About the CARE Award

Of the nation’s 76 million children, up to three million have complex medical conditions that require extensive health services. Two million of these children depend on Medicaid. As the highest utilizers of health care resources, they have a direct impact on overall health care costs. The Children’s Hospital Association (CHA) received a three-year, $23 million Health Care Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI) to transform care for these children and their families. The Coordinating All Resources Effectively (CARE) Award is a landmark national study focused on improving outcomes and reducing the cost of health care for children with medical complexity (CMC) enrolled in Medicaid. 

“For the child who’s got five or six specialists, three or four complex chronic conditions, their families really struggle.”

By focusing on care coordination with providers and families, children’s hospitals are positioned to reduce avoidable hospital and emergency department utilization, improve the patient and family experience, and better manage the costs of serving these children. But new payment models are needed to support sustainable change.

To implement and test changes, CHA partnered with:

  • 10 of the nation's leading children’s hospitals
  • More than 8,000 children and their families
  • Eight state Medicaid programs and Medicaid managed care organizations
  • and, 42 primary care practice sites

The stress families experience as they manage home care, organize numerous specialty visits, deal with transportation issues and try to decipher information from multiple providers is a challenge that children's hospitals need to address. "For the child who has five or six specialists, their families really struggle. Designing a system of care that better integrates their experience across different providers is an important goal for us,” said David Rubin, M.D., medical director, Population Health, Children’s Hospital of Philadelphia.

The CARE Award–the largest study of CMC–targeted care delivered in hospital-based complex care clinics at children's hospitals and community-based primary care practices to improve care coordination and ensure a high quality of care across all settings.

The Goals

Through implementation of change concepts for care delivery, participating hospitals hoped to:

Outcome Measures Three-year Aggregate Goal
Decrease inpatient days 40%
Decrease ED discharges 10%
Decrease spend 6.8%

This project concluded in June 2018. View the preliminary results. The insights and outcomes may contribute to larger-scale innovations and transformation among the 10 CARE Award hospitals and, ultimately, other children's hospitals and health care organizations that care for CMC across the U.S.

Thank you to CMMI for the opportunity to focus on a very important and vulnerable population, as well as the experts and leaders who guided this work over the last three years.

Contact the CARE Award team for more information.

Related resources

Executive Summary

Important Insights from the CARE Award

View Results

A Visual Look at Project Highlights

View Infographic
CARE Award Webinar Series

Stories of Improving Care and Reducing Costs

Access Webinars
Press Release

Children's Hospitals Improve Medicaid for Children with Complex Medical Conditions

Read Press Release
White paper

Early Lessons Learned: Caring for Children with Medical Complexity

Read Paper