Wednesday, May 25, 2011

Commonwealth Care Alliance: A Comprehensive Prepaid Accountable Care Organization for Medicaid and Dual Beneficiaries with Complex Care Needs



... Phew! Say that 10 times fast!!

Hello! My name is Anna Polk, and I am a soon-to-be P4! I am spending my summer in Boston (please see photo of how stunningly beautiful Boston is in the spring) working at the Commonwealth Care Alliance, henceforth referred to as CCA. This is a small (around 3200 members) not-for-profit managed care organization that mainly covers dually eligible (Medicare/Medicaid) seniors throughout Massachusetts. I started earlier this month and have been working on several projects since arriving. More on those later, but first I want to tell you all about CCA and the work that they do. Before arriving I was excited to learn more about the world of managed care and was happy to be doing so in a not-for-profit so I would have a leg to stand on when people with managed-care-misconceptions accused me of being one of the bad guys! Once I arrived, however, and began learning more about the organization, I have become incredibly proud to be associated with such an innovative team. I really hadn’t begun to grasp the scope of the care they provide until I attended orientation this past Tuesday. Our CEO, Bob Master started off the day talking about the mission and the culture of the organization.

They don’t think of themselves as a managed care company, but rather a health-care delivery system. They employ their own group of primary care providers, nurse practitioners, registered nurses, social workers, physical therapists- the list goes on and on! They use a team based, multidisciplinary, coordinated approach to care, in an effort to keep patients functioning independently in their homes for as long as possible. Through this approach, they have been successful in reducing the hospitalization rate of their members nearly in half!

The field workers are granted the autonomy to make decisions for their patient’s care. For example: they don’t have to wait for a patient to develop bed sores before authorizing a specialized mattress for them- if their team feels it is in the best interest for the patient, then they can have it. If you are dying to know more, here is an article about CCA from WBUR (Boston’s NPR News Station.)

I took a few courses at the public health school in my first year of pharmacy school, and it has been so exciting seeing how the theories I learned about there are actually being put into action to improve care for this specialized group of patients. I am working on several projects here and can’t wait to tell you all about them.... stay tuned!

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