The U.S. healthcare system faces a critical challenge: how to improve outcomes, contain costs, and address long-standing inequities. Social workers are uniquely positioned to meet this moment. Trained to integrate the social, psychological, and structural dimensions of care, they are often embedded across healthcare settings—providing essential services to individuals…

Our team led the first comprehensive analysis of activity-based costing and management (ABC/M) data from Uganda and Tanzania, providing critical insights into how HIV services are delivered and resourced. We analyzed five key HIV services—antiretroviral therapy (ART), HIV testing and counseling, prevention of mother-to-child transmission (PMTCT), voluntary medical male…

This paper introduces a number of existing Medicaid policy instruments and explains how to use them more effectively for programs and providers dedicated to serving CMC. Because Medicaid programs are so variable across the nation, we also provide a diagnostic approach to understanding each state’s Medicaid policy and service delivery…

The federal Advancing Care for Exceptional (ACE) Kids Act became law in 2019 and aims to provide access to a high quality, well-coordinated system of care for children with medical complexity (CMC) and their families. This policy brief describes the background on the need for the ACE Kids legislation and…

This report on the Michigan Partners for Children program is a helpful cost effectiveness resource, referenced in Steve Fitton’s paper, A Perspective on Cost Effectiveness in Pediatric Comprehensive Complex Care Service Models.

Care Coordination Measurement Through the Care Coordination Measurement Tool (CCMT) and Pediatric Integrated Care Survey (PICS)

After attending this event, participants will be able to identify the steps to identify social risk factors that could be incorporated into a payment model, understand the process a state Medicaid program can use to add social risk to medical complexity, and be able to approach their payers about the…

North Carolina’s Integrating Care for Kids and Duke’s Pediatric Complex Care Integration Learning Health Unit present an overview of the programs/ NC landscape, measures used and proposed by InCK and their refinement in NC, Alternative Payment Model types under consideration, including children with medical complexity and those with other risk…

After this session, participants will understand other state’s models, successes, and challenges, to be able to apply the knowledge to their own projects, identify ways to sustain projects beyond participation in the Care Coordination Academy, and develop relationships with other state teams that advance the priorities of sustainable care coordination.

After this session, participants will develop a plan to sustain their work, identify their target audience to communicate about their work, identify partners to expand collaboration, and identify steps to broaden the work to increase its appeal to funders.