Commonwealth Care Alliance logo






Network News 

Commonwealth Care Alliance Primary Care Site Newsletter

In This Issue
Program Statistics
Contact Information
Staff Spotlight
New Staff Hires
New Dental Benefits Administrator
informedRx Name Change
Fraud, Waste & Abuse Training
Contracts Corner
Innovation Grant to Improve Care
New Site Opened at Holyoke
Join Our List
Join Our Mailing List
Program Statistics
Senior Care Options
Current Enrollment
4,326 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 
 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 Manager 
857.246.8843
 
 Pharmacy Issues
Pharmacy Director
857.246.8838
 
 Newsletter Submissions 
Communications Manager
857.246.8844
Staff Spotlight
Director of Provider Relations & Quality Tanya Sloutsky   
Tatiana (Tanya) Sloutsky, LICSW 
Director of Provider Relations & Quality

Tanya has been part of our Senior Care Options Program team at Elder Service Plan of the North Shore (ESPNS) since 2005.

Tell us about yourself:

I hold a Masters Degree in Social Work, as well as a Masters Degree in Fine Arts, in painting and sculpture. I live in Marblehead with my daughter and enjoy raising her very much.


Tell us about your professional background: 

As a bilingual professional, I have worked as an interpreter and case aid in refugee resettlement and as a social worker in  behavioral health, schools, and a skilled nursing facility.

 
What does a typical workday look like?

Very busy: I answer a lot of emails and calls; participate in many meetings and keep copious notes; follow up on network issues and complaints; orient and support staff; work on policies and procedures and quality improvement; advise staff on issues related to health care proxies, guardianship, power of attorney, HIPAA, regulatory issues, hospice, palliative care, and end of life behavioral health issues, and outreach and marketing, as needed.

 
What is the best part of your job?

I enjoy the variety of tasks that I am involved in, the many people I interact with, the knowledge I gain and share on a daily basis, and when successful, the ability to maintain and improve our program for our members.

  
What makes Commonwealth Care Alliance special?

I generally have not liked the idea of managed care in the past, that is, until I learned about the kind of care that Commonwealth Care Alliance coordinates and provides to its members. I am truly impressed by a program that incorporates the medical, social, behavioral health, and community needs of elders and wraps services around members' needs. Commonwealth Care Alliance does that. I work from our Lynn office with wonderful people who are truly dedicated to meeting our members' needs and feel that we are part of the organization's greater mission of taking care of the neediest members of society with compassion and grace.

 

What do you like to do when you're not at work?

When I have time, I enjoy the ocean, making artwork, reading, watching movies, dancing, and spending time with my daughter and my friends.


If you could invite any five people to dinner, who would you choose?
The Clintons, Obama, and a couple of NPR/WBUR reporters--that would make for an interesting dinner conversation.
 
Tanya's artwork will be exhibited at
LynnArts from August 6 to September 5, 2012.
New Staff Hires

2012 has been a busy and growing year thus far at Commonwealth Care Alliance!

 

Between February and July 2012, our clinical group grew by around 20%, including the addition of 13 new primary care nurses and nurse practitioners.

 

Our nonclinical staff based in Boston and Charlestown increased by nearly 22% during the same period. Key new hires include our Vice President of Finance, Maureen O'Sullivan; our Behavioral Health Network Manager, Judy Erskin; and our new Director of Operations, Maryellen Sheehan.

 

Click here for a complete list of new hires from February to July 2012.
Issue 12
Summer 2012
Evelyn Malave (center) 2012 Direct Service Award winner 

Dear Network Provider:

 

The Affordable Care Act (ACA) changed the healthcare game in relation to creating a climate of innovation. Its finest accomplishment to date has been to ignite the greatest explosion of care delivery innovation for Medicare and Medicaid beneficiaries since the inception of these public programs in the 1960s.

 

Some examples of the innovations now going on all around us: 

  1. In response to the shameful fact that one in five hospital discharge results in an unintentional readmission within 30 days, we are seeing an array of new approaches to re-engineering the hospital discharge process and new promising care transition models.
  2. To make the wealth of information in EMRs available to patients, families, and in-home caregivers to better promote "health literacy" and self-management of chronic illnesses, entrepreneurs from the publishing industry are translating "medical speak" into a continually refreshed in-home personalized educational document that describes clinical problems, treatments, and self-management care goals.
  3. In response to the need for hospital alternative approaches for homebound frail elders, or younger individuals with involved disabilities, what is termed "hospital at home" programs are entering the market featuring a new generation of portable imaging, home infusion and nursing capabilities in the home.
  4. In response to the mismatch between busy emergency rooms and the unique needs of frail elders, we are seeing the first generation of specialized separate geriatric emergency departments developing in one or more forward looking Pioneer ACOs.
  5. In response to the need to amplify existing clinical resources caring for individuals with advanced chronic illnesses, we are seeing an array of "telemedicine" innovations entering the market with a  goal of improving the clinical management of conditions such as congestive heart failure in home settings.

Now that the ACA has unshackled the unique American genius for innovation, if we at Commonwealth Care Alliance are the least bit smug, if we become self-satisfied and too content with the status quo, if we lose our passion for continuous innovation and improvement, others will leapfrog over us to be the new innovation leaders before we know it. We cannot let this happen. We must continue with unwavering focus as a leader in this arena, reimagining and redesigning what meaningful primary care looks like, developing continuity across inpatient and outpatient medical and mental health care, and, metaphorically, finally reconnecting the head to the body in all aspects of care.

 

Sincerely,

 Robert J. Master, MD, CEO

Signature of Robert J. Master, MD, CEO 


 

Robert J. Master, MD

Chief Executive Officer
Program Developments

DentaQuest: New Dental Benefit Administrator

ToothbrushEffective August 1, 2012, DentaQuest is Commonwealth Care Alliance's new dental benefit administrator. This is an extremely exciting new partnership, as DentaQuest's comprehensive provider network will allow greater access to dental care for Commonwealth Care Alliance members throughout the state.

 

All contracts between Commonwealth Care Alliance and our current dental network will terminate on July 31, 2012; however, members who are mid-treatment during the transition period are authorized to complete their care with their current dentist. Almost all dentists in Commonwealth Care Alliance's current network are also part of DentaQuest's network. DentaQuest will attempt to recruit the remaining few.

 

Questions? Please contact Diane Ryberg, Manager, Provider Network Management, at 857.246.8854 or via email.

Name Change for PBM 

Photo of prescription drugsCommonwealth Care Alliance's pharmacy benefit manager (PBM) company, informedRx/SXC, has merged with another PBM, called Catalyst Health Solutions. The merger was effective July 2, 2012.

 

As a result of the merger, the combined PBMs will have a new name -- Catamaran. The names SXC and informedRx will no longer be used. We will be updating our member and provider materials soon to reflect the change, however, this is the only impact Commonwealth Care Alliance, its members and providers will experience in response to the merger. Everything else will remain the same, including phone/fax numbers, contact information, etc.
 

The merger creates the fourth largest PBM by prescription volume, with an annual prescription volume of more than 200 million adjusted PBM scripts. With combined annual revenues of approximately $13 billion, the combined company is expected to cover approximately 25 million members, of which 4,000 are Commonwealth Care Alliance's SCO members.

If you have any questions about this change, please do not hesitate to contact me.

 

Questions? Please contact Basem Shebli, Pharmacy Director, via email.
Provider Training

Fraud, Waste & Abuse

Every year, medical fraud, waste, and abuse costs taxpayers billions of dollars. Commonwealth Care Alliance's providers, vendors, and contractors are required to take fraud, waste, and abuse training at least once every year. However, if you, as a provider, vendor, or contractor, are enrolled in the Medicare Part A or Part B program, you do not need to participate in Commonwealth Care Alliance's training.

 

If you are not enrolled in Medicare Part A or B, you, as a provider, are required to ensure that you and all of your employees who provide services to Commonwealth Care Alliance members participate in fraud, waste, and abuse training.

 

Commonwealth Care Alliance has posted the CMS training program titled "Medicare Parts C and D Fraud, Waste and Abuse Training" here on our website.

 

Please ask each employee to complete the training and the certificate at the end of the training and maintain a copy of the certificate. Commonwealth Care Alliance reserves the right to request verification that all of your employees have completed this training.

 

Questions? Please contact the Department of Regulatory Affairs and Compliance at 617.426.0600 or via email.

Contracts Corner
Commonwealth Care Alliance welcomed over 140 new providers to its network between February and July 2012.

 

A key new provider is International Health Solutions (IHS) who joined us on July 1, becoming Commonwealth Care Alliance's 26th primary care site. IHS is an experienced home health agency and adult day health provider that primarily serves Russian-speaking clients in the Springfield area.

 

Click here for a complete list of new providers from February to July 2012.

 

Questions? Please contact Provider Network Management at 857.246.8834
The Watercooler

Innovation Grant to Improve Care

Commonwealth Care Alliance, in partnership with Vinfen Corporation, Bay Cove Human Services, North Suffolk Mental Health, and Brookline Mental Health, is receiving a $2.9 million award from the Center for Medicare and Medicaid Innovation (CMMI).

The grant will fund programs to integrate the health care and behavioral health care for individuals with serious mental illness (SMI) in metropolitan Boston by embedding nurse practitioners and primary care physicians with their existing psychiatric rehabilitation care teams. By combining psychiatric rehabilitation care with high-quality primary care, the program will create community based health homes and improve individuals' health by increasing access to health services, reducing the impact of their disorders, and reducing overutilization of acute services.

Dr. Bruce Bird, CEO of Vinfen, commented "Although we have been doing a good job helping people recover from mental illness, our system's capacity to coordinate medical care and teach people how to manage their own health has not been adequate. This program will provide better care at a lower cost for a population that is at risk for severe chronic disease, and is often in need of critical care."

As part of the program, care management counselors and peer counselors will use a unique training program developed by Dr. Steve Bartels at Dartmouth to help individuals to self-manage their medical and behavioral health issues. Telehealth technology will enable health care teams to monitor patients, prioritize care, and intervene as necessary.

Over a three-year period, the program will train an estimated 57 workers, and will create an estimated 11 jobs for health outreach workers, nurse practitioners, a primary care physician, and a project manager. The project is forecast to produce net savings by the third year of 2.5% and greater sustainable savings in the future.

Dr. Robert Master, CEO of Commonwealth Care Alliance, noted, "We are excited about this opportunity to create an entirely new approach to integrated primary care and mental health services for a population that has been so poorly served in our fragmented, impersonal medical care system."

"I applaud Vinfen and their community partners for leading the way on this innovative program to integrate and improve care for individuals with serious mental illnesses," said Health and Human Services Secretary Dr. JudyAnn Bigby. "This initiative is very important to enhancing the efforts we are leading under Governor Patrick to improve care for people with chronic illness."

New Site Opened at Holyoke

President Lois Simon, Site Manager Ann Peterson, and Mayor Morse open the Holyoke new office.Holyoke Mayor Alex B. Morse helped Commonwealth Care Alliance celebrate the opening of its new office at 57 Suffolk Street in Holyoke, Mass. by speaking and participating in an inaugural ribbon-cutting ceremony and open house on June 22, 2012.

 

The new Holyoke office houses 22 staff who provide health care services to Commonwealth Care Alliance members who are patients of the Holyoke and Chicopee Health Centers and several community primary care physician practices in the greater Springfield area.

 

"We are beyond excited to have this new office in Holyoke," said Commonwealth Care Alliance President Lois Simon. "The new location allows Commonwealth Care Alliance, in its valued partnership with the Holyoke Community Health Center, to reach more patients with complex needs in Holyoke and surrounding areas."

 

Joining Ms. Simon at the Open House were Commonwealth Care Alliance Regional Administrative Director Terri Theroux, Regional Clinical Director Cheryl Pascucci and Holyoke Site Manager Ann Peterson.

 

The new office marks the third office in Massachusetts' Pioneer Valley for Commonwealth Care Alliance. Commonwealth Care Alliance also has other offices in this area including the Western Mass Regional Office at 140 High Street in Springfield and a location contiguous to the Brightwood Health Center in the North End of Springfield. In addition to patients of the Holyoke and Chicopee Health Centers, Commonwealth Care Alliance currently provides services to patients at the Brightwood Neighborhood Health Center, the Mason Square Neighborhood Health Center, the High Street Health Center, and numerous community primary care physician practices in the Pioneer Valley.

If you have submissions or suggestions for this primary care site newsletter, please send me a note via email or call me during office hours at 857.246.8844.

Sincerely,

Nerissa J. Fry 
Communications Manager
 
2012 Commonwealth Care Alliance, Inc.