Pediatric Care Management in a Managed Care Environment

Abstract

A system of specialty pediatric care management requires an understanding of how medical management and care coordination integrate. This article describes an assessment process undertaken in a specialty pediatric medical center to determine the scope and cost of care management for specific diagnostic groups. The results of this assessment demonstrated the cost of care coordination and the influence of medical severity and psychosocial factors on cost. Replicating the case type assessment approach with clinical care teams expands the understanding of care management functions and helps teams embrace the concepts of severity of illness and complexity of care coordination.