A strange quirk of value-based care innovation in the United States is that, until recently, it has largely focused on primary care. The notion that an ounce of prevention is worth a pound of cure is a reassuring one. But upstream, preventative care is only going to get us so far, and quite a bit of healthcare spending is the result of being on the wrong end of random chance.
Because of this aleatory uncertainty, there’s something comforting about the fact that, as a society, we have programs like Medicaid in place to finance health care for high-acuity pediatric patients.
A financing mechanism, however, can’t take care of a kid with multiple comorbid conditions. It’s necessary but insufficient. You need a model to orchestrate the interdisciplinary provider teams and actually deliver care. Imagine Pediatrics is hard at work on precisely this task for more than 70,000 kids, mostly on Medicaid, and I had the opportunity to talk with Taylor Beery, Imagine Pediatrics’ Co-Founder, Chief Innovation and Administrative Officer, about how they’re going about this.
Questions
Q1: It’s well known but hard to really appreciate the degree to which healthcare spending is really driven by a small percentage of high acuity, high complexity patients which is as true in pediatric populations as it is in the senior population, although there’s a bit more infrastructure in place for seniors, thinking of the PACE program for example, than there is for pediatric populations. You described the group as “heterogeneous and high acuity,” so I presume there isn’t a typical patient, but can you give our readers some sense of the case mix and complexity for the Imagine Pediatrics population?
Interview
Q1: It’s well known but hard to really appreciate the degree to which healthcare spending is really driven by a small percentage of high acuity, high complexity patients which is as true in pediatric populations as it is in the senior population, although there’s a bit more infrastructure in place for seniors, thinking of the PACE program for example, than there is for pediatric populations. You described the group as “heterogeneous and high acuity,” so I presume there isn’t a typical patient, but can you give our readers some sense of the case mix and complexity for the Imagine Pediatrics population?
When we talk about children with special health care needs, we’re referring to a vulnerable and highly heterogeneous population that represents roughly one in five children in the United States. That includes children with medical complexity, but it’s broader than that. Within our population are children with neurologic and genetic conditions, chronic pulmonary disease, feeding challenges, diabetes, sickle cell disease, and behavioral health conditions such as severe ADHD and anxiety. Many have multiple comorbid conditions. Some rely on medical equipment or complex medication regimens. They require integrated support across medical, behavioral, and social domains.
A typical child in our model has multiple specialists involved and moves between care settings often. Caregivers spend hours coordinating appointments, medications, and school support. Many have experienced emergency department visits or hospitalizations that might have been avoided with earlier intervention. The acuity is real, but it’s also dynamic. A child can be stable for months and then destabilize quickly because of an infection or a medication change. That longitudinal variability is a defining feature of this population.
These children account for nearly half of pediatric healthcare spending. A high level of spending doesn’t necessarily translate into integrated, continuous support, especially when children are moving between specialists, schools, pharmacies, and community resources. Most healthcare delivery is built around short appointments, which can work for routine issues but are less effective when children’s needs shift over time. That means parents often end up acting as the connective tissue between systems, filling in gaps without consistent, real-time support. When we say the population is heterogeneous, we mean that each child’s path looks different, and that care must adjust as those needs change.
Q2: Given the high acuity and high complexity, what does the Imagine Pediatrics care model look like and how does staffing that model work on a patient or case basis?
Our model is built around the understanding that children with special health care needs require both acute and longitudinal support, often simultaneously. We deliver that through a 24/7 integrated virtual and in-home care model designed specifically for children with special health care needs. Every child is empaneled to a multidisciplinary team that stays with them over time. That team includes a pediatrician, advanced practice provider, nurse, behavioral health specialist, social worker, pharmacist, dietitian, care navigator, and other tailored services. This empaneled structure ensures that the professionals caring for the child know their history and understand their family context. That way, they can recognize subtle changes before they escalate to a crisis.
We adjust the level of support as a child’s risk and acuity change over time, and our teams are set up to respond to those shifts. Sometimes that means more frequent check-ins. Other times it means an in-home visit, a medication consult, or a change to the care plan in collaboration with the child’s existing primary care provider and specialists. Those changes don’t just affect one part of a child’s health. For example, a respiratory illness can increase anxiety. A change in medication can affect behavior or sleep. Caregiver and family resources can influence medical stability. That’s why integrated medical, behavioral, and social care are part of the day-to-day work of the team.
We do this in close partnership with a child’s existing medical home and specialists. We are not replacing the existing care team; we are extending their reach. Our teams share information bi-directionally and reinforce existing care plans while providing 24/7 access that most traditional clinic-based models cannot sustain. That structure allows us to deliver integrated medical, behavioral, and social care and support in a way that reduces fragmentation while preserving the trusted relationships families already have.
Q3: The venture markets have gone back and forth on whether tech-enabled services are an investable model in healthcare. It seems like we’re entering a moment where the appetite is back, with Imagine Pediatrics raising a $67 million Series B last fall. What is your technology philosophy, and where are you seeing the benefits of those investments in productivity, operational, or financial performance?
Our philosophy has always been that technology should enable clinicians to deliver more personalized, proactive care. For children with special health care needs, the challenge isn’t a lack of data; it’s a breakdown in data interoperability. Clinical data, claims, behavioral health insights, social context, caregiver-reported information — all of it lives in different places. Our technology infrastructure is designed to unify those inputs into a single, actionable view that supports both acute and longitudinal care. That’s the foundation of our proprietary Care Hub platform. When Imagine Pediatrics was founded, we discovered that there were no existing population health tools that could manage the extensive data we have for children with special health care needs, nor could existing tools process insights with the evolving and heterogeneous nature of this population. So, Care Hub was purpose-built to ingest multi-source data in real time and surface next-best actions directly within the clinical workflow at the point of care, which helps us improve outcomes, experience, and cost of care.
The impact of that investment shows up first in productivity and care quality. Because our teams have a comprehensive, contextualized view of each child and family, they can proactively identify gaps in care, medication risks, or emerging instability before it becomes a crisis. That allows us to intervene earlier and more efficiently. In practice, that has contributed to more than 5,000 avoided emergency and urgent care visits, and approximately 80 percent of those children did not require additional acute care in the following month. Our caregiver experience metrics, including a Net Promoter Score above 86, reinforce that the technology is supporting — not replacing — trusted relationships.
From a financial perspective, technology becomes even more important in risk-based arrangements. When you’re accountable for total cost of care and quality outcomes, you need real-time visibility into what’s happening across a population. Our analytics engine allows us to adapt quickly as needs evolve. The Series B capital has allowed us to deepen these capabilities while scaling into new states and expanding into the commercial market. We view technology not as a separate product line but as the infrastructure that makes scalable, integrated pediatric value-based care possible. Without that infrastructure, delivering consistent performance across 70,000 children in multiple states would not be feasible.
Q4: Can you give us a sense for your payer mix and how those contracts are structured — particularly the split between fee-for-service and value-based care, and within value-based arrangements, whether those are global capitation, upside/downside risk, or quality bonuses? How do you think about aligning incentives in pediatrics?
Today, the majority of the more than 70,000 children we serve are covered through value-based, risk-based partnerships with Medicaid managed care organizations and, as of late 2025, commercial health plans. Medicaid remains a significant portion of our footprint because this is where the greatest need surfaced when the company was founded in 2022. Because of our success and proven outcomes with the Medicaid population, we’ve seen growing demand from commercial plans that recognize this population requires a different model of care. Fee-for-service does not align well with the longitudinal, team-based support these children need, so our growth has largely been driven through value-based structures rather than traditional service-based reimbursement.
Pediatric value-based care requires innovation in care models. Children’s conditions often evolve rapidly. Their developmental stages matter, and caregiver engagement is central to success. Incentives must support that complexity. For us, alignment means being accountable for keeping children stable and supported over time — which we measure through indicators like Safe Days at Home — while reinforcing collaboration with the child’s existing medical home and specialists. When incentives are structured correctly, plans, providers, and families are all working toward the same goal.
Our contracts are typically structured around total cost of care accountability, paired with quality and experience measures. In more mature markets, we take meaningful downside risk. In other markets, we may begin with shared savings or performance-based arrangements that evolve over time as trust and data transparency deepen. The goal is not just to reduce avoidable utilization but also to improve outcomes, quality metrics and member and clinician experience, all leading to more Safe Days at Home. Because our 24/7 integrated virtual and in-home care model delivers support outside of traditional office visits, it requires payment structures that recognize proactive outreach, behavioral health integration, medication management, and longitudinal stabilization as value-generating activities.
Q5: In the Series B announcement last fall, it looked like you had 40,000 children under your care, and by early January that number had grown to 70,000. How would you describe payer appetite right now for these arrangements? Given Medicaid budget pressures and regulatory changes, are states and MCOs more cautious or more open to innovative solutions? And what’s constraining growth for Imagine in 2026?
We’ve had tremendous growth because plans are actively looking for better ways to support children with special health care needs. Both Medicaid managed care organizations and commercial insurers are seeing firsthand that episodic, fee for service models don’t work well for children whose needs change frequently. These families need support that spans medical, behavioral, and social factors over time. When that kind of consistent, longitudinal support is in place, children tend to stay more stable, and plans see better outcomes and lower cost of care.
Regulations and funding priorities change, especially in Medicaid, and plans must adapt to that reality. What hasn’t changed is the day-to-day experience of families raising children with special health care needs. These are children whose stability affects not only their health, but their caregivers’ ability to work and participate in their communities. When budgets tighten, states and managed care organizations look closely at where avoidable emergency department visits and hospitalizations are occurring and how to prevent them. That tends to bring more attention to models that improve access to integrated, personalized care.
As for constraints, our approach to growth is deliberate. Scaling responsibly requires recruiting and training high-quality multidisciplinary teams and building strong local provider relationships. We also need to make sure our technology infrastructure can support expansion without compromising performance. Workforce depth, operational readiness, and maintaining consistent quality across geographies are critical considerations. We are fortunate that payer appetite is strong. Our focus in 2026 is on continuing measured expansion. That means deepening existing partnerships, launching thoughtfully in new markets, and ensuring that as we grow, we continue to deliver the outcomes, experience, and accountability that define our model.