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Program Statistics | |
Senior Care Options Enrollment
2,834 members
Gender
68% = female; 32% = male
Clinical Overview
56% diabetic; 23% with CHF Network Health Alliance
Enrollment
2,226 members
Gender
61% = female; 39% = male |
| 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 Department
1.800.306.0732
Cheryl M. Snyder
Member Services Manager
Quality Issues
Kerry Markert
Quality Program Manager
617.426.0600 ext. 261
Contracting Issues Diane Ryberg Provider Network Manager
617.426.0600 ext. 254
dryberg@commonwealthcare.org |
| Staff Spotlight |  |
Linda Manoukian
Provider Network Developer
Linda Manoukian has been a Provider Network Developer at Commonwealth Care Alliance for almost two years.
Tell us about yourself: I was born in Beirut, Lebanon to Armenian parents. We moved to Massachusetts when I was 12 and settled in Watertown. I graduated from Boston University. I continued to Lesley College for my Masters degree, majoring in business management. I loved school and travelling. My first school venture was Paris for one year. Then Armenia for about five years. Later, I had a passion for the Spanish language, so I went to Madrid. I travelled extensively in Europe and the former Soviet Union. I currently live in Bedford with my lovely husband Henry who is from Greece.
Tell us about your professional background:
I worked in accounting and administration for many years. Sometime in the late 90s, I got into workers compensation and became an insurance adjuster for about eight years. These were not good years for that industry in Massachusetts. The mergers and moving out of state were getting to be too much. In eight years I worked for six different companies, so I decided it was time for a career change.
What does a typical workday look like for you?
Our days in the Provider Network Department start with e-mails. Most of our requests come to us online or via phone calls. I make calls and try to materialize all the requests. I call facilities and providers and explain our model, who we are, what we do, why we are so special, and why they will be so happy to join our network. What is the best part of your job?
When I see our provider network grow. When I fulfill a difficult request and make our care managers and NPs happy, so that in return they can make our members happy.
What makes Commonwealth Care Alliance special?
Bob Master, Lois Simon, Bob Fallon, Nancy Roach, and all of us. Our passion, hard work, and dedication is what makes this organization very special. I see the types of requests that come our way and get approved and I am amazed at Commonwealth Care Alliance's generosity and how much they care and give to their members.
What do you like to do when you are not at work?I am forever thinking about how to make others happy. I try this with my own 82 year old mother who lives in an elderly apartment, and there are many like her in her building. I try to do what I can by giving them my time and my love. I also like to cook, read, and write. I love travelling.
If you could invite any five people to dinner, who would you choose?
My boss and friend Diane Ryberg, she has so much to give and teach about positive thinking and healthy living. My grandmother, who I never got to know after I was 12 years old, my brother Eddy, Charles Aznavour, and Oprah. And the list goes on! |
| New Staff Hires
April-August |
Commonwealth Clinical Alliance
Mervin Adams, Nurse Practitioner
Renai Allen, Nurse Practitioner
Michelle Nall, Nurse Practitioner
Mary Uhrich, Physician Assistant
Maurita Chukwuezi
Community Health Worker
David Staples
Community Health Worker
Jody Kenneally, Nurse Practitioner
Mercy Bashir, Nurse Practitioner
Elizabeth Wilson
Community Health Worker
Vadra Tabb, Nurse Practitioner
Devorath Ruiz, Social Worker
Joel Ramos
Behavioral Health Care Manager
Angélica Boutin, RN
Nurse Case Manager
Carol Interrante, RN
Nurse Case Manager
Sarah Bonilla
Behavioral Health Care Manager
Amy Chmela, RN
Nurse Care Manager
Commonwealth Care Alliance
Stephen Grella
Nurse Clinical Coder
Mikhail Utin
Information Security Analyst
Stewart McIntire, Business Analyst
Kathy Devaney
Senior Provider Network Developer
Rodolfo Parra
Outreach & Marketing Specialist
Kim Shellenberger
Director of Business Development
Dabhenie Gabriel
Member Services Representative
Tara DiSalvo, Accounting Assistant
Travis McGee, Software Engineer |
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| Dear Network Provider:
Earlier this month, Commonwealth Care Alliance launched a corporate restructuring of its two clinical entities, Boston's Community Medical Group (BCMG) and Commonwealth Clinical Alliance, in order to streamline and enhance coordination of care to our members around the state. Many current and future Commonwealth Care Alliance members will now receive their care via one consolidated clinical organization--the Commonwealth Clinical Alliance--which will be a statewide rather than a Western Massachusetts only entity. Our clinical employees currently serving Commonwealth Care Alliance's Senior Care Options and Network Health Alliance members in the Eastern part of the state will transition to the newly expanded Commonwealth Clinical Alliance over the coming months.
BCMG will focus entirely on its unique and historic mission to serve individuals with severe physical disabilities. This is even more important than ever, as currently, BCMG's care delivery model is considered by policy makers in Washington as the approach to be promoted nationally in future health care reform efforts.
We look forward to the opportunities that this restructuring will bring.
In much sadder news, I would like to acknowledge the shock and heartbreak of the entire Commonwealth Care Alliance family as we have been trying to come to terms with the recent death of Guillermo Gonzalez, our Outreach and Marketing Manager. The loss of someone so young, so needed and with so much potential is incomprehensible, cruel, and unfair. We will do everything that we possibly can to honor Guillermo's memory, advance his values, and support his wife, Sobely, and their children.
Robert J. Master, MD
President & CEO |
| Public Policy and Advocacy |  Star System and Special Needs Plans
The CMS Medicare 5-Star Quality Rating System was originally developed to help Medicare beneficiaries who wanted to enroll in health plans make informed choices during open enrollment periods. Each plan's "Star" rating is determined by assessing a number of parameters, inclusive of certain Healthcare Effectiveness Data and Information Set (HEDIS) scores, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey scores, data from the Health of Seniors (HOS) survey, plan performance data such as complaint files, as well as results from the CMS "secret shopper" program and other similar monitoring approaches.
Since the recent Health Care Reform legislation requires that added premium dollars be given to plans that perform well in the Star ratings, beginning in 2012, performance in the CMS 5-Star Quality Rating System will have more than just "marketing" implications. For Commonwealth Care Alliance, as for other Medicare health plans, the CMS star rating performance will directly determine a proportion of the premium dollars that Commonwealth Care Alliance receives for each of its enrolled beneficiaries.
A concern for Special Needs Plans like us is that the data by which we are measured for the Star ratings may not necessarily be the most appropriate for the population that we serve and the type of plan we are. Critically important metrics for our special needs population are not yet in place to replace those that are not applicable to our work. The SNP Alliance, a national organization specifically dedicated to representing the needs and interests of Special Needs Plans, has engaged CMS in discussions over the past months and will be recommending modifications to the rating system over the first three years of its implementation. However, Commonwealth Care Alliance will be focused on understanding and meeting the requirements of the Star rating system as it is currently structured until the issue is resolved.
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| Program Developments |  Network Health Alliance Pediatrics
When 2010 began, we launched one of the most ambitious efforts in Commonwealth Care Alliance's history, assuming clinical care for nearly 2,000 medically complex members connected to 10 primary care sites in the Cambridge Health Alliance system, and beginning administrative and information technology relationships with Network Health and Cambridge Health Alliance personnel at all levels. Phase II of Network Health Alliance went into operation on July 1, 2010, with 500 new high-risk pediatric members joining the program. Primary care physicians in the Cambridge Health Alliance practices have expressed praise about the positive impact of our efforts on their practices. Network Health Alliance is offered by Network Health in partnership with Commonwealth Care Alliance and Prevention and Access to Care and Treatment ( PACT) for Network Health members who have complex care needs. The Network Health Alliance program utilizes a unique coordinated clinical team approach of nurse practitioners, behavioral health specialists, and community health workers employed by Commonwealth Care Alliance.
Questions? Please contact Zoila Feldman, Commonwealth Clinical Alliance Executive Director, at 617.426.0600 ext. 248 or zfeldman@commonwealthcare.org |
| HEDIS 2010 |  Our 90th Percentile Results Commonwealth Care Alliance recently completed data collection for its annual Healthcare Effectiveness Data and Information Set (HEDIS) report. This tool, which is used by over 90 per cent of health plans in the United States, measures important dimensions of care and service, such as comprehensive diabetes care, controlling high blood pressure, and breast cancer screening. We are pleased to report that Commonwealth Care Alliance scored in the 90th percentile or above on the following measures: - Comprehensive Diabetes Care: Annual HbA1c & Medical Attention for Nephropathy
- Medication Reconciliation Post Discharge
- Care of Older Adults: Functional Status Assessment
- Annual Monitoring for Patients on Persistent Medications
- Adults' Access to Preventive/Ambulatory Health Services
Additionally, we improved since last year's report in the following measures: - Breast cancer screening
- Glaucoma screening
- Comprehensive diabetes care: LDL screening
- Comprehensive diabetes care: LDL <100 mg/dl
- Comprehensive diabetes care: BP control
Thanks to all who helped with the data collection process. If you would like more information on HEDIS and for a complete report on our 2010 rates, please contact Kerry Markert.
Questions? Please contact Kerry Markert, Quality Program Manager, at 617.426.0600 ext. 261 or kmarkert@commonwealthcare.org |
| In Memoriam |  Guillermo Gonzalez
It is with great sadness that we announce the sudden passing of our Outreach and Marketing Manager Guillermo Gonzalez on July 31, aged 37 years. He was the beloved husband of Sobely and devoted father of Tatiana, Gabriel, and Guiomar.
Guillermo's energy, commitment, warmth, and sheer joy in the art of human relations moved everyone whom he touched. Guillermo was immensely proud of his Latin heritage and Cuban roots. He was an emerging community leader in the larger Boston Community where he was an advocate for social justice, equity, and opportunity.
A small aircraft pilot, collector of watches, Cuban cigar aficionado, and a man who was deeply passionate and committed to his work and family, Guillermo will be greatly missed by the Commonwealth Care Alliance community. |
| Contracts Corner |
Please join us in welcoming the following providers to Commonwealth Care Alliance's network:
Questions? Please contact Provider Network Management at 617.426.0600 ext. 234 |
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If you have submissions or suggestions for this primary care site newsletter, please send me a note via email at nfry@commonwealthcare.org or call me during office hours at 617.426.0600 ext. 244.
Sincerely,
Nerissa J. Fry
Communications Coordinator
Commonwealth Care Alliance |
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