Costs to Deliver Care Coordination
Hospitals participating in the CARE Award first had to understand the cost of the new care model, which focused on decreasing unnecessary utilization and improving the family experience, then assess the effect of the new model on decreasing overall spend in excess of these new costs. Calculated care coordination costs for these children ranged from $150-$400 per member per month (PMPM).
Under traditional fee-for-service reimbursement models, care coordination has not been supported at the extent required for a complex pediatric population. Analysis of resources dedicated to care coordination at CARE Award sites provided information as to an adequate PMPM care coordination payment to support new care models. Understanding the costs of care management will assist hospitals in adequately accounting for resources to provide care transformation.