Pediatric Care Coordination: Using More Than Claims Data to Define and Understand Children With Special Health Care Needs

Abstract

Purpose: Children with special health care needs (CSHCN) are a significant and growing population, accounting for approximately 19% of all pediatric patients and account for over 33% of healthcare costs Cohen, 2011). The unique and complex needs of this population require practice and payment models that adequately plan for resource needs (system utilization, subspecialist involvement, or care coordination; Pordes et al., 2018). The CSHCN population is at risk for high system utilization including primary care physician (PCP) encounters, inpatient, and emergency room (ED) admissions. The complex nature …