•Identify current and potential sources of revenue and reimbursement to support a pediatric palliative care program.•Describe components of US healthcare reform that support a business model for pediatric palliative care.•Review examples supporting pediatric palliative care as a strategy in an accountable care organization. The majority of children at the end of life in the United States do not have access to designated pediatric palliative care (PPC) services. A key obstacle to implementing inpatient and outpatient/community-based PPC programs appears to be a lack of adequate reimbursement to make a financial case. This session reviews the current pillars of PPC reimbursement in the United States: fee-for-service (including the 2010 Concurrent Care for Children requirement), philanthropy, and institutional support. Looking into the future, through current payment reform, the fee-for-service model appears to be moving toward value-based or accountable care organization/bundled billing strategies. PPC can be a key health-system strategy in realigning healthcare delivery, as population health management includes seriously ill children (highest risk and highest cost). Emerging data will be reviewed to help participants make the case that the integration of PPC not only improves quality of life and symptom management during the end-of-life period for children but also lowers costs.