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Pediatrics. 2018 Mar;141(Suppl 3):S259-S265. doi: 10.1542/peds.2017-1284K.

Evolving Federal and State Health Care Policy: Toward a More Integrated and Comprehensive Care-Delivery System for Children With Medical Complexity.

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Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Massachusetts;
Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.
School of Medicine, Stanford University, Stanford, California.
State Senate, Sacramento, California; and.
Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colorado.


Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health. Notwithstanding, the implementation of care systems with meaningful quality measures for CMC poses unique and substantive challenges. Stakeholders must view policy options for CMC in the context of transformation within the overall health system to understand how broader health system changes impact care delivery for CMC.

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