Children, youth, and families have unique health needs, which set the foundation for health across the life course; chronic conditions now affect nearly one in three U.S. children, with disproportionate prevalence in those enrolled in Medicaid and CHIP.
Pediatric care delivery and financing interventions can address system fragmentation and unmet needs to improve health outcomes for children, youth, and families. Strategic improvements in care access; child and family support; patient-centered planning; comprehensive medication management; cross-sector care coordination; connection to services addressing health drivers; and support for transitions of care are key, though evidence remains limited by inconsistent methodologies and a lack of standardized, child-specific outcome measures. Consistent, relevant, quality measurement across the health care continuum and outcomes, while challenging, is critical to advance care quality, support payment, and ultimately improve health. Value-based payment approaches, including accountability for total cost of care and quality outcomes, have the potential to improve outcomes and health care delivery while reducing costs. Value-based payment requires appropriate operationalization and testing that accounts for the unique pediatric landscape.
The newly announced CMS Innovation Center Accelerating State Pediatric Innovation Readiness and Effectiveness (ASPIRE) Model presents an opportunity for states to improve care and address key issues highlighted in this brief for children who have or are at risk of developing complex health needs.
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