Payment Model Guidance for Caring for Children with Complex Medical Conditions

Payment Model Guidance for Caring for Children with Complex Medical Conditions

This guidance is for aligning payment incentives to support a focus on families, the use of care coordinators, enhanced relationships across providers, and support of the primary care physician.
Download
care_payment_model_report

The 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.
  • Examine new models with a focus on care coordination and community, payer and provider partnerships.
  • Understand the demographics of your specific population and consider the difficulty in crafting specific models for smaller populations; industry experience shows leveraging larger populations or adult populations mitigates 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 or a champion to build and maintain strong payer relationships.
Hand

Contact Us

For more information, connect with us.

(202) 753-5333

Related Content

Mapping the Patient Experience for Rural Alaskan Populations

Understanding the patient’s journey helps build health equity and streamline processes.

May 19, 2023

Community Partnerships Help Break Transportation Barriers

Getting to and from medical visits can present a challenge for some patients and their families. One children's hospital developed community partnerships to address this barrier to care.

May 15, 2023

A Patient-Centric Approach to Ambulatory Care

Learn how one children's hospital changed their approach to scheduling to improve access to care for children and their families.

May 01, 2023