Project Description:
The overall aim of the Coordinating All Resources Effectively (CARE) initiative is to inform sustainable change in the health care delivery through new payment models supporting improved care and reduced costs for children with medical complexity (CMC). These are children with the most complex chronic conditions, typically involving multiple organ systems and requiring many specialists. The costs of care for these children, much of which is borne by Medicaid, are high; the population of CMC, though relatively small in number at 6% of the total pediatric Medicaid population, represents an estimated 40% of Medicaid spending on children.
Specific project goals, aligned with the National Quality Strategy (NQS) aims, are to 1) improve the health of CMC and their families by increasing access to complex care program resources and reducing family stress related to care, 2) improve health care as assessed by patients experience of care, increased access to preventative care services, and use of a written care plan, and 3) reduce health care costs primarily through a reduction in hospital days and emergency department (ED) visits.
CARE will serve 8,664 children in nine childrens hospitals nationwide by the end of the three-year project. Through CARE, we propose to improve care and reduce overall health care expenditures for CMC by 1) creating a medically-appropriate tiered system of care so that CMC are cared for in the most appropriate settings to meet varied patient and family needs while lowering costs, 2) designing a payment system that is flexible and sustainable, and 3) creating a collaborative learning system so that programs and payers across the country can rapidly learn to improve care and design and implement effective payment models.
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Disadvantaged Circumstances, Limited English, Geographic Areas
