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Children’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination. The authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. Findings from the article demonstrate that a large number of Medicaid/CHIP-insured children could benefit from targeted care coordination and differential resource allocation that aligns with their health complexity. 

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Children with complex medical conditions often face significant social barriers to accessing and benefiting from available health care. The high cost of their care and...