• Report
  • July 11, 2017

Payment Model Guidance for Organizations Caring for Children with Complex Medical Conditions: The CARE Award

Development of alternative payment models for the children with complex medical conditions (CMC) population is challenging. Movement from the traditional fee-for-service model to alternative payment models requires detailed planning that involves the entire health care network (both internally and externally). When developing new sustainable payment models, children’s hospitals should:

  • Leverage components of emerging Centers for Medicare & Medicaid Services (CMS) payment models for complex adult patients; look closely at new models that abound with a focus on care coordination and community/payer/provider partnerships
  • Understand the demographics of your specific population and take into consideration the difficulty in crafting specific models for smaller populations; industry experience shows leveraging larger populations or adult populations mitigate both the cost and risk
  • Develop the infrastructure to build solid analytics, primary care provider support, and payer relationships
  • Begin to better understand your health system’s unreimbursed costs
  • Obtain actuarial expertise to analyze, implement and monitor any alternate payment model
  • Obtain payer expertise and/or a champion to build and maintain strong payer relationships 
Visit the CARE Award page for more information.