Reducing the Health Care Spend for Children with Complex Medical Conditions

Reducing the Health Care Spend for Children with Complex Medical Conditions

Children with complex medical conditions comprise 40 percent of the spend in Medicaid. Children’s hospitals are exploring new care delivery models resulting in smarter spending and healthier children.
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Children with complex medical conditions (CMC) represent a high-cost population for children’s hospitals. They comprise 6% of the pediatric Medicaid population and 40% of the spend in Medicaid. For pediatric academic medical centers, these children may represent up to 80% of the total hospital days. Children’s hospitals are beginning to explore new care delivery models resulting in smarter spending, healthier children and better care for this important population.

Participants in the Coordinating All Resources Effectively (CARE) Award implemented changes to their current health care delivery systems through the development and implementation of change concepts. The effort is anticipated to reduce spend and utilization while improving the quality of care for 8,000 CMC patients enrolled in the project.

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