Children with Complex Medical Conditions: an Under-Recognized Driver of the Pediatric Cost Crisis

Abstract

Children with medical complexity (CMC) represent less than 1 % of all US children, but account for more than 30 % of total pediatric healthcare costs. They are a rapidly growing population of children with the highest levels of medical fragility and intensive healthcare needs that drive them in and out of inpatient settings, particularly intensive care units, at astounding frequencies. CMC account for 34 % ($1.6 billion) of all Medicaid pediatric healthcare expenditures, 47 % of Medicaid’s total spending on pediatric hospital care, and for 71 % of the 30-day unplanned hospital readmissions. As major drivers of the national pediatric healthcare cost crisis, CMC urgently need high value systems of care that are responsive to their longitudinal needs. We encourage healthcare leaders to recognize the unique needs of CMC and their families and to provide intensive inpatient and outpatient comprehensive care in team-based models of goal-directed care. We emphasize the importance of safety, of rapid access to home and community based care, and of continuity of care across acute inpatient, post-acute, and outpatient settings. Resources of palliative care, post-acute care, telehealth, and strong parent-provider partnerships are needed to support value-driven systems. Emerging evidence suggests that comprehensive care for CMC and their families drives total healthcare expenditures down and offers an innovative approach to the provision of high value care for this growing population of children. Efforts to design, implement, and measure outcomes for innovative systems of care for CMC are needed.