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Commonwealth Care Alliance Primary Care Site Newsletter

In This Issue
Program Statistics
Contact Information
Staff Spotlight
New Staff Hires
New Program for Dually Eligible Adults
New Pharmacy Benefits Manager
Listening Rounds
Contracts Corner
SCO Program Clinical Conference
Join Our List
Join Our Mailing List
PROGRAM STATISTICS
Senior Care Options
Current Enrollment
3,918 members
Gender
 68% = female; 32% = male
Clinical Overview
 56% diabetic; 23% with CHF
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
148 State Street, 10th floor
Boston, MA 02109
ATTN: Claims Department
1.800.306.0732

Current Member Issues 
Cheryl M. Snyder 
Member Services Manager
857.246.8875

Enrollment & Marketing
Outreach & Marketing Manager
617.600.3382
 
Clinical Issues 
Clinical Operations Manager
857.246.8828
 
 Service Plan Issues 
Claire McCarthy
Business Process Improvement Manager
857.246.8878

Quality Issues
Quality Program Manager
857.246.8874
 
Contracting Issues 
Provider Network Manager
857.246.8854
 
CaseNET/CER Issues
Clinical Program Analyst
857.246.8843
 
Newsletter Submissions 
Nerissa J. Fry
Communications Manager
857.246.8844
STAFF SPOTLIGHT 
Melissa Sueiras, MA
Melissa Sueiras, MA 
Clinical Assistant

Melissa was one of the first two medical assistants to join our clinical group in Western Massachusetts in June 2004.

Tell us about yourself: I was born and raised in Puerto Rico. I have a 19 year old daughter named Daisy who is working towards becoming a nurse and a 14 year old son named Michael who plays guitar like a rock star.

Tell us about your professional background: I completed a year of college at the University of Puerto Rico in Carolina. Shortly thereafter I moved to Springfield where I graduated from UMass Amherst with a Bachelor's Degree in Early Childhood Education, Spanish & Psychology. I took summer courses at the University of Oxford and at the University of Salamanca. I've worked as a CNA in a nursing home in the Berkshires, counselor at Tapestry Health Services, and now as a medical assistant.
 
What does a typical workday look like for you? My role as a medical assistant has changed tremendously over the course of the last six years according to the needs of the ever changing team. Currently there is a lot of communicating with providers about patient care and conducting home visits for patient vitals, blood work, medication compliance check, and patient education. I provide support for our nurses in any aspect they need.
 
What is the best part of your job?
I feel especially satisfied when I've been able to establish a connection with a member whose circumstances are "challenging". I've been able to develop relationships where the member opens up and listens to me. This in turn improves communication between the member and providers, thereby improving the member's health.
  
What makes Commonwealth Care Alliance special?

Commonwealth Care Alliance has given us the opportunity to create relationships with members that allow us to treat not only the physical symptoms of medical conditions but also psychological and social symptoms such as loneliness or substandard housing circumstances. This approach is the secret to making the care we provide so comprehensive.


If you could invite any five people to dinner, who would you choose? I would love to have dinner with my Dad -- he lives in the most amazing beautiful forest in Puerto Rico and I miss him so much; Nick Vujicic, an outstanding human being who has inspired so many to overcome adversity; Gilberto Rolon, one of our members who adopted me as his granddaughter and who passed suddenly 12 months ago; Jacques Cousteau; and Steve Irwin.
NEW STAFF HIRES
 
Nov. 2011 to Jan. 2012
Clinical Group

 

Marta Szymczak

Resource Nurse

 

Edwin Medrano

Resource Nurse

 

Christina Camara
Physician Assistant

 

Sally Crowther, RN
Site Manager


 Maria Hamilton

Licensed Practical Nurse

 

Sharon Cecca

Clinical Documentation Support Assistant

 

Karen Burnham

Clinical Documentation Improvement Specialist

 

Barbara MacDonald

Primary Care Nurse

 

Claribel Parra

Clinical Support Coordinator

 

Jahaira Rosario

Clinical Assistant

 

Desiree Torres

Clinical Assistant

 

Kathy Mastorakis

Occupational Therapist

 
Commonwealth Care Alliance

Glenys Palomino
Community Marketing Coordinator

 

 Janice Henry
Senior Director, Provider Network Management 

 

Keyla Suarez
Clinical Quality Improvement Manager
  
Cynthia Glennon
Regulatory Affairs Compliance Auditor
 
Elizabeth Wilson
Enrollment Reconciliation Specialist
 
Eugene Wallace
Chief Financial Officer 
Issue 11Winter 2012
Commonwealth Care Alliance staff lend support to a HCFA rally.

Dear Network Provider:

 

2012 will clearly be a watershed year in the life of Commonwealth Care Alliance, as we unequivocally transition out of our "start up" phase. It will be a year when we will develop new strategic relationships, when we will bring on new clinical and administrative staff, and when we will dramatically upgrade our technology and analytic capabilities to support our clinical work.

 

Furthermore, 2012 brings changes and new additions to our executive leadership team:

 

Lois Simon has assumed the title of President of Commonwealth Care Alliance. As many of you know, this corporate officer title has been associated with my role as Chief Executive Officer since our inception. I will remain as Chief Executive Officer and Lois and I will continue to partner together as we always have to lead the organization's work.

 

Nancy Roach has been promoted to the role of Chief Operating Officer. In her eight years of work with our organization, she has had a broad array of responsibilities including the management of Member Services, Provider Network Management, Enrollment, Marketing, and Outreach functions as well as the early phase of the Health Education and Training Department. We are so pleased that Nancy will serve our organization in this executive leadership capacity.

 

Jan Levinson has assumed the new role of Senior Vice President for Senior Care Options Program. Building on Jan's extensive experience in clinical program development and design of primary care models both inside and outside of the organization, Jan will lead the integration of Commonwealth Care Alliance's clinical and administrative SCO activities.

 

Finally, our Chief Financial Officer, Bob Fallon, left our organization in January to assume new professional responsibilities. Bob's contributions to Commonwealth Care Alliance have been key to our success throughout his tenure and we wish him well.


With Bob's departure, we are pleased to announce that Gene Wallace is now serving as our new CFO. Gene has extensive healthcare financial leadership experience, serving as the CFO of Beth Israel Hospital for twenty five years and more recently as the CFO for Harvard Vanguard and Atrius and Signature Healthcare. Gene is well known and well respected as a finance leader in the Massachusetts healthcare industry. We welcome him to Commonwealth Care Alliance.

 

Sincerely,

 Bob Master, President & CEO

Robert J. Master, MD signature


 


Robert J. Master, MD

Chief Executive Officer
Program Developments

New Program for Dually Eligible Adults

The Massachusetts Executive Office of Health and Human Services (EOHHS) has announced that it will develop a program to integrate care for MassHealth/Medicare beneficiaries aged between 21 and 64. The program is expected to procure contractors (Integrated Care Organizations) in Spring 2012 and commence operation in January 2013.

 

Commonwealth Care Alliance views this new program as an opportunity to build a care system that serves different adult populations with unique health care needs, such as those who are:

  • Medically complex
  • Developmentally disabled
  • Severely physically disabled
  • Severely and persistently mentally ill

Commonwealth Care Alliance will apply to become an Integrated Care Organization (ICO) that serves these high-risk populations.

 

Although the program will not begin until 2013, Commonwealth Care Alliance is working now to plan and develop it by:

  • Collaborating with primary care providers who are involved in the care of people who are dually eligible for MassHealth and Medicare and are aged between 21 and 64
  • Designing multidisciplinary primary care/care coordination models of care to meet unique member needs.
  • Working with human services organizations that are currently serving adults with disabilities -- physical, developmental, and mental illness -- in order to design a program that coordinates community and home-based supports and services with primary medical and behavioral health care
  • Recruiting new providers including specialists, hospitals, primary care physicians, and other community supports to meet the geographic needs of dually eligible members

We look forward to discussing this new program with you.

 

Questions? Please contact Janice Henry, Senior Director, Provider Network Management, at 857.246.8809 or jhenry@commonwealthcare.org

InformedRx: New Pharmacy Benefits Manager 

InformedRx, a subsidiary of SXC Health Solutions, was selected as our new pharmacy benefits manager (PBM) effective January 1, 2012. InformedRx won this contract because of their demonstrated ability to customize their processes to meet the unique needs of our members and our care model. Commonwealth Care Alliance is no longer be working with Express Scripts (ESI).

 

Due to this change, all of our Senior Care Options program members were mailed a new member ID card. The new card has updated billing codes that are critical for pharmacies to use in order to fill prescriptions and bill Commonwealth Care Alliance correctly.

 

Furthermore, we launched a campaign to educate pharmacies of our PBM switch to informedRx. While we have tried to preemptively address any issues related to this transition, should you learn of any delay in your patients' ability to fill their scripts, please call our Member Services team at 1-866-610-2273. They will help facilitate a resolution.

 

Questions? Please contact Basem Shebli, Director of Pharmacy, at 857.246.8838 or bshebli@commonwealthcare.org

Listening Rounds 

Listening Rounds were developed by Commonwealth Care Alliance's Life Choices Palliative Care team to give our interdisciplinary care teams an opportunity to gather and discuss the psychosocial, emotional, spiritual, and medical aspects of our members' care. These elements of patient care are often not often discussed in other forums.

 

We invite family members of patients who have passed away to attend the Listening Rounds and let them become the center of the discussions, sharing their stories and experiences. These narratives help our teams empathize and understand how they can truly provide patient- and family-centered care at all stages of our members' lives.

 

"I heard unforgettable stories of people who have strong visions for how to live and how to die. The family members and clinicians shared both joyful and sad memories creating an emotionally rich experience. As a clinician I felt inspired to listen to my patients so that I can truly allow their goals to direct care." Listening Rounds Attendee

 

"This gave me the opportunity to share my husband's story with some of the most important people in his life -- the practitioners and founders of BCMG and Commonwealth Care Alliance. Reflecting on my husband's end-of-life experience is an important part of my grieving process. By openly discussing some of the more difficult aspects, I came away with a sense of closure and peace." Listening Rounds Speaker

 

The next Listening Round session is being planned for May.

 

Questions? Please contact Michelle Papazian, Program Manager, Life Choices Program, at 617.600.3197 or mpapazian@commonwealthcare.org
Contracts Corner
Please join us in welcoming the following providers to Commonwealth Care Alliance's network:

 

November 2011 to January 2012
 

Name

Location

Provider Type

Alan Kurtz, EdD

West Springfield

Counseling

Associated Surgeons, PC

Cambridge

General Surgery

Baystate Urogynecology

Springfield

Gynecology

Boston Home Health Aides, LLC

Roxbury

CHHA

Boston Psychiatric Care, LLC

Jamaica Plain

Behavioral Health Outpatient

Charlestown Vision Associates, Inc.

Charlestown

Optometry

Douglas F. Watt, PhD

Quincy

Behavioral Health Outpatient

Ear, Nose, and Throat Consultants, Inc.

Woburn

Otolaryngology

Charlesbank Home Care

Waltham

CHHA

Franklin Orthopedic Group

Greenfield

Orthopedic Surgery

Gathering Point Acupuncture Center

Malden

Acupuncture

Hampshire Orthopedics & Sports Medicine, Inc.

West Hatfield

Occupational Therapy, Orthopedic Surgery & Physical Therapy

Harbor Counseling Center

Westwood

Behavioral Health Outpatient

Hearing Services of Cape Ann

Gloucester

Hearing Services, Audiologist

TransCare

Methuen

Transportation

Jacquelyn B. Stevens, MD

Malden

Ophthalmology

Jennifer Salvo, OD

Holyoke

Vision & Optometry

John E. Beaulieu, MD

Swampscott

Primary Care Site

Spark*L. E. Cleaning

Lawrence

Chore Services

Martin L. Gelman, MD

Brighton

Nephrology

Maury A. Goldman, MD, PC

Melrose

Allergy & Immunology

Medical Interpreters of the North Shore

Lynn

Interpreter

Michael Kutka, MD, LLC

Haverhill

Plastic Surgery

New England Cardiology, LLC

Lawrence

Cardiology

North Shore Neurology & EMG, LLC

Beverly

Neurology

Osborne Pharmacy & Health Care

Lynn

Durable Medical Equipment

Podiatric Healthcare, PC

Salem

Podiatry

Shirley Kairis, LICSW

West Roxbury

Counseling

Stanley H. Ducharme, PhD

Boston

Behavioral Health Outpatient

SV Pain Management

Longmeadow

Pain Management

The Children's Heart Center of Western Massachusetts

Springfield & Northhampton

Specialty Group

Women's Health, Inc.

Salem

Women's Health

 

Questions? Please contact Provider Network Management at 857. 246.8834
Reminders

Save the Date: SCO Program Clinical Conference 

The annual SCO Program Clinical Conference will be held at Regis College in Weston, on Friday, June 1, 2012. PLEASE SAVE THE DATE!

 

Mark your calendars for this important and exciting conference for Commonwealth Care Alliance Senior Care Options primary care team members. More details will be announced in the coming weeks.
 
Questions? Contact Jan Levinson, Senior Vice President for Senior Care Options, at 857.246.8807 or jlevinson@commonwealthcare.org

Tell Us About Any Changes 

Please remember to tell us if your contact information changes (address, telephone, email, etc.):
Carol St. John
Provider Network Management
30 Winter Street
Boston, MA 02108
Telephone 857.246.8834
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 Manager
Commonwealth Care Alliance