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Primary Care Site Newsletter

In This Issue
Enrollment Numbers
Contact Information
Staff Spotlight
Contracts Corner
Pharmacy Program
Consumer Involvement
Summer Institute
Join Our List
Join Our Mailing List
Enrollment Numbers
As of August 3, 2009 
Senior Care Options (SCO)
= 2253 members
Contact Information
Commonwealth Care Alliance
30 Winter Street
Boston, MA 02108
Telephone 617.426.0600
Enrollment Fax 617.830.0534
Clinical Fax 617.507.0416
MS Fax 617.426.1311
 
Claims Information
Commonwealth Care Alliance
148 State Street, 10th floor
Boston, MA 02109
ATTN: Claims Deptartment
1.800.306.0732
 
Current Member Issues 
Cheryl M. Snyder 
Member Services Manager
617.426.0600 ext. 275
[email protected]

Enrollment & Marketing 
Guillermo Gonzalez
Outreach & Marketing Manager
617.426.0600 ext. 229
[email protected]

Clinical Issues 
Janet T. Norton, RN, CCM
SCO Nurse Clinical Coordinator
617.426.0600 ext. 280
[email protected]

Service Plan Issues 
Annie Halland
Benefits Operations Coordinator
617.426.0600 ext. 250
[email protected]

Contracting Issues 
Diane Ryberg
Provider Network Manager
617.426.0600 ext. 254
[email protected]

CaseNET/CER Issues
Ritu Mahajan 
Systems Business Analyst
617.426.0600 ext. 283
[email protected]

Newsletter Submissions 
Nerissa J. Fry
Communications Coordinator
617.426.0600 ext. 244
[email protected]
Staff Spotlight 
Orissa Viza
Orissa Viza, RN
Clinical Coordinator
 
Orissa Viza recently joined Commonwealth Care Alliance in the role of Clinical Coordinator. We interviewed Orissa to find out a little more about her:

Tell us about yourself:
I moved to Boston a year ago (via Cape Cod) from Rochester, NY. I have three sons in their 20s, and I enjoy the outdoors and the arts. 
 
Tell us about your professional background:
I have a background in community health and not for profit organizations. There were a few corporate stays thrown in too.

What does a typical workday look like for you?
Meetings, communicating with our primary care sites regarding member status, managing member status in Commonwealth Care Alliance and MDS software. I also just help out where I can. 

What is the best part of your job?
Working with the very professional, competent, and caring staff of Commonwealth Care Alliance and its community.

What makes Commonwealth Care Alliance special?
What drew me to Commonwealth Care Alliance was its commitment to a very important and overlooked population that I happen to also care about.

What do you like to do when you are not at work?
I learn and explore this wonderful city; enjoy my friends.

If you could invite any five people to dinner, who would you choose?
Barack Obama, Michelle Obama, Dalai Lama, Lily Tomlin, and my mother.
New Staff Hires
April-June
Kimberley Caffrey, RN, Nurse Case Manager
Commonwealth Clinical Alliance
 
Emma Chung, Business Analyst
Commonwealth Care Alliance central office
 
Gina Ciaramitaro, Compliance Program Manager
Commonwealth Care Alliance central office
 
Stacey Nguyen, Registered Nurse
Commonwealth Care Alliance Clinical Group
 
Maureen Olsen, RN, Nurse Partner
Commonwealth Care Alliance central office
 
Kate Shoch, Nurse Practitioner
Commonwealth Care Alliance Clinical Group
 
Polo Vernet, Registered Nurse
Commonwealth Care Alliance Clinical Group
 
Orissa Viza, RN, Clinical Coordinator
Commonwealth Care Alliance central office 
  
Marlena Witczak, Registered Nurse
Commonwealth Care Alliance Clinical Group
 
Harold Young, Provider Network Developer
Commonwealth Care Alliance central office
Issue 5 Summer 2009
Nurse checking blood pressure
Bob Master, President & CEODear Network Provider: 
 
Whatever we may think Commonwealth Care Alliance is, Congress views us as a Fully Integrated Dual Eligible Special Needs Plan. That means that we are one of approximately 30 Special Needs Plans out of nearly 1,000 in the United States who receive combined Medicare and Medicaid financing to care for "Duals" (those individuals who are both Medicare and Medicaid beneficiaries).
 
"Duals" have now moved to front and center in the health care reform debate. Why? The "Duals" represent about 16% of Medicaid beneficiaries in each state but they account for nearly 50% of Medicaid spending nationwide. Concurrently, they also represent about 15% of Medicare beneficiaries that account for nearly 26% of Medicare spending. That is a lot of healthcare spending -- about $250 billion every year! Because care for "Duals" has been so uncoordinated, with such poor management of chronic illness, and many missed opportunities to prevent hospitalizations or delay nursing home placement, there is extraordinary opportunity to substantially reduce costs through improved care. That is why there is such intense policy interest in Fully Integrated Dual Eligible Special Needs Plans in general, and Commonwealth Care Alliance in particular, as potential models to better coordinate care and manage costs.
 
Sincerely,
 
Robert J. Master, MD signature
 
 
 
Robert J. Master, MD
President & CEO
Contracts Corner
Please join us in welcoming the following providers to Commonwealth Care Alliance's network: 
 

Name

Location

Provider Type

Bay State Medical Equipment Distributors & Supply

Brockton

Durable Medical Equipment

Adventure, Inc, dba Loving Care Agency

Springfield

Adult Day Health

Hospice Services of Massachusetts, LLC

Wareham

Hospice

Janice Funk, PhD

Bradford

Behavioral Health

Alliance Imaging, Inc

Andover

Radiology

Alternative Care Providers, Inc

North Chelmsford

Durable Medical Equipment

Easton Eye Consultants, PC

North Easton

Ophthalmology

Greater Boston Home Health Care, LLC

Boston

Certified Home Health Agency

Harvard Square Optical, Inc

Cambridge

Optometry

Imaging Consultants, Inc

Andover

Radiology

Metropolitan Anesthesia, LLC

Westwood

Anesthesiology

Richard L. Jasiak, OD, PC

Haverhill

Optometry

Alegre Dental Center

Lynn

Dentist

Center for Community Health, Education & Research, Inc (AlCide Center)

Mattapan

Behavioral Health

East Longmeadow Skilled Nursing Center (Berkshire Healthcare Systems)

East Longmeadow

Skilled Nursing Facility

Geriatric Authority of Holyoke

Holyoke

Skilled Nursing Facility

Hallmark Imaging Associates, PC

Wareham

Radiology

Millard T. Hennessee, DPM, PC

South Boston

Podiatry

Atlantic Prosthetics and Orthotics Co, Inc

Westport

Durable Medical Equipment

Questions? Please contact Provider Network Management at 617.426.0600 ext. 234

Pharmacy Program
Rx
Important Pharmacy Change 
Over the past three years since the inception of the Medicare Part D benefit, Commonwealth Care Alliance's pharmacy program has endeavored to offer an array of flexible coverage policies that are generally not found in other Medicare Part D options to reduce "hassle". However, regulatory requirements and financial constraints are making it increasingly difficult to continue some of these policies.
 
Historically, Commonwealth Care Alliance has allowed network clinicians the flexibility to continue to prescribe brand name medications in instances where generic equivalents are available, as a convenience to those patients and clinicians who are reluctant to switch to a generic equivalent for a variety of reasons. However, we can no longer justify this "convenience" given the substantial increase in expenditures inherent in this policy and the lack of evidence of quality compromise when "generics" are substituted for brand name medication (e.g. simvastatin for Zocor). Therefore, effective August 1, 2009, Commonwealth Care Alliance will only cover the generic equivalent of multi-source branded medications.

Care managers have been notified which of their patients are currently on branded medications and should be switched to generics before August 1. If the prescribing clinician believes that the generic alternative is not medically indicated, the clinician may request an exception by calling our pharmacy benefit manager Express Scripts at 1.800.417.8164.

Questions? Please contact Basem Shebli, Pharmacy Director, at 617.426.0600 ext. 238 or [email protected]
Consumer Involvement 
Healthy Eating for Successful Living in Older Adults
Commonwealth Care Alliance is currently piloting an evidence-based community health program for its members called Healthy Eating for Successful Living in Older Adults. The six-week course focuses on nutrition and lifestyle changes that promote better health. 
  
We are working with Hebrew Senior Life to offer the program to our members beginning in Fall 2009 as a complement to My Life, My Health, a chronic disease self-management program, which our members have been participating in since 2006.
 
If you are interested in finding a Healthy Eating program in your community or if you would like more information on how your patients can benefit, contact Rosa Palacios at the number below.
 
Questions? Please contact Rosa Palacios, Department of Health Education and Caregiver Training, at 617.426.0600 ext. 226 or [email protected]
Summer Institute on Evidence-Based Practice 
Achieving Excellence with Evidence 
Laurie Wojtusik, Western Massachusetts Clinical Coordinator at Commonwealth Clinical Alliance, recently presented at the Summer Institute on Evidence-Based Practice in San Antonio, Texas. The conference, which has convened annually for the past seven years, allows "participants to learn 'what works' in building care processes and supporting care providers in the evolving environment of improvement."
 
As a leader and expert, Commonwealth Care Alliance was invited to present on two papers created as part of a AHRQ Healthcare Innovations Exchange:
 
 
Plan-Funded Team Coordinates Enhanced Primary Care and Support Services to At-Risk Seniors, Reducing Hospitalizations and Emergency Department Visits 
 
The response to our presentation was extremely positive. As Laurie notes, 'Commonwealth Care Alliance is clearly creating the "evidence" for evidence-based practice in care management."
 
Questions? Please contact Laurie Wojtusik, Western Massachusetts Clinical Coordinator, at 413.306.3599 or [email protected]
If you have submissions or suggestions for this Primary Care Site newsletter, please send me a note via email at [email protected] or call me during office hours at 617.426.0600 ext. 244.
 
Sincerely,

Nerissa J. Fry
Communications Coordinator 
Commonwealth Care Alliance