New research from Mathematica Policy Research weighs the question: “Can we draw lessons from Medicare to improve care coordination for children with special health care needs - especially those covered by Medicaid?” The answer is yes.
Increased attention to children with medical complexity has occurred because these children are growing in number, consume a disproportionate share of health-system costs, and require policy and programmatic interventions that differ in many ways from the broader group of children with special health care needs. But will this focus on complex care lead to meaningful changes in systems of care and outcomes for children with serious chronic diseases?
As health care and financing systems become more sophisticated, health care systems are increasingly using a process known as "risk tiering" to group patients with similar degrees of need for health care and care coordination services. Payers are becoming part of this conversation, which for children is in its very early stages. Families and care providers of children with chronic and complex conditions should understand the risk tiering process, as it may affect access to services these children need. This February 28 conversation describes current tiering practices and uses, and makes recommendations for policy and research, particularly as the process relates to children with special health care needs.