Boston Medical Center (BMC) has received a $6.1 million award from the U.S. Center for Medicare and Medicaid Innovation to establish the Massachusetts Alliance for Complex Care (MACC) and expand healthcare services and support for children with complex medical needs. The alliance, which is a collaboration between BMC and Baystate Medical Center in Springfield, Mass., will offer services to primary care providers who treat children with complex medical needs. As a result, 500 families in Massachusetts are gaining medical home-like benefits during the award's three-year period.
A medical home is a team-based model of care that coordinates recommendations from providers involved in a child's care, including nursing and medical providers, specialists, and school personnel. The MACC developed the Collaborative Care Coordination and Consultative Model (4C) specifically for this at-risk pediatric patient population that accounts for approximately 18 percent of U.S. children. The 4C program, modeled after BMC's Comprehensive Care Program (CCP) and a similar program at Baystate, serves children with the greatest degree of medical complexity and unmet social needs; it is intended to reduce family stress, improve a child's functioning and wellness, and minimize hospital admissions and health costs.
"The 4C Model considers each case holistically, ensuring a child's care is optimized in the context of the family's goals while identifying their supports and assessing their needs. Many of these children require care and attention 24-7," said Jack Maypole, MD, BMC's CCP director and co-principal investigator of the 4C/MACC project.
Since 1992, BMC's Comprehensive Care Program (CCP) has provided integrated, "one stop shopping" specialty care, and was one of the first programs in the country aimed at integrating care for pediatric patients with chronic medical conditions. BMC currently provides a multidisciplinary team approach to primary care for more than 450 patients through the CCP.
"The growing number of children with complex, long-term medical needs presents ongoing challenges to families, community-based resources and educational services, as well as the healthcare system," Maypole said. "As any parent who has experienced it will tell you, caring for a child with significant and complex medical needs is an enormous undertaking - one that goes beyond just finding the right medical care."
Prior to enrolling in the MACC, families undergo a comprehensive process of intake, multi-disciplinary assessment and care planning at BMC, or at Baystate Medical Center starting in January 2015. Matthew Sadof, MD, is the 4C/MACC program director at Baystate Children's Hospital and is co-principal investigator of the project. All local primary care providers referring children to either 4C/MACC site (Boston or Springfield) have access to a multidisciplinary team offering a supportive, collaborative care model with the family and primary care provider. Each child is seen by a complex care pediatrician, child psychiatrist, developmental/behavioral pediatric specialist, clinical social worker, and nutritionist. The 4C program seeks to work, as needed, to enhance and optimize medical care and the child's access to community and education resources.
A family navigator helps patients and family members overcome access barriers, serves as an advocate, and coordinates care across multiple agencies, including behavioral health services provided by the MACC for Massachusetts families in proximity to BMC and Baystate Medical Center. Referrals for families in outlying areas around the Commonwealth also are accepted. All of these services incorporate the latest technology as each patient has a secure and individualized cloud-based care plan accessible to family and providers. The complex care pediatrician sees the patient at least once every six months.
The Center for Medicare and Medicaid Innovation funding, part of the second round of awards issued from the Affordable Care Act, will help evaluate the 4C/MACC and the services it provides. In addition, the physician leaders are conducting research about the program. "Our goal is to demonstrate that this coordinated approach leads to improved care, more time at home and in school, less time in the ER or hospital, less family stress, and overall savings in health care costs," Maypole said.
The project described was supported by Grant Number 1C1CMS331326-01-00 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.
For more information about Boston Medical Center's Comprehensive Care Program, visit http://www.bmc.org/pediatricscomprehensivecare.htm.