By Yewellyn Sánchez
“Just last week I treated somebody that was just in the middle of having an asthma attack” said Laura Black, nurse practitioner and Vice President of Care Partnership and Clinical Delivery of Commonwealth Care Alliance. “I was able to treat her at home, she didn’t have to go to the hospital.” This is one of many possible issues for Medicaid and Medicare. It’s just a part of Laura’s daily job.
CCA is a dual demonstration plan that focuses on helping these high risk Medicaid and Medicare patients by helping them financially align the Medicare and Medicaid money, closely engaging with members to help with managing chronic disease, managing long term support services, and helping address social determinants to make sure that they have adequate access to healthcare.
Approximately five percent of the population in the US have Medicaid and Medicare but that five percent accounts for a large amount of Medicaid spending (35 percent).* CCA has two programs that help these members; the Senior Care option for people 65 or older, who have Medicaid but do not have to have Medicare and the One Care program for members under 65 who have Medicaid and Medicare.
CCA serves as a health plan and health delivery system. Their goal is “to help people meet their individualized goals and also to live as healthy a life as possible” says Black. To accomplish this, they offer different services such as preventative care. Preventative care consists of screenings, mammograms, some blood work and screenings for diabetes.
They work with members who are medically or behaviorally complex or have a lot of issues with, what are known as social determinants of health, to help them stay home and avoid hospitalization. CCA deploys their own clinical staff that can make home visits on a regular or urgent basis. The staff consists of advanced practiced clinicians, nurse practitioners and physician assistants who have prescriptive authority. During off hours, they deploy paramedics through their Mobile Integrated Health Innovation program, as well as set up long term care services.
Long term care services are meant to keep at risk members from going into a nursing home by creating a comprehensive health plan. This includes assistance with personal care, setting up Meals on Wheels, making sure they are taking their medication correctly and have the appropriate equipment in their house such as a walker, toilet seat or electric recliner, while also ensuring they have dental care and preventative dentistry services.
CCA takes dental care very seriously. “I think that’s one area we have the opportunity to improve on that for membership” said Laura Black, “because there is a very close connection between poor dental hygiene and chronic mental illness basically like a cardiac condition.”
The organization also does a lot of work with mental health, substance abuse and the opioid crisis and working on reducing the stigma around behavioral health diagnosis and mental illness.
“So what we do, it has to do with our motto, it has to do with meeting people where they are, “ said Black. “By taking a trauma approach to care and appreciating that many people who have a mental illness may have gone through some sort of trauma early in their life or as young adults. And so really trying to appreciate individuals and as we approach our members and as we work with them as clinicians, being very empathetic and working with them in a way that is respectful no matter what this member is like or where they may come from or what they look like or what diagnosis they have. Really treating people with dignity and respect.”
In order to ensure that members have the best experience, CCA promotes community outreach and a positive member engagement. “We try to bring the community to CCA as well where we have our members sitting on advisory panels to help guide us on what we do as an organization,” said Laura. They also partner with other organizations such as Aging Service Access Points, Independent Living Centers and Human Service Providers to provide local services.
As a result of CCA’s work, Senior Care Option members have been able to reduce hospital admissions by 24 percent and One Care members’ admissions decreased by 22 percent in the first 18 months. According to Laura, approximately 170,000 people are technically eligible and much less have it.
“The challenge is how to grow the program and continue to provide the excellent care and services and really learning how to do that to ensure that we grow this program and be able to touch everyone who is eligible.”
“We come from a place of being very mission driven. I feel like it’s just important to know that our goal is so much to help populations that may not have been touched in the past and to really look at how we can help them not only from a medical perspective but also to help with any behavioral health needs and also to help from social needs as well. And really, we’ve been so happy to have this opportunity to serve the community and we’re just really looking forward to helping and seeing the program grow.”