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Principles of Managing Children with Medical Complexity and a New Delivery Model

Kurtis T Sobush1

  • 1Kurtis T. Sobush, MD, is Associate Professor of Pediatrics in the Department of Pediatric Pulmonary and Sleep Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.

Missouri Medicine
|May 2, 2019
PubMed

Insights

Caring for children with medical complexity (CMC) requires dedicated pediatric management. New programs enhance care coordination and manage high-acuity patients outside hospitals.

Area of Science:

  • Pediatric healthcare
  • Complex care management
  • Healthcare program development

Background:

  • Children with medical complexity (CMC) require significant provider commitment.
  • Increasing patient acuity and evolving reimbursement models necessitate specialized care.
  • Focus is shifting towards managing CMC outside traditional hospital settings.

Purpose of the Study:

  • To review the management strategies for CMC.
  • To highlight a specific program designed for CMC.
  • To discuss the drivers behind specialized CMC program creation.

Main Methods:

  • Review of current literature and best practices in CMC management.
  • Case study of the Complex Medical Care Program at SSM Health Cardinal Glennon Children's Hospital.
  • Analysis of key drivers for program development: care coordination, value-based reimbursement, and high-acuity patient management.

Main Results:

  • Specialized programs are essential for effectively managing CMC.
  • Enhanced care coordination improves outcomes for CMC.
  • Value-based reimbursement models incentivize efficient, high-quality care for this population.

Conclusions:

  • The development of dedicated programs is crucial for optimizing the care of CMC.
  • Effective management of CMC involves integrated care coordination and adapted reimbursement strategies.
  • The highlighted program serves as a model for addressing the unique needs of CMC in non-hospital settings.

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