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For Medical Professionals

The Collaborative Consultative Care Coordination (4C) Program supports the ongoing relationship of those pediatric patients with the most significant or severe medical complexity by bringing together a multidisciplinary team. This team works with a referred family and their primary care provider to manage care and offer behavioral, developmental and emotional assessments and care coordination based on their needs and goals. 4C is not a replacement for the child’s current primary care provider (PCP). Rather, we provide help through increased communication and specialized care.

When a patient is referred, a comprehensive exam is conducted which includes not only medical evaluation, but also an initial intake with a nurse care coordinator, social worker, behavioral health and developmental specialist, dietician, and family navigator. The 4C team then works in partnership with the family and PCP to develop a secure, cloud-based care plan intended to serve as a salient medical summary for a medically complex child.

Families return after one month to review and approve the comprehensive care plan. In the event of illness or other consultation during the time between appointments, parents, clinicians, and participants in a child’s care can access the care plan securely via any web-enabled device/computer. As needed, plans will be revised and updated.

Over time, 4C will assess the impact of these services to determine if this care model reduces hospital admissions, ER overuse, complication rates, school and work absences, parental stress, and health costs.

4C is a program between Boston Medical Center and Bay State Medical Center and is funded by a $6 million grant from the Center for Medicare and Medicaid Innovation over three years to help primary care providers and families of medically complex pediatric patients navigate the numerous challenges involved with caring for these patients.

At BMC, 4C is led by Jack Maypole, MD.

Who should be referred?

To be eligible for 4C services, referred children must have:

  1. Empirical evidence of high utilization as evidenced by:
    • 10 or more combined ER and/or clinic visits
    • 10 or more hospital days
  2. Be a risk of high utilization as evidenced by having conditions that:
    • Involve the referral to multiple specialists (e.g. neurology, pulmonology, endocrinology, etc.)
    • Affect multiple body systems (e.g. head, lungs and glands→ seizures, asthma, and diabetes)
    • An ICU admission that causes a significant change in a child's health and need of services
    • Complicating psychosocial and economic factors that are (or are at risk of) adversely affecting outcomes, including children whose caregivers have significant stressors

Clinic Hours

The Clinic meets on Wednesdays from 9-12 in the Yawkey Building at BMC, 6th floor.

Refer a Patient

Families may contact the program directly or PCPs may make a referral as done with traditional specialty programs; patients will only be enrolled with a referral from their primary care provider.

  • To refer a patient, please call (617) 414-2222 or email us at [email protected]; we will make every attempt to return your message within one business day. You can also page 3099.

Keeping us updated between visits
To help us keep a patient’s care plan up to date, we encourage providers to notify us of any known ED visits, admissions, new referrals, change in treatment or any significant change in a child’s health and need of services.