Health care overhaul
(MCO)
Health reform is a victory for the soul of America
More than 13 million American
non-elderly adults have been
denied insurance specifically
because of their medical condition
s,
according to the Commonwealth
Fund, and the Kaiser Family
Foundation says 21 percent of
people who apply for health
nsurance on their own get turned
down, charged a higher price or
offered a plan that excludes
(ACO)
insurance plan to use pre-existing
conditions to exclude, limit or set
unrealistic rates on the coverage
an
individual or dependent can
receive.
HEALTH CARE HISTORY
This is what change looks like
PATIENT CENTERED
MEDICAL HOMES
Health reform bill finds
supporters
, det
ract
ors
Many senior
citizens
worry
about
Reform
(PPACA)
will close the "doughnut hole
gap in Part-D where Medicar
paying once a senior has spen
more than $2,830 on prescrip
drugs and resumes when the
individual's out-of-pocket sp
has reached about $4,550.
CENTERS FOR MEDICARE
& MEDICAID SERVICES
coverage for their pre-
existing
condition. StarPROTECTION
PATIENT
AND
ting in 2014, the new
health care reform legislation
makes it illegal for any heal
AFFORDABLE
CARE
ACT
th
Law of the land
The AARP, formerly known as the
American Association of Retired
Persons, says health care legislation
does two important things for
seniors: It gives people on Medicare
new access to free preventive
services such as screenings for
cancer and diabetes. Also, by 2020 it
the effect that the health care reform
bill may have on them. After all,
they generally use the health care
system more than do younger
people. And those living on fixed
incomes may have little leeway in
their budgets to help if their health
costs rise. Will the healthcare
reform legislation that President
Obama plans to sign into law on
Tuesday affect seniors in any direct
way? The short answer is “yes.”
(CMS)
Historic legislation means
coverage for millions more
Health care history is made
ACCOUNTABLE CARE
ORGANIZATIONS
Annual Report 2010
Health care bill passes
Health bill signed, but
questions linger
(PCMH)
When I look at our country, I see
the great diversity of people who
make up our nation. I see parents,
children, seniors, businessmen,
workers, homemakers and
students. It is for all these people
that I proudly voted for the Patient
Protection and Affordable Care Act.
I voted for reform that will ensure
my constituents have the health
care they need when illness or
injury befalls them. I voted for the
HISTORIC LEGISLATION
House oks historic health bill
working hard and saving for the
future when she was diagnosed
with a brain tumor and ultimately
lost her health insurance. I voted so
children born with a heart defect or
diagnosed with diabetes cannot be
denied health insurance because of
their pre-existing condition. I voted
so young adults graduating from
college will not have to play
Russian roulette with their health
because of a tough job market.
MANAGED CARE
ORGANIZATION
Sebastian Matamala & Elsa Serrano
Sebastian and Elsa love trying new things, exercising together,
and participating as often as possible in the workshops and member
meetings offered by Commonwealth Care Alliance.
They are passionate about volunteering in their community and
helping their fellow Latinos who are migrating to the United States. They
believe Commonwealth Care Alliance has kept them healthy and active,
enabling them to continue doing what they love.
“Commonwealth Care Alliance is a blessing,” says Sebastian. “I would
love for more people to get involved and benefit from their services.”
ACO (Accountable Care Organization)
A provider entity (not an insurer or HMO)
that both offers and contracts important
components of the healthcare system such
as primary care, behavioral health services,
and hospital services and is accountable for
the cost and quality of care for a defined
population. Anyone wanting to see a fully
functioning ACO for Medicaid and dual
eligible populations need look no further than
Commonwealth Care Alliance.
Leadership Message
When President Franklin Roosevelt introduced
his “New Deal” in the 1930s, it was regarded
as the most ambitious legislative program ever
seen. The multitude of government bureaus and
regulatory groups created to support the New
Deal were dubbed the “alphabet soup” agencies,
a moniker that referred to the abundance of new
abbreviations and acronyms.
spotlight when folks in Washington, DC ask,
“Well, how can this be done?”
When President Obama’s healthcare reform
legislation became law in early 2010, it
not only echoed (if not surpassed) FDR’s
ambitiousness but again brought forth an
“alphabet soup” of newly developed acronyms
— ACA, ACO, PCMH, MCO, FIDESNP
— which represent health care initiatives that
lead the way to reform; Commonwealth Care
Alliance finds itself firmly ensconced among
these new programs. President Obama’s
legislation charts the course to near universal
healthcare entitlement. It validates our work
and the policies that support it, and it places
Commonwealth Care Alliance squarely in the
Closer to home, here are a few of
Commonwealth Care Alliance’s own
achievements in 2010:
Robert J. Master, MD
President & CEO
enhance the ability of clinicians and managers
to engage in ethical decision-making
We should certainly celebrate the long awaited
redefinition of our country’s social compact;
however, let’s also take a deep breath and roll
up our sleeves, as the hard work of healthcare
reform implementation has just begun.
• We supported 554 full-time equivalent
personal care attendant jobs in low income
communities all over Massachusetts as part of
individualized plans of care
• We earned a 4+ out of 5 Star Rating from the
Centers for Medicaid and Medicare
• Our staff grew in number by 25%
• We invested $16.9M to create
multidisciplinary team models of care,
financing services above and beyond what fee
for service payers would have reimbursed for
our enrolled population
• We developed an Ethics Committee to
provide consultation services to help clarify
and resolve ethical conflicts at a clinical and/
or organizational level, and to support the
dissemination of educational resources that
• Our primary care network expanded to 25
practices
Thank you to our extraordinary staff, our
healthcare clinicians, our provider network, and
all of our supporters for contributing to our
successes in 2010.
Lois Simon, MPH
Chief Operating Officer
COMMONWEALTH CARE ALLIANCE ANNUAL REPORT 2010 | 3
Nguyen Pho
Before Pho joined Commonwealth Care Alliance, he had a hard
time managing his health care — it was difficult to keep track of
Senior Care Options Program
doctor’s appointments and communicate in English. Now, he has
a primary care team that helps him keep his schedule straight and
they translate information into Vietnamese.
Commonwealth Care Alliance helps Pho stay healthy and
independent, so he can better enjoy the important things in life,
such as spending time with his grandchildren.
GET TO KNOW SCO
2010 PROGRAM HIGHLIGHTS
CONSUMER ENGAGEMENT
To raise the profile of Senior Care Options
— also known as SCO, the publicly funded
program that helps low-income seniors maintain
health and independence at home, which some
call the “best kept secret in health care” —
Commonwealth Care Alliance joined forces
with the three other senior care organizations in
Massachusetts to create and launch a “Get To
Know SCO” campaign.
• 24% membership growth
An integral part of Commonwealth Care
Alliance’s Senior Care Options program is its
advocacy work on behalf of our membership.
In 2010, we facilitated local consumer advisory
meetings, held in English, Spanish, Cape Verde
Creole, Russian, and Vietnamese, for over 180
participants, many of whom have mobility
impairments and are extremely frail.
The campaign was launched at the
Massachusetts State House and included a
keynote address by State Senator Richard T.
Moore, chairman of the Health Care Financing
Committee and author of the legislation that
created SCOs.
• We initiated the Life Choices program
centered on members’ wishes for palliative
and end-of-life care
• 33% decline in futile ICU days in the last 6
months of life
• Hospital admissions were 55% of that
predicted by Medicare risk scores
• 18% decrease in unplanned hospital
readmissions compared to 2008
“We’re always talking about Accountable Care
Organizations or Medical Homes as the future
of health care, and what people don’t know is
that SCOs have been doing this for years, and
it works,” said Senator Moore. “SCOs represent
the model for how we should be providing care
in the community.”
FIDESNP (Fully Integrated Dual Eligible Special Needs Plan)
4 | COMMONWEALTH CARE ALLIANCE ANNUAL REPORT 2010
A subcategory of all Special Needs Plans, receiving combined financing
from Medicaid and Medicare to care for those individuals who are both
Medicare and Medicaid beneficiaries and accordingly, are responsible
for paying for and delivering a comprehensive set of both Medicare and
Medicaid benefits to enrollees.
Additionally, Commonwealth Care Alliance
promotes the peer-led Stanford Chronic Disease
Self Management Program (CDSMP) for our
members, and our staff is certified at master
trainer level in both English and Spanish. In
2010, members participated in these workshops
to learn how to better manage their chronic
conditions, and Commonwealth Care Alliance
held multiple leader trainings as well to ensure
that community lay leaders are available to
continue offering these evidence-based programs
to our membership.
Respected national opinion leaders described
Commonwealth Care Alliance’s consumer
engagement work as “pioneering” and an
example for others to follow. This is recognition
that makes all of us proud.
COMMONWEALTH CARE ALLIANCE ANNUAL REPORT 2010 | 5
Julia Chapman
If there is one thing Julia loves most, it’s socializing with
others. She’s formed close relationships with her primary
Clinical Program Development
care team and she gets together every Wednesday with a
group of other Commonwealth Care Alliance members.
Julia raised four sons on her own. Now, for the first
time in her life, she doesn’t have to worry. She knows that
if she has a problem, she can call her nurse or our Member
Services department and they will take care of everything.
IN THE FEDERAL SPOTLIGHT
In February, Boston’s Community Medical Group was
nationally recognized as a finalist for the 18th annual Monroe
E. Trout Premier Cares Award for its unique model of primary
care excellence for individuals with involved disabilities. At the
end of the year, we found the national model status of this care
program reaffirmed through a very positive response to our
proposal to the Center for Medicare and Medicaid Innovation.
Centers for Medicare and Medicaid Services (CMS)
used their discretionary authority to award Commonwealth
Care Alliance a continuation of our frailty adjuster payment,
despite phasing it out for virtually all other plans under
the Medicare Advantage umbrella. This represented a very
important shift in the mind set of CMS policy makers towards
the realization that different sets of rules are needed to support
the work of fully integrated and innovative organizations like
Commonwealth Care Alliance who specialize in serving frail
individuals with complex care needs.
ETHICS COMMITTEE
LIFE CHOICES PROGRAM
INFRASTRUCTURE DEVELOPMENT
Commonwealth Care Alliance launched its
Ethics Committee earlier this year, chartered
by our Board of Directors and the Patient Care
Assessment Committee to support the full
implementation of the organization’s core values
across all clinical programs. Its members consist
of front-line clinicians, experienced bioethics
professionals, Commonwealth Care Alliance
Board members, and organization leaders.
Among the most difficult aspects of caring for
patients is discussing end-of-life issues. Providers
and patients form a bond and relationship over
years of care and facing the reality of mortality
can be overwhelming. Ground breaking work
published in the Dartmouth Health Atlas shows
that end-of-life care in the United States is
driven by the medical culture and institutions
that provide their communities medical care,
not patient’s wishes. In most cases this leads to
expensive, intervention-driven care ordered by
providers who have only known patients for a
short time.
Commonwealth Care Alliance is in the
privileged and challenging role of a federally
recognized delivery innovator. Our ability to
measure and improve clinical and administrative
performance, as well as to support our clinicians
to be as efficient and effective as possible in their
work with members, assumes a priority that
demands significant investment in information
technology and other infrastructure resources.
In 2010, we expanded our executive leadership
team to include a Chief Information Officer and
Chief Quality Officer; enhanced our finance
department to successfully address our growing
budget, planning, and finance management
needs; and launched a corporate restructuring of
our two clinical entities, Boston’s Community
Medical Group and Commonwealth Clinical
Alliance, in order to streamline and enhance
coordination of care to our members around the
state.
Our clinical and resource allocation decisions
encompass values of reducing suffering,
improving function, enhancing safety,
promoting wellness, supporting autonomy,
protecting life, promoting equity, and being
responsible stewards of public resources. But
what happens when one or more of these
values are in conflict? For our primary care
teams, reconciling competing values is certainly
challenging.
The purpose of our Ethics Committee is
not to sit as “judge and jury”, nor enforce
Commonwealth Care Alliance policies. Rather,
the Committee uses a consultative case approach
to educate participants about ethical dimensions
that are inherent in our decisions, as well as the
policies and procedures that are central to our
company’s operations.
Commonwealth Care Alliance’s Life Choices
program is focused on providing patientcentered care at all stages of the life cycle. We
view palliative care as part of the normative
process of medical care and strive to provide
our members with education, discussion, and
medical care that honors member-centered
care goals while providing the highest level of
symptom control and maximizing quality of life.
CMI (Center for Medicare and Medicaid Innovation)
A branch of CMS that tests innovative payment and delivery
system models that show important promise for maintaining
or improving the quality of care in Medicare, Medicaid, and
the Children’s Health Insurance Program, while slowing the
rate of growth in program costs.
Financial Highlights
Ester Keselman
When Ester first joined Commonwealth Care Alliance,
she had several dental issues. Her care manager helped her
set up appointments, travel to the dentist, and now she has
FOR THE YEARS ENDING DECEMBER 31, 2010 & SEPTEMBER 30, 2009
comfortable new dentures.
Ester also lives with osteoporosis. Recently, Ester found a
Changes in Unrestricted Net Assets
yoga exercise program on television, which she really enjoys.
She tries to exercise 30 minutes every day because it helps her
feel better.
Ester says Commonwealth Care Alliance has helped her, not
only with her medical needs but also with other things such as
2010
2009
Capitation revenue
Interest
Other income
$136,932,064
$22,411
$2,345,372
$100,900,560
$65,965
$1,191,584
Total Unrestricted Operating Revenue
$139,299,847
$102,158,109
Clinical expenses
Salaries, wages, payroll taxes and fringe benefits
Other administrative costs
Claims adjudication
Information services
Depreciation and amortization
Interest
$107,845,538
$13,333,390
$7,518,475
$2,356,149
$605,054
$1,313,304
$181,985
$87,338,845
$5,662,087
$2,781,995
$1,787,424
$756,413
$497,316
$182,012
Total Operating Expenses
$133,153,895
$99,006,092
$6,145,952
$3,152,017
Financial highlights
include Commonwealth
Care Alliance, Inc.,
Commonwealth Clinical
Alliance, Inc. and Boston’s
Community Medical
Group, Inc. in a combined
statement of activities.
Operating Expenses
transportation. She feels like there is always someone there for
her, no matter what she needs or when she needs it.
Increase in Unrestricted Net Assets
PCMH (Patient Centered Medical Home)
Enhancements of primary care practices with
multidisciplinary teams, data and management
infrastructure, and clinicians to manage transitions
of care. A validation of the Commonwealth Care
Alliance approach.
COMMONWEALTH CARE ALLIANCE ANNUAL REPORT 2010 | 9
Staff
LEFT: Central administration
staff at 30 Winter Street.
LEFT: Commonwealth
Care Alliance Clinical
Group staff in Eastern
Massachusetts.
BOARD OF DIRECTORS
Dean Richlin Foley Hoag Attorneys at Law
Susan Gilbert Epstein New England SERVE
Scott Miyake Geron BU School of Social Work
Sergio R. Goncalves University of MA
Frances Hubbard Community Volunteer
Lisa Iezzoni, MD Harvard Medical School
Thomas Lynch Lynch, Ryan & Associates
Mary Lou Maloney Disability Consortium
Robert Restuccia Community Catalyst
Mark Reynolds Neighborhood Health Plan of RI
Jeffrey Scavron, MD Brightwood Health Center
Phil Thompson MA Institute of Technology
CLINICAL GROUP WEST
Nancy Turnbull Harvard School of Public Health
30 WINTER STREET PARTNERSHIP
Commonwealth Care Alliance works as part of a unique
collaboration of organizations located at 30 Winter
Street. We acknowledge our partners Health Care For
All, Community Catalyst, Health Law Advocates, and
the Public Policy Institute.
LEFT: Commonwealth
Care Alliance Clinical
Group staff in Western
Massachusetts.
10 | COMMONWEALTH CARE ALLIANCE ANNUAL REPORT 2010
LEFT: Boston’s Community Medical
Group, a nonprofit clinical affiliate of
Commonwealth Care Alliance, providing
high quality, comprehensive primary care
to individuals with disabilities.
DESIGN BY NERISSA J. FRY. CONTRIBUTING PHOTOGRAPHERS LEWIS GLASS, IAN POULIOT, AND BERNARD GRANT. © 2011 COMMONWEALTH CARE ALLIANCE, INC.
www.commonwealthcare.org
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(617) 426-0600
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