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Commonwealth Care Alliance Elderly And Disabled Care Case Solution
Dr. Robert Master, the founder of Commonwealth Care Alliance (CAA), had created the company with the vision to ‘bring high-quality and personalized care to people with complex medical and behavioral needs, resulting in improved health and better self-management of chronic illness, thereby reducing hospitalizations and institutionalizations.' Therefore, the main objective was to provide care outside the walls of hospitals and institutions to make it easier for the chronically ill and disabled to receive the attention they needed.
CAA was founded in 2003 and was established to be a nonprofit health plan and delivery system which is why in contrast with other insurers it did not focus on generating profits rather focused more towards helping those in need. CAA's target audience comprised of the elderly, developmentally and physically disabled and lastly the people who had multiple chronic illnesses. Unlike most insurers who aim to maximize profits, CAA had a different target audience as it was founded to solve the problem of having inadequate nursing facilities and physicians to carter to the needs of the ill, transferring the entire burden on teaching hospitals.
Following questions are answered in this case study solution
Why is CCA targeting a population that most insurers tried to avoid?
Describe CCA's health plan in the Senior Care Plan. How does it differ from other insurance models and why?
Describe CCA's approach to providing care and contracting for care delivery. What is the rationale?
Evaluate CCA's overall model for elderly and disabled care? How can it be improved?
What challenges and constraints will CCA have to contend with? What recommendations would you make to Dr. Master?
Case Analysis for Commonwealth Care Alliance Elderly And Disabled Care
2. Describe CCA's health plan in the Senior Care Plan. How does it differ from other insurance models and why?
CCA's Senior Care Option Plan (SCP) was a health plan based on a voluntary basis which offered all benefits of Medicare and Massachusetts Medicaid to high-risk and often dually eligible members. Members who were at least 65 years old, residing within CCA service area and enrolled in or eligible for Massachusetts Medicaid could join the SCP. The plan aimed to cover non-traditional items such as providing transport to medical appointments, assistance with daily chores and personal emergency response systems which were related to socially and medically vulnerable states of its members.
The SCP members were grouped into four program designations based on their clinical severity: patients based in institutional settings, patients at home but eligible for nursing home care, patients with a chronic mental illness such as Alzheimer's and patients with common aging related chronic care conditions. The plan allowed the majority of SCP members to receive Medicare Part D prescription drug benefits where were exempted from paying any premiums or co-payments, being low-income beneficiaries. CCA covered the payment of drugs for all its SCP members under all circumstances. Moreover, almost all non-emergency SCP services were delivered by the providers who were part of the network contracted by CCA. These contracted sites for primary care where able to serve more than 300 SCP patients.
3. Describe CCA's approach to providing care and contracting for care delivery. What is the rationale?
Every SCP patient was assigned a team for primary care which consisted of at least one physician as well as at least one nurse practitioner or physician assistant who the expertise of taking care of elderly patients. These teams also included social workers for elderly care, known as geriatric support services coordinators; who were responsible for linking the patients with services to allow them to live independently. Most if the staff was employed by primary care sites and depending on the patient volume each primary care center had one to three geriatric coordinators.
For new patients, a comprehensive intake evaluation was undertaken which could assess their medical, behavioral and social circumstances conducted by nurses. Geriatric coordinators too evaluated patients to check their ability to perform daily activities to determine whether or not the patients needed community-bases long-term care services. Following the initial assessment, patients met with their primary care physician; all physician visits were initiated by the nurses and scheduled by the administration. While most physician appointments were held at health centers some physicians had to pay home visits for patients with limited mobility.
Some of the primary care sites employed social workers and physical and occupational therapists directly and acquired durable medical equipment such wheelchairs and home and medical equipment on their own. When primary care sites were unable to carry out these operations due to space or financial constraints, CCA contracted for these types of care. The rationale behind CCA's approach was to provide every individual with the attention and care they needed to live better lives.
4. Evaluate CCA's overall model for elderly and disabled care? How can it be improved?
Since the frequency of physician visits varied, it was the nurse practitioners who were the provider of the majority of primary care service and main contact for care delivery.
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