Population-Based Payment Models Can Streamline Care And Reduce Inequities For Children With Medical Complexity

Health Affairs October 12, 2022
Paige Bhansali, Adam Boehler, Alison Curfman

Children with medical complexity (CMC) represent a small but growing population and a disproportionate amount of pediatric health care costs. While exact definitions of CMC continue to evolve, prior studies estimate CMC to represent fewer than 1 percent of children and more than 30 percent of pediatric health care costs. Broadly, CMC have at least one complex chronic condition; severe functional limitations, often requiring technology dependence; increased health care service needs; and increased health care costs. The prevalence of CMC continues to grow as life-saving advances in medical technology have enabled the survival of many with childhood-onset diseases.

Unfortunately, the health care system and supporting policy infrastructure have not kept pace with the needs of CMC and their families. CMC...

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