Commonwealth Care Alliance homes in on senior set
Aug. 30, 2012
The Commonwealth Care Alliance, founded in 2003 by Drs. Bob Master and Lois Simon, is a not-for-profit care delivery service for seniors 65 and older. Its Senior Care Options program is available to ambulatory and stay-at-home seniors who have dual eligibility for Medicare and MassHealth Standard, or just MassHealth Standard.
The alliance has a working relationship with Dorchester House Health Center, Uphams Corner Health Center, and Codman Square Health Center, and has a membership of over 4,000.
Maureen McNally, the CCA’s lead nurse practitioner in Dorchester, said one of the benefits of the program is that it helps seniors manage their medications. Patients are often confused on matters such as: Should they continue to take medications provided by their primary care physicians or through the program? the nurse practitioners make sure that they take the right ones, McNally said.
Seventy percent of the patients enrolled in the program are either at home or eligible to enter a nursing home. MassHealth Standard requires a monthly income of $931 and $2,000 in assets for individuals, or $1,261 and $2,000 in assets for couples. Seniors who have a monthly income of $2,094 and a medical need can apply for MassHealth’s Community Based Waiver (Frail Elder Waiver) and still take part in the SCO program.
Patients enrolled in the SCO program do not have to pay a co-pay on their medications, unlike MassHealth, which often requires a small copayment for medications and other services.
The program also offers benefits that MassHealth and Medicare do not cover, such as dental and optical, and provides eyeglasses and hearing aids as well. All of these services are provided for free.
Ann Campbell, 81, has been living alone for 12 years and has been with the SCO program for three years. Besides having a primary care physician at Dorchester House who provides home visits, Campbell is cared for by McNally and another registered nurse, Edwin Medrano. She also has a social worker and a physical therapist.
“I was lucky to get him,” Campbell said about her physical therapist. “He was going on vacation and when he heard my name he postponed it because he knew he had to be here.”
Campbell also has a personal care assistant who helps around the house twice a day, five days a week, and does the food shopping.
The program also provides patients with transportation to doctors’ appointments. For patients who are able to walk, the program provides a taxi, while patients like Campbell, who uses a scooter, are picked up in a wheelchair van.
“If you meet her in the corridor, you better run,” McNally said. “You have to run to keep up with her, she’s very fast outside of the apartment.”
McNally and Medrano said they typically see 100 patients at various times in a month. They generally see four or five patients a day, depending on a patient’s needs. They see Campbell every week, but said she knows how to reach them if a non-urgent issue arises. She also has a medical alert bracelet for emergencies.
McNally said Medrano can contact her if he sees something during his visit and she can talk him through it over the phone, or she can come in for an additional visit if the issue is something he believes she should double-check for herself.
“I can’t remember how I managed before he came,” McNally said about Medrano, who joined the CCA in November 2011. “We’re a very good team,” Medrano said. “We work very well together, and we bond with each other very well.”
McNally, who has been with the CCA since 2004, has been with Campbell since she entered the program and calls Campbell her “buddy.” Campbell calls McNally the “love of [her] life” and says she has been wonderful to her.
According to Robert Katzman, the CCA’s outreach and marketing manager, most of the program’s referrals came from providers or people who know the program. “We don’t do much advertising,” Katzman said. “It’s really kind of grown through word of mouth.” Campbell said she found out about the program from a friend who lives in her building and is a member.
The doctors the CCA works with are contracted through the program to allow for continuity, which Dr. Master believed was essential. Katzman said they didn’t want patients to have to switch primary care physicians, and that the point of using doctors that are contracted with the program is to make things work better, and to enhance what the patients have.
Katzman said the type of relationship that McNally and Campbell have was one of the main goals the program’s founders had in mind. Drs. Master and Simon didn’t want “some person in a tie somewhere making decisions,” but wanted the clinicians who were dealing with patients face-to-face to be in charge of their care.
“There’s this familiarity, as you can see, everybody knows everybody, and so it’s kind of an easy relationship,” Katzman said. “I think it’s wonderful.”