You are using an older version of Internet Explorer that is not supported on this site. Please upgrade for the best experience.

Federally Funded 4C Program Benefiting Region's Sickest, Most Complex Kids

March 31, 2016

The first six years of Jazmed Martinez’s life have been filled with one challenge after another: cerebral palsy, epilepsy, severe developmental delays, a serious heart condition, muscle spasms, and other issues. By every definition, he is a very complicated medical case, and a prime candidate for the federally funded 4C Program. The Collaborative Consultative Care Coordination Program is designed to provide improved care and cut health care costs for some of the sickest pediatric patients at Baystate Medical Center and Boston Medical Center.

“Thanks to recent medical advances, we have a growing number of patients in our region who are able to live in the community outside of a hospital setting,” said Dr. Matt Sadof, Co-Director of the 4C Program. “The demands of caring for these children can place a huge burden on families and their health providers. These children get care that spans multiple settings, health systems and siloed information systems. Our program bridges the space between complex layers of services that are required to care for these children and families.”

How It Works

Here’s how it works: once children are referred to the 4C program, the intake process includes an evaluation with several team members. For these patients, routine pediatric care just doesn’t cut it.  A designated nurse care coordinator, child psychologist, child psychiatrist, clinical social worker, family navigator, nutritionist, and a dedicated complex care pediatrician are brought to the table when the child arrives, and remain engaged throughout their care. This way, Jazmed’s mother, Jazmin, knows that when it is time for an appointment she will not have to start from scratch by explaining her son’s situation to a different physician. This is designed to prevent medical setbacks.

To be in the program, children like Jazmed must have:

  • three or more organ systems impacted;
  • be cared for by three or more specialists;
  • attend 10 clinic visits in a year; and
  • have 10 hospital days each year, including intensive care visits.

Too often these complicated children see many different physicians, who happen to be working or on call at the time of their visits, such as routine visits to an emergency room. This often leads to mental stress and can often grow extremely frustrating for the child and his family. By being part of the 4C program, Jazmed is regularly seen by a consistent team of professionals, which includes those who look after him at home and at school.  They evaluate him as an entire person, and not just organ by organ.

When necessary, they bring in the appropriate specialists to receive proper care. The social workers on the team, meanwhile, help parents balance the extreme medical needs of the child with their own personal necessities, like finding a job and putting food on the table. In many cases, the care that children like Jazmed need is so intense that it is difficult for parents to remain employed. For the Martinez family, finding a safe home that will allow for large medical equipment like a hospital bed and feeding equipment has proven to be a major obstacle.

“Jazmed was recently hospitalized and is now ventilator-dependent, which requires a separate electrical circuit,” 4C Program Manage Matt Lustig said. “Due to the fact that the family they are staying with cannot add Jazmed to their lease, they are unable to request for this electrical circuit to be put in place. Our work has been centered on finding placement through DHCD for this family.” 

Mission accomplished, at least temporarily.

“My son was in intensive care and at the same time we were homeless, I didn’t have a place for him when he came out the hospital,” Jazmin said. “Thanks to 4C, now I’m in a shelter that is appropriate for my son.”

With so many stresses on Jazmin, Dr. Sadof says that it’s critical that patients like Jazmed never experience a gap in care. To ensure proper communication and a more efficient process, caregivers are given access to a specialized and secured cloud-based living care plan that they can access on just about any device at any time. It includes a medical summary, a list of who and what is involved in keeping the child well, daily goals, and emergency plans for when things go wrong. This way, there is a “medical home,” no matter what practice, facility, or geographical area the child is in.

Financial Benefits

It’s estimated that 70% of pediatric health care expenditures are found within the pediatric special needs population. Using funding and guidance provided in the Affordable Care Act, the 4C Program seeks to drastically improve care for the sickest kids of this group, while driving down healthcare costs. Kids who have the highest service need, medical conditions associated with medical complexity, functional limitations, and high health care use suddenly see improved results. In just over one year, almost 200 children have been enrolled and many patients like Jazmed are showing tremendous improvement.

“This program is very important to me, they have not just helped me with my son, but also with many other personal things,” Jazmin said. ”They have helped me a lot.”

There’s a financial benefit for the public, too. Over the course of one year, an estimated savings of over 20% for costs of care has been seen, with a projected total of over $10,000 per patient. With gradual improvement and fine-tuning, Sadof expects those numbers to grow, patient lifestyles to improve, and predicts that one day this 4C model will become the norm to making life more enjoyable for children and families who need help the most.

“The health care system is very complicated and difficult for health care providers, families, and patients to navigate. We are here to help,” he said. 

The project described was supported by Grant Number 1C1CMS331326 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.