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Lessons Learned, Best Practices: Care Coordination for Children with Medical Complexity.

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    Effective care coordination for children with medical complexity (CMC) requires strong clinician-family partnerships and resources. This study clarifies identifying, coordinating, and funding care for these medically fragile, high-cost youth.

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    Area of Science:

    • Healthcare Management
    • Pediatric Health Services
    • Care Coordination Models

    Background:

    • Care coordination in the US often conflicts with existing care teams.
    • Effective care coordination necessitates clinician-family partnerships and adequate resources.

    Purpose of the Study:

    • To provide clarity on identifying, coordinating, and funding care for children with medical complexity (CMC).
    • To address the challenges in calculating the cost of care for CMC due to cost shifting and population heterogeneity.

    Main Methods:

    • Literature review incorporating the latest research on care coordination for CMC.
    • Analysis of existing algorithms for identifying CMC.
    • Examination of reported care coordination team structures, staffing, and costs.

    Main Results:

    • Algorithms for identifying CMC are available.
    • Care coordination team structures, staffing ratios, and cost ranges are consistently reported across studies.
    • Cost calculation for CMC is complex due to cost shifting and population variability.

    Conclusions:

    • Care coordination for CMC is a team-based approach requiring integrated strategies.
    • Models for funding care coordination can be adapted to specific practice settings.
    • Addressing the unique needs of CMC requires tailored and adequately resourced care coordination.