based contracts with Medicaid managed care organizations. Instead of being paid for volume, we’re paid for outcomes: well-child visit rates, avoidable ER and hospital utilization, and total cost of care. Our model aligns incentives - families get better care, payers see lower costs, and clinicians are free to focus on what children truly need. 

Through value-based contracts, we share in the savings created through better outcomes. That shared-risk structure enables us to reinvest in services that traditional pediatric practices can’t afford - things like care coordination, behavioral health integration, and the data/tech architecture that supports taking financial risk for our outcomes. It’s a virtuous cycle: better outcomes drive financial performance, which in turn funds more comprehensive care.

From a payer contracting perspective, we’re increasingly operating in the Category 3B to 4 range of the HCPLAN framework – shared upside/downside risk and population-based payments. We have ambitions to move even more contracts toward full risk-bearing arrangements as our data matures and our patient panels scale. The long-term goal is to redefine what “value-based pediatrics” looks like nationally.

In terms of ambition… Our north star is simple: every child deserves exceptional care, regardless of zip code or household income. Over the next several years, we aim to expand into several major metro areas, creating a network of regional hubs offering robust whole-child care for communities who need us most. But our bigger ambition is to demonstrate that when children have consistent, high-quality care, they not only stay healthier but also thrive in school and life. That’s the generational return on investment we’re chasing: healthier kids who can flourish and build strong, thriving communities and a better, more sustainable model for delivering healthcare to half of America’s children.

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Florida was a very intentional choice for us. It’s a state with tremendous need - large pediatric care deserts, high Medicaid enrollment, and a strong managed care infrastructure. That combination makes it an ideal place to demonstrate how a value-based pediatric model can work at-scale. While reimbursement rates in Florida are lower than average, the state’s managed care structure creates room for innovation. We’ve established risk-based agreements with Medicaid MCOs that reward outcomes like preventive care compliance, reduced emergency department utilization, and improved total cost of care. When we deliver better outcomes, we share in the savings - which makes the model both mission-driven and financially sustainable. We also participate in Florida’s Medicaid Physician Incentive Program, which provides additional quality and access-based payments. Those incentives help offset the cost of community outreach, care coordination, and behavioral health integration - the very elements that drive better long-term results. In short, Florida gives us the right combination of need, scale, and payer alignment to prove that exceptional pediatric care for Medicaid populations can be both equitable and sustainable.

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We decided to acquire because it allowed us to move faster while building from a position of strength. Palm Beach Pediatrics, led by Dr. Shannon Fox-Levine, had spent more than forty years developing a high-quality, integrated care model that already reflected many of our core principles: whole-child care, behavioral health integration, and a deep commitment to access for all families. Partnering with them gave us an established patient base, trusted clinical teams, and strong relationships with local payers, creating a foundation that aligned naturally with our mission. The integration was energizing because our team shares systems, values, and a common vision to bring more care to more kids who need us. It is about scaling a shared philosophy and model of care together.

If we hadn’t found a partner so well aligned, we would have built from the ground up. In this case, the acquisition simply gave us a head start on scaling a model we already believed in together. It helped us accelerate access for families while staying true to what matters most - delivering exceptional care so every child can thrive.

Looking ahead, our acquisition approach is primarily a tool for entering new states, where a like-minded partner helps us establish credibility and local expertise early on. But our long-term growth strategy is rooted in organic expansion- opening new sites, hiring exceptional teams, and adding pediatric capacity in communities that need it most. When we evaluate a market, we look for three things: large populations of children enrolled in Medicaid, inadequate pediatric supply to meet market demand, and a strong managed care infrastructure, with forward-thinking payer partners who share our commitment to value-based care.

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You’re exactly right - pediatric care is really family care. Every interaction involves not just a child, but a parent or caregiver balancing work, school schedules, transportation, and often the broader realities of social and economic stress. So, while our patients are kids, our true unit of care is the family, and that perspective has shaped every element of our model.

We make it easy for families to access care on their terms. Our locations offer same-day and next-day appointments, with expanded hours that stretch into evenings and weekends. Families can reach us around the clock through phone, text, or virtual care, which helps them avoid unnecessary emergency room visits. Our centers are located right in the neighborhoods where our families live which removes another major barrier to care.

Engagement also depends on clear, compassionate communication. Our care plans are written in simple, plain language, often multilingual, and focus on what parents can do at home between visits. We use text reminders, follow-up calls, and proactive outreach from our care coordinators and behavioral health teams - not just to close care gaps, but to check in, listen, and build trust. For us, engagement isn’t a series of reminders; it’s a relationship. Families need to feel that their care team is a partner in their child’s development, not just people they see when something’s wrong. When that trust exists, everything else follows: adherence improves, preventive care visits increase, and outcomes get better. That’s why our model consistently achieves well-child visit rates that outperform the market among Medicaid patients. Those results are proof that when you meet families where they are (in both location and spirit) - they show up.

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For us, patient acquisition starts with trust. The families we serve often live in communities where access to pediatric care has been limited or stretched thin, so we approach growth as a partnership effort before anything else. We build relationships and work alongside local organizations that have long served children and their families with dedication and expertise. 

Our teams build relationships with community-based organizations, faith-based groups, social service agencies, healthcare organizations, schools, early childhood centers, and local advocates. We attend neighborhood events, meet school leaders, visit daycares, and show up at open houses. These aren’t transactional interactions; they’re opportunities to listen, collaborate, and contribute to a shared goal of helping more children thrive.

We complement this grassroots presence with a robust outreach program that includes both telephonic and text-based engagement. This supports the patient attribution we receive from our payer partners, helping families understand their benefits, schedule their first visits, and stay connected to care in a way that feels simple, respectful, and welcoming.

Our marketing engine helps build awareness and sustain relationships with established families. Families can find and engage with us across digital platforms, but the message is always the same: accessible, compassionate, high-quality care for every child. Ultimately, our most effective “acquisition strategy” is authenticity - real people building real relationships, expanding access in partnership with others who share our mission. That’s the heart of how we grow and the reason families choose to stay with Bluebird Kids Health.

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Reducing unnecessary emergency room and hospital utilization starts with access, trust, and proactive care. Many of the families we serve have historically used the emergency department as their main source of care, not because they prefer it, but because it’s the only place that’s open when their child needs help. We solve that first problem directly by offering same-day and next-day appointments, extended hours, and 24/7 telephonic and virtual access to our care teams. When families can reach us anytime, the ER becomes a last resort, not the default.

But access alone isn’t enough! What we do between visits is how we really change outcomes. Our population health technology identifies children who may be at risk of exacerbations or avoidable hospitalizations, allowing our clinicians to intervene early before crises emerge. We use predictive analytics to flag kids with missed immunizations or screeners, poorly controlled asthma, emerging behavioral health needs and more. From there, our care coordinators reach out proactively. We don’t wait for families to call us.

As for scalability, that’s where our model really differentiates. We’ve designed our clinical protocols, care workflows and a technology platform so that we can grow without simply adding more people. Our AI-enabled tools streamline documentation, automate outreach, and help our clinical teams work at the top of their license. Every new market benefits from the same underlying infrastructure, which means we can scale outcomes, not just operations. All of this is economically viable only because we’re paid for outcomes, not volume.

At the end of the day, our success comes from combining high-touch care with high-tech enablement. Families get better access and continuity, clinicians spend more time on care and less on paperwork, and payers see lower total cost of care. That’s the promise of value-based pediatrics.

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Our leadership team’s experience in value-based care has been invaluable and our work in pediatrics has required us to rethink how those principles are applied. The fundamentals are the same: proactive, coordinated care that improves outcomes while lowering total cost. What’s different is the time horizon and the unit of care. In adult populations, value-based care often centers on managing chronic conditions and avoiding acute events. In pediatrics, it’s about setting a foundation for lifelong health.

At Landmark Health and Atrius Health, we learned how to build systems that align incentives, data, and teams around better outcomes. Those lessons translate directly into how we structure our contracts, measure success, and design care coordination. But in pediatrics, the patient is rarely the decision-maker. Parents and caregivers play a central role. That adds layers of complexity around engagement, communication, and trust.

We’ve had to design an entirely different approach to activation - one that meets families where they are, acknowledges social and logistical barriers, and empowers parents as partners in care. Similarly, the economic model is different: pediatric cost curves are flatter, so the “return” on preventive care is measured not just in avoided hospitalizations, but in developmental milestones addressed, school attendance, and long-term wellbeing.

Those challenges have pushed us to innovate - to use data not only for risk prediction but also for proactive outreach and education, and to build care teams that integrate behavioral health and social services from day one. The experience we bring from adult value-based care gave us the playbook; pediatrics has required us to rewrite it with families at the center.

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It’s still early, but the data from families who’ve been part of the Palm Beach Pediatrics system for more than five years gives us a compelling preview of what’s possible. We’re seeing medical loss ratios that are consistently in the double digits below baseline targets, alongside significant reductions in unnecessary emergency department visits and avoidable hospitalizations.

These improvements come from compounding effects across three areas. First, better chronic condition management. Children with asthma, for example, show steady progress as their care plans mature. Early on, we focus on accurate diagnosis and establishing strong baseline management. Then, we layer in personalized action plans that help families recognize early warning signs and respond before symptoms escalate. The result is fewer exacerbations and far fewer hospitalizations.

Second, preventive care compounds. Regular well-child visits, immunizations, and developmental screenings create a rhythm of engagement that pays off over time. For example, identifying vision issues before they affect learning, identifying developmental concerns earlier, and supporting behavioral health before a crisis develops. Each of these touchpoints builds resilience for the child and lowers costs for the system.

And third, trust. Over time, families build meaningful relationships with their care teams. They call us before small problems become big ones, and they follow care plans more consistently. That trust can’t be rushed, but once it’s established, it’s the single biggest driver of improved outcomes.

We’re already seeing signs that this pattern is replicating as we grow. A few months into our first Jacksonville practice opening, engagement and utilization patterns are mirroring what we’ve seen in Palm Beach County. That tells us our model, our ethos, and our systems are portable and that the results we’re seeing are repeatable wherever families need us.

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You’re right, the administrative complexity of value-based care is real, especially in pediatrics. We contract with more than a dozen commercial payers and multiple Medicaid and CHIP plans, each with its own quality measures, reporting requirements, and incentive structures. Without the right infrastructure, the operational burden could easily outweigh the benefit.

That’s why we invested early in a unified technology and data platform that standardizes performance metrics across payers and automates much of the reporting process. Our population health tools pull data directly from payers and EHRs, map it to shared quality measures, and deliver actionable insights to our care teams in real time. This allows us to close gaps in care proactively instead of chasing documentation after the fact.

AI and workflow automation play an important role as well. We use AI-enabled tools to streamline documentation, pre-populate visit summaries, and flag missing information needed for quality reporting. This reduces the administrative load for clinicians and staff, giving them more time for direct care, outreach, and family engagement.

Operationally, we’ve also built dedicated teams to manage payer relationships and performance analytics, freeing our clinicians from that complexity. The result is a system where compliance and care quality reinforce one another rather than compete for attention. Our goal is simple: make doing the right thing for the patient the easiest thing for the provider. When technology handles the complexity, our care teams can stay focused on what matters most - taking care of kids and families.

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We’re starting to see encouraging signs that investors are paying closer attention. For a long time, most innovation and capital flowed toward Medicare Advantage, but a shift is happening towards Medicaid, which represents the largest underserved opportunity in healthcare. Half of America’s children are covered by Medicaid, and there’s a growing recognition that improving pediatric care for them is both a moral and economic imperative.

The structural challenges remain: lower reimbursement, higher mobility, and longer time horizons to see the impact of preventive care. However, the momentum is shifting. Bluebird’s experience shows that sustainable, scalable models are possible when value-based principles are thoughtfully applied to pediatrics.

Technology, and especially automation, is helping make that shift real. Automation allows us to extend access without simply adding more staff. It powers the reminders, outreach, and scheduling that keep families connected to care, while freeing clinicians to focus on what only humans can do: listening, diagnosing, and building trust. That combination of high-touch care and intelligent systems is what makes value-based pediatrics both scalable and sustainable.

What pediatrics needs next is dedicated infrastructure built for families: tools that make it easier to stay connected, measure developmental progress, and address social needs early. We’re building some of that ourselves, but there’s room for much more innovation. If the next wave of healthcare investment focuses on children’s health, the returns will be generational - stronger families, healthier communities, and a more equitable system overall.

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