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Program Statistics |
Senior Care Options Current Enrollment
4,683 members
Gender
68%=female; 32%=male
Clinical Overview
56% diabetic; 23% with CHF |
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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
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 |
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Staff Spotlight |  |
Hazel Audet, RN
Nurse Manager, Resource Nurse
Hazel has been part of our Clinical Group in the East since September 2009.
Tell us about yourself:
I'm originally from the Philippines, and I moved here in 2002. After passing my nursing boards, I worked at MGH for six years. I began looking for a company that offered flexibile hours, as at the time,my son was three years old. I also wanted to work as a nurse so I could practice what I had learnt, especially at MGH. Commonwealth Care Alliance was a big change from what I was doing before, but I learned the job and I love it. I like interacting with the elderly. It's also good to see them in the home setting and not in the hospital setting.
What does a typical workday look like?
I'm the enrollment nurse at CCACG East, so I handle and manage the initial assessment for our sites out here. A typical day is doing initial assessments, meeting people in their homes, gathering medical information. I try to find out what current services they have with the local elder service so as much as possible we can continue them as they become our members. I spend a lot of time processing what is called the MDS and making sure that I assign the proper rating category to our new members.
What is the best part of your job? The flexibility. It allows me to be a nurse, to do the work that I like and at the same time, it allows me to be a mother and that is very important for me.
What makes Commonwealth Care Alliance special? We're creative about taking care of our members. No two members are alike and our care managers tailor their care according to that individual.
What do you like to do when you're not at work? I like to spend time with my son.
If you could invite any five people to dinner, who would you choose? My boss--she's wonderful. My friend Steve, Judy Ackerman, Robert Downey Jr., and my husband. I wish I had [his] Iron Man suit so I could fly around all this traffic in Boston; my son and I are big "Iron Man" and "Avengers" fans.
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New Staff Hires |
Between August and November 2012, our clinical group grew by around 14%, including the addition of 8 new primary care nurses and nurse practitioners.
Our nonclinical staff based in Boston and Charlestown increased by nearly 25% during the same period. Key new hires included our Privacy & Security Officer, Lassaad Fridhi; our Assistant General Counsel, Zachary McBride; our Director of Clinical Group Education & Staff Development, Susan Koblara; and our Medical Director, Randi Berkowitz.
Click here for a complete list of new hires from August to November 2012. |
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Dear Network Provider:
Looking back on 2012, I believe that one of our most important accomplishments was, once again, demonstrating extraordinarily nimbleness in response to unanticipated challenges. Year after year, it seems that "nimbleness" has been a constant characteristic of our organization, and it doesn't seem to diminish with growth.
In 2011, our nimbleness was exemplified by our heroic response to three natural disasters in Western Massachusetts. This year we demonstrated "nimbleness" with our response to the January/February cold shower of inexplicably lower premium revenue and high medical expenses. Being unexpectedly confronted with a $15M negative financial swing was certainly not the ideal way for our newly minted finance team to begin to work together. Fast forward to the present and we can only applaud the sophisticated analytic efforts that identified the culprits on the revenue and expense side, as well as the interventions that remedied this set of circumstances. As the year progressed, the loss trajectory first was blunted, and then reversed. Now it looks like we will end the year a lot smarter, a lot more tested, and, incidentally, with a profit.
The largest annual Senior Care Options Program membership expansion in our history was certainly another 2012 accomplishment. Accordingly, the SCO leadership, the Outreach and Marketing team, as well as the Human Resources department, and clinical group leadership merit recognition for this very impressive enrollment growth, as well as an equally impressive recruitment and hiring effort that kept pace with this growth.
Finally, 2012 was the year where we crystallized the vision and implemented the lion share of the complex project plan to launch our Integrated Care Organization (ICO) product in 2013. See article below for more information.
Have a safe and happy holiday season!
Sincerely,
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| Program Developments | |
Commonwealth Care Alliance Selected as ICO in Massachusetts Healthcare Initiative
Commonwealth Care Alliance has been selected for contract negotiations to participate as an Integrated Care Organization (ICO) in the Massachusetts Duals Demonstration, which seeks to improve care and contain the cost of caring for Massachusetts 111,000 adults aged 21 to 64 eligible for Medicaid and Medicare. Commonwealth Care Alliance will now advance to a joint state and federal readiness review process to prepare to serve as an ICO.
Implemented through MassHealth and the Centers for Medicare and Medicaid Services (CMS), the program selected six organizations to participate in the three-year demonstration program. Commonwealth Care Alliance, a nonprofit care delivery system committed to providing integrated health care and related social support services for people with complex needs, was selected as a health care option for dual eligibles located in Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Suffolk and Worcester counties, and part of Plymouth county. With 30 years as healthcare pioneers and innovators, the founders of Commonwealth Care Alliance bring together highly specialized clinical and administrative services and a broad provider network to design and deliver personalized, patient-focused care.
Dual eligible beneficiaries are among the sickest and most costly patients, costing on average five times more to care for than the average Medicare beneficiary. Since 2003, Commonwealth Care Alliance, in partnership with its primary care network and affiliated clinical organizations Commonwealth Community Care (formerly Boston's Community Medical Group) and Commonwealth Care Alliance Clinical Group, has helped to improve care, and contain and stabilize medical costs for elderly adults and younger individuals with serious disabilities by providing preventive, continuous care that keeps patients out of hospitals and emergency rooms.
"Being selected for ICO contract negotiations is a huge testament to the excellent work that Commonwealth Care Alliance and its associated clinicians and primary care network have done for its members over the past nine years," said Commonwealth Care Alliance Chief Executive Officer Dr. Robert Master. "We are thrilled to be a part of this project that will significantly improve health care and cost outcomes for the dual eligible population."
Commonwealth Care Alliance was one of 10 health plans that submitted a proposal to participate in the state's program this July. In August, CMS officially approved the Massachusetts demonstration, which allows dual eligible individuals between the ages of 21 and 64 to receive health care through organizations that provide integrated medical, behavioral health, and community support services.
Questions? Please contact Janice Henry, Senior Director, Provider Network Management, at 857.246.8809 or via email.
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| Reminder |
NPI Prescriber Identifier Requirement for PDE
Effective January 1, 2013, Centers for Medicare and Medicaid Services (CMS) will require an active and valid Prescriber National Provider Identifier (NPI) on all Medicare Part D claims submitted on the PDE to CMS.
Two Phase Implementation
- CMS requires all PDE submissions to contain only a valid Type I or II NPI effective 1/1/2013.
- CMS requires all PDE submissions to contain only a valid Type I NPI effective 5/6/2013.
Physicians will need to include a valid individual Prescriber NPI, rather than a Group NPI, upon the act of prescribing.
Questions? Please contact Provider Network Management at 857.246.8834 |
| Contracts Corner |
Commonwealth Care Alliance welcomed over 75 new providers to its network between August and November 2012.
Click here for a complete list of new providers during this time.
Questions? Please contact Provider Network Management at 857.246.8834 |
| The Watercooler | |
Medicare Star Quality Ratings
Commonwealth Care Alliance once again achieved a 4.5 star rating from the Centers for Medicare and Medicaid Services (CMS) 2013 plan ratings.
Each year through the Medicare Star Quality Ratings system, CMS rates Medicare health plans (both parts C and D) on a scale of 1 to 5 stars, with 5 stars representing the highest quality. The overall scores are based on more than 50 care and service quality measures across five categories, including staying healthy, managing chronic conditions, member satisfaction, customer service, and pharmacy services.
No other Medicare Advantage special needs plan for people in Massachusetts aged 65 or over was rated more highly for quality and performance by Medicare. |
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Nurse Practitioner Receives Somerville-Cambridge Elder Services Award
 We congratulate Shona Gibson, NP, on being recognized by Somerville-Cambridge Elder Services for her dedication to patient advocacy and interagency elder care collaboration. On Wednesday, November 7, Shona received the Nancy Kahn Award during this year's Serving Seniors award ceremony in Cambridge. The Nancy Kahn Award is given in honor of the namesake caregiver whose work with the Somerville Cambridge Interagency Task Force on Protective Services for the Elderly championed senior independence and dignity in service. Shona's work with Commonwealth Care Alliance and other area elder care agencies earned her this year's nomination. Friends and colleagues from across the area joined Shona to celebrate her recognition for excellence.
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A Walk in the Park
 Commonwealth Care Alliance recently hosted a member walk and luncheon at its Boston location. The event was part of a pilot that seeks to engage members, families, and caregivers, promote healthy behavior, and decrease social isolation.
 The event attracted 22 Spanish and English speaking members and 20 Commonwealth Care Alliance employees. Members and staff had the rare opportunity to engage with one another, while enjoying the health benefits of walking around Boston Common together.
 The members strolled in their new, bright gold, Commonwealth Care Alliance t-shirts, Keep Moving hats, and pedometers that were donated by Ed Pomfred, Director of the Department of Public Health's Keep Moving program.
"That was the most I think I have walked in 10 years!" said one member after the event.
"Every staff member here is so kind and wonderful!" said another member.
Employees also expressed the benefits of connecting with the members, learning more about the folks we serve, and how much fun they had on the walk. We hope to plan similar events in the future. |
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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. |
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