COMMONWEALTH CARE ALLIANCE
In 2014, V-Cap made its first loan to Commonwealth Care Alliance (CCA). CCA is a special organization, committed to transformation of care delivery for the most poorly served and expensive Medicaid and Dual beneficiaries with complex needs. CCA adopts new models of interdisciplinary primary care, and innovative palliative and hospitalist care programs.
What’s special about CCA?
High needs Medicare/Medicaid dually eligible individuals, including frail seniors, people with disabilities, and people with medically complex conditions. CCA welcomes those who have been the most poorly served – and most expensive to serve – in a fragmented healthcare system. Hence CCA’s motto: “Healthy is harder for some. That’s why we’re here.”
PERSON-CENTERED: Personal care plans are developed based on the individuals’ needs and wants to optimize their health and maintain their independence.
CONSUMER-DIRECTED: CCA ensures its programs accurately address the needs of its members by engaging consumers for their personal experiences and perspective.
EVIDENCE-BASED: CCA brings depth of clinical experience with complex populations and sophisticated decision support systems to its care planning process.
TRANSFORMATIONAL: CCA shares knowledge and provides financial support to help its core primary care practices to implement person-centered coordinated care.
INTEGRATED: CCA receives a risk-adjusted capitated payment from Medicare and from Medicaid and takes responsibility for the full continuum of care for its members.
CCA is at the forefront of efforts to better integrate the people who most directly touch the lives of its members into a supportive team, with support for training, compensation, and enhanced roles.
CCA has a positive track record of helping its members stay healthier, independent, and satisfied with their care, while successfully restraining risk adjusted cost.
How does CCA do this? CCA pays up front for enhanced primary care and supportive services, and saves money by helping people stay out of the hospital, and prevent avoidable complications.
CCA was part of the first demonstration efforts over 10 years ago to test the effectiveness of integrated care for Medicare/Medicaid dually eligible individuals.
As new integrated care initiatives for “duals,” funded through the Affordable Care Act, are launched around the country, CCA has become a national leader. Massachusetts’ OneCare program for dually eligible adults under 65 is the first of the new initiatives to launch. CCA accounts for a substantial majority of new enrollees in OneCare.
V-CAP’S LOAN TO CCA
V-Cap’s $10 million loan, made in partnership with the Robert Wood Johnson Foundation, supported CCA’s work to scale its compelling model of care. V-Cap’s loan was used by CCA to meet regulatory requirements for financial reserves. These requirements vary from state to state, but can be a substantial barrier to growth and innovation on the part of non-profit plans.
A Better Path to Health with CCA: Sally and Edna’s Story:
Produced by our friends at Community Catalyst
- Borrower: Commonwealth Care Alliance
- Year of Investment: 2014
- Use of Proceeds: Regulatory reserve requirements
- Financing Partner: Robert Wood Johnson Foundation
- Social Impact Goals:
- Scale person centered, integrated care model for high-needs populations
- Demonstrate “triple aim” outcomes in health status, care metrics, and cost effectiveness
- Training, development, and job creation for frontline healthcare workforce
- Innovation in workforce engagement in coordinated care plans
What’s amazing about CCA is that meaningful consumer engagement is at the heart of everything they do. They work with each member to build a care plan based on that person’s own goals, preferences and needs. They run health education and self-management programs and facilitate consumer advisory councils to solicit their members’ views on what works and what doesn’t. This is what has made CCA a successful model for improving the lives of people with complex needs.