In recent years, the number of youth with chronic medical conditions surviving into adulthood has increased. The transition from paediatric to adult care has previously been associated with poor clinical outcomes, increased costs and low patient and family satisfaction. The complexity of these transitions demands system-level solutions that address the alignment of providers in multiple settings, enhance collaboration across various sectors, and facilitate both communication and capacity building, all of which commonly demand new, flexible funding arrangements. Prior studies have not systematically examined system-level strategies designed to streamline and safeguard care for this population, who is often vulnerable to exclusion from health system reform discussions.