October 21, 2020

Background & Context

Complex health needs include the treatment of chronic medical or behavioral health conditions through multiple service providers. Care for children with complex needs is currently fragmented, confusing, stressful, and not patient centered. There is a lack of integration of health and community services for children with complex needs. We have complex care systems for adults, but we need them for children as well, as children are the largest publicly uninsured population.     

  • 20% of children have complex health problems and account for the majority of complex care costs (2). They require close supervision and coordination of care to organize the many providers, community services, and teams involved.
  • Support from clinics is often poorly organized, inconsistent, and isn’t timely. Too often clinical teams are “catching up” after problems are already out of control
  • Children with complex health needs see many doctors, often need special procedures or tests, and often have to visit the emergency room or be hospitalized.


Between these health “events,” families are often left on their own to take care of day-to-day needs and coordinate providers, supplies, and services. Too often, families are the only ones who truly know what is going on.

(Image from 1. Kuo et al.)

North Carolina (NC) Medicaid, which insures the majority of children in NC, is currently moving towards a value-based care model. This means that providers will increasingly be reimbursed based on the quality of their care rather than the volume of care provided. This aligns the incentives of health systems, payers, and providers with those of the families—providing high-quality care to children with complex health needs. This will increase the focus on addressing social determinants of health, mitigating healthcare disparities, and improving care coordination for patients with complex needs. 

A healthy life for all children with complex health needs (CCHN) requires addressing the intersection of medical needs, social needs, family health, and health equity. The health care sector, medical, and non-medical sectors need to be seamlessly integrated and involved in each child’s care through vertical and horizontal care integration.

Two key challenges to better integrate children’s complex care in NC:


(Image from 3. National Center for Complex Health & Social Needs)

Through a series of virtual convenings in January, February, and March 2021, we will generate key priorities and actionable recommendations to address scope and scale of care for children with complex needs in North Carolina. This project is a collaboration between Duke University, UNC-Chapel Hill, NC DHHS Title V, and Legal Aid of NC, and is funded by The National Center for Complex Health and Social Needs. 



1.  Kuo, D. Z. et al. (2018) ‘Care Coordination for Children With Medical Complexity: Whose Care Is It, Anyway?’, Pediatrics, 141(Supplement 3), pp. S224–S232. doi: 10.1542/peds.2017-1284G.

2.  Kuo, D. Z. et al. (2015) ‘Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance’, PEDIATRICS, 136(6), pp. 1521–1529. doi: 10.1542/peds.2015-0871.

3.  The National Center for Complex Health and Social Needs, Regional complex care convenings. Retrieved from https://www.nationalcomplex.care/regional-convenings/