The pediatrician members of the Children’s Health Foundation recognize the value of office-based care management competencies which enable pediatric practices to better meet the complex care needs of families with children/ youth with special health care needs in the pediatric primary care setting.

CHF is hosting a Pediatric Care Management Improvement Collaborative in order to facilitate the development and spread of the above competencies supporting proactive, targeted office-based pediatric care management. This includes monthly facilitated learning sessions where participants benefit from:

  • Definition of current and developing protocols and methods related to Medical Home, Care Management/Coordination and Primary Care Transformation
  • Practical discussions and development of solutions for implementation
  • Stratification and prioritization of CYSHCN populations
  • Patient identification models and methodologies, including analytical support in some cases
  • Training and use of CHF-developed tools including patient tracking/tickler tools and a developing registry
  • Participation in networking forums with pediatric care managers/coordinators from hospitals, pediatric specialty groups and health plans
  • Analytical and leadership support from skilled CHF staff in areas including:
    • practice data management (potentially offering a registry for CYSHCN)
    • metrics tracking
    • implementation support
    • team building and care management competencies
    • parent feedback surveys
    • health policy and payment reform

This work by participants of CHF supports the goal to improve the care experience and health outcomes of children while enabling better opportunities to equip families for successful self-management. Improved coordination of care across pediatric health services is also expected to reduce utilization of hospital visits and emergency services as evidenced in adult care.