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

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


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.

Publication types

  • Review

MeSH terms

  • Child
  • Chronic Disease / therapy*
  • Comprehensive Health Care / economics
  • Comprehensive Health Care / trends
  • Delivery of Health Care / economics
  • Delivery of Health Care / trends*
  • Health Planning / economics
  • Health Planning / trends*
  • Health Policy / trends*
  • Humans
  • National Health Insurance, United States / economics
  • National Health Insurance, United States / trends*
  • Patient-Centered Care / economics
  • Patient-Centered Care / trends*
  • United States / epidemiology