Healthcare Business Today: Measuring What Matters In Pediatric Care: The Role of Safe Days at Home

When people talk about success in pediatric care, the conversation usually starts with utilization: emergency department visits, hospital admissions, and readmissions. Those numbers matter. They help explain how the system is functioning. But they don’t fully reflect what families of children and youth with special health care needs are faced with day-to-day.

Roughly one in five children in the U.S. — about 14.5 million — has a special health care need. That includes children living with chronic medical and behavioral conditions that require more support than most children need. Together, they account for half of pediatric healthcare spending.

It’s easy to think of this as a small, highly complex group. It isn’t. The population is broad and heterogenous, spanning dozens of clinical areas. Some children depend on medications or equipment. Others see multiple specialists or rely on community-based services. Many experience multiple conditions at the same time.

What they have in common is not a single diagnosis, but the level of ongoing support their care requires — and how much of that responsibility falls to caregivers and families.

For these families, success is defined by whether the day stays manageable at home and in their community. Whether symptoms stay under control. Whether care and support are available right away when something changes.

Traditional indicators usually reflect what has already happened. An emergency visit or hospital stay often means a condition has already escalated. This fragmentation creates a cascade effect that extends far beyond the individual episodes of care.

A more useful measure starts earlier. It asks a different question: was the child able to stay stable and supported at home?

The Reality for Children and Youth with Special Health Care Needs

Many children and youth with special health care needs experience multiple comorbid conditions. Their care is shaped not only by the complexity of their medical and behavioral health needs, but also by social challenges and the realities of daily life.

Their care rarely happens in one place. A child may receive services from a primary care provider, specialists, therapists, and other support systems. Parents and caregivers are often left managing this complexity on their own. In fact, more than 40% of caregivers of children with special health care needs report spending significant time managing their child’s care across providers, services, and daily needs.

For these families, stability can change quickly. When care is fragmented or guidance is hard to reach, small concerns can become large and urgent. Families can end up in the emergency department or urgent care because the healthcare system is built to react to emergencies rather than prevent them. The solution lies in reimagining how we define and deliver successful pediatric value-based care.

Safe Days at Home is Built Through Continuous, Accessible Care

“Personalization” is a familiar term in health care, but for children and youth with special health care needs, it carries a different weight. In these cases, personalization must be based on the family’s unique lived experience.

Care must reflect how conditions show up for that child and how they respond to treatment. It also has to account for what’s happening outside the clinical care setting. Things like housing, transportation, or access to food can shape whether a care plan actually works day-to-day. That’s why caregiver trust, expertise and engagement matters so much. They understand what’s happening in real time.

But personalization on its own is not enough. 

When care is episodic and spread across settings, important information and context can be missed between visits. Families are often asked to repeat the same story, coordinate across specialists, and changes in a child’s condition may not be recognized early.

Continuity changes that. When the same care team stays involved and knows the child and family, they notice changes sooner. A new symptom can be addressed before it turns into something bigger. Families don’t have to start over each time they need help. 

That continuous support is what makes stability possible. And when that care team providing continuous support is enabled by technology that helps them identify risks early and deliver proactive integrated care, outcomes improve dramatically.

Access to integrated medical, behavioral health, and social care is just as important as personalized, continuous care. When families can reach their care team virtually and in-home 24/7,— especially in moments of uncertainty — they are better able to manage issues early, often avoiding the need to escalate to emergency care.

Aligning Pediatric Value-Based Care Around Stability

Children and youth with special health care needs require a level of support that most care models, whether Medicaid or commercial, are not built to sustain. Their needs are medical, behavioral, and social, and stability depends on how well all three are managed together continuously, not episodically.

Across payer types, families face a shared set of barriers: fragmented provider networks, long waits for specialist access, and care that responds to crises rather than preventing them. For children with complex, comorbid conditions, these gaps compound quickly. A missed early signal becomes an ED visit. A lapsed care relationship becomes a readmission.

Technology-enabled care models are beginning to change that dynamic. When care teams have longitudinal visibility into a child’s history, real-time risk identification tools, and the ability to engage families virtually and in-home, they can recognize changes earlier and respond before conditions escalate. The model shifts from reactive to proactive, and that continuity is what makes stability possible.

When that kind of infrastructure is in place, the results follow. Children stay more stable at home. Caregivers have guidance when something changes. Avoidable utilization decreases. And the system has a foundation for value-based care that actually reflects how these families experience care.

Safe Days at Home offers a way to measure whether that model is working — not after a crisis, but in the everyday moments where stability is either maintained or lost. When the model works effectively, the benefits extend beyond individual families and transform the entire care ecosystem.

The concept of a Safe Day at Home also carries different weight depending on the stakeholder. For caregivers, it reflects trust in a care team that is truly partnered with them. For providers, it signals how effectively care is integrated, personalized, and connected to outcomes. For health plans, it demonstrates a commitment to both improved member experience and lower total cost of care. And for children, it represents something harder to quantify but impossible to ignore — more of their childhood spent at home, not in a hospital bed for a stay that could have been prevented.

Reframing Pediatric Success

If pediatric health care is meant to support children in living stable, healthy lives, then success should be measured by how well that stability holds. For families of children and youth with special health care needs, the most meaningful outcome is not a reduction in hospital visits alone. It is the ability to have more Safe Days at Home. 

Strengthening pediatric value-based care requires alignment across providers, health plans, and policymakers. The focus cannot stop at utilization. It has to include the conditions that prevent escalation in the first place. Safe Days at Home gives that outcome a name. 

The infrastructure for this transformation already exists today, and a shared commitment to measure what families actually experience can help create the alignment. It’s time to move beyond counting hospital visits and start counting the days children get to be children – safe, stable, and at home. 

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About the Author 

George Boghos is CEO of Imagine Pediatrics, where he leads strategy and operations to expand access to multidisciplinary, integrated care for children and youth with special health care needs. He also oversees the company’s Impact initiatives, focused on advancing access to care.

Prior to Imagine Pediatrics, George co-founded AIM Clinics, an in-home and center-based provider of applied behavior analysis (ABA) services for children with autism. As CEO, he led the company’s growth from a single clinic to more than 25 locations across five states, culminating in its merger with Hopebridge Autism Therapy Centers in 2021, where he later served as Chief Strategy Officer.

Earlier in his career, George worked in healthcare investing at Primus Capital, Baird Capital, and Citadel. He holds a B.A. in Economics and Mathematics from Vanderbilt University and an MBA from the University of Chicago Booth School of Business.

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