By Jennifer M. McGivney
A recent study by UMass Boston’s Pamela Nadash assesses how well the Commonwealth Care Alliance serves vulnerable populations in Massachusetts.
The Commonwealth Care Alliance (CCA) has a long-standing reputation for high-quality service to vulnerable populations in Massachusetts. Yet despite the number of studies evaluating similar managed care models, very little has been published about CCA, an integrated care plan serving about 48,000 dually eligible individuals in Massachusetts.
A recent study led by Pamela Nadash, PhD, an associate professor of gerontology at UMass Boston, addressed this gap.
Nadash and her UMass Boston colleagues collaborated with Marc Cohen, co-director of the LeadingAge LTSS Center @UMass Boston, to assess how effectively CCA fulfills its mission. LeadingAge and UMass Boston’s Gerontology Institute established the LTSS Center in 2017 to expand the capacity of both organizations to translate research into policy and practice.
About the Study
“CCA has always been incredibly supportive of giving people with disabilities what they need to stay at home instead of going to a nursing home,” says Nadash. “We want to keep people at home as much as possible. That was one reason we were so interested in studying this organization. It’s always been a model of good care, at least by reputation.”
The researchers set out to evaluate how well CCA’s strategies served people who were dually enrolled in Medicare and Medicaid. Many of these dual enrollees have a high level of medical and other needs, making them a high-cost population for a managed care organization to serve. Nadash and UMass Boston Gerontology PhD students interviewed key informants to understand how CCA serves its members and then asked members about their experiences with the plan.
Nadash’s findings are available on the LTSS Center website.
Key Takeaways
The key takeaways from Nadash’s research indicate that CCA’s commitment to innovation—especially in mobile integrated health and behavioral health—made it effective for vulnerable populations.
“There’s a unique culture there,” says Nadash. “Their approach to innovation was really great, and that stemmed from the need to serve members and to really think about what members need.”
This innovation led CCA to introduce InstED mobile integrated health, which enables people to receive care from paramedics for minor medical conditions at home rather than being transferred to the emergency department. It was a win for both CCA and patients. The service saves money and helps avoid some of the negative consequences of an emergency department visit, such as exposure to infectious diseases. Other care plans have adopted similar programs since CCA piloted InstED.
CCA’s innovation has also led to high-quality care for people with behavioral health conditions. While all CCA members have a care partner as their primary point of contact, those with significant behavioral health needs are often assigned a care partner who specializes in behavioral health. These specialists can connect CCA members to community-based services. Members reported that the support they received from these organizations, in addition to CCA’s therapy and crisis stabilization programs, helped them better manage their health and avoid psychiatric hospitalizations.
“We need to reset what’s considered high-quality care,” Nadash says. “A lot of studies just look at the health plan and the outcomes. There’s no understanding of the mechanisms that result in good outcomes. This study was meant to look at specific mechanisms that deliver those positive outcomes.”
One challenge the UMass team uncovered, however, was CCA staff turnover. As in the healthcare industry generally, a lack of continuity among CCA staff led to poor communication and occasional confusion. Some members reported being poorly informed about their benefits and experiencing delays in receiving responses to their complaints.
Nadash hopes that the lessons learned from this study will lead to improvements in care plans nationwide and that CCA’s attention to behavioral health disorders becomes standard practice. These contributions are central to Nadash’s research at the Gerontology Institute.
“We’re essentially interested in innovative ways to serve older adults,” she says. “That’s the bottom line. We’re trying to disseminate information about the best ways to serve that population.”
Learn more about the study by visiting Serving Vulnerable Populations: Commonwealth Care Alliance’s Senior Care Options and One Care Plans