How Can the Integrated Care for Kids Model, a CMS Alternative Payment Model, Help Health Systems Learn to Better Address Pediatric Social Determinants of Health?

This dissertation investigates the efficacy of the Integrated Care for Kids (InCK) Model, a CMS alternative payment model (APM), in addressing social determinants of health (SDOH) in pediatric populations. The research explores how this model can reduce healthcare costs and improve outcomes through early identification, comprehensive treatment, and care coordination of behavioral and physical health needs. Utilizing an exploratory sequential mixed-methods approach, the study seeks to understand how InCK can be used to establish a pediatric APM framework that enhances the well-being of medically complex children.Through qualitative interviews with leaders from InCK Model sites and quantitative surveys of InCK Partnership Council members, the research examines the development of payment structures and population health infrastructure. The study identifies six emerging topics and twelve guiding principles vital to the framework's success. These findings suggest that an effective pediatric APM frameworks require community engagement, well-defined payment incentives, and robust data sharing systems. Additionally, the findings reveal challenges in maintaining engagement with both clinical providers and families, highlighting the importance of accessible communication channels and flexible funding mechanisms.Results indicate that the InCK Model’s collaborative structure fosters an environment for improving care coordination, establishing preventive care protocols, and bridging healthcare delivery gaps. However, barriers such as limited long-term funding and scalability concerns underscore the need for adaptable models that support continuity beyond federal funding timelines.This research culminates in the design of a pediatric APM framework that seeks to address SDOH and support integrated, sustainable care for children with complex needs. The framework developed is expected to guide future Medicaid-managed pediatric care initiatives, providing a model that aligns incentives across healthcare and community-based organizations to holistically support pediatric health. This study’s findings contribute to the ongoing efforts in health policy to redefine value-based care for vulnerable pediatric populations and informed a plan for change.