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

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.