How Do We Know Payment Reform Will Work? Because it already is: The CCA Story

CCA is Commonwealth Care Alliance, the consumer-focused health plan that serves low-income seniors and disabled people as part of the Senior Care Options program and other state programs for people with complex medical needs. (Full disclosure: HCFA is one of the founding partners of CCA, along with the Boston Center for Independent Living, and co-appoints its board members.) CCA provides integrated health care and related social support services, with the goal of empowering patients and promoting a team approach to primary care.

CCA is a living, breathing example of how payment reform can work. Global payments (adjusted based on the severity of the enrollee’s medical condition) are made by the insurers to CCA. CCA is able to use the funds to provide flexible, patient-centered care. The care managers have the checkbook, and the freedom to allocate funds to keep the patients healthy.

We’ve claimed that payment reform both tastes great and is less filling – that it can save money and provide better quality care. Patients are happier, too.

A WBUR CommonHealth blog post documents some of the real-world experience with the most medically-needy patients in the state:

[CCA CEO Dr. Bob Master] is able to re-invest cash into his uber-primary care network through savings achieved by reducing hospitalizations and nursing home placements.

Here are some numbers:

– In 2008, CCA invested $3.24 million in primary care enhancements above what Medicare would have paid.

– CCA’s hospital use is 55% what would be predicted based on the risk scores of its patient population (Overall savings are in the range of $500 per person, per month, Dr. Master says); nursing home placement is about 75% of what would be predicted.

–Among CCA’s homebound elderly, their annual medical expense rate increased 3.8 percent between 2004-2009 (compare that to the general population with a yearly medical expense rate that increased around 7-10 percent.)

–Among CCA’s ambulatory elderly, the annual medical expense rate rose 0.2 percent.

We’ve been bringing CCA staff to our public forums on payment reform, because they are a concrete demonstration of how this can work in practice. The CommonHealth blog promises to provide some more depth on how CCA does its work, and we look forward to their reports.
-Brian Rosman

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2 Responses to How Do We Know Payment Reform Will Work? Because it already is: The CCA Story

  1. Pingback: Obama New Health Care - Residents Rights In Nursing Homes / Educational Video - Health Care Plan

  2. Pingback: How Do We Know Payment Reform Will Work? Because it already is: The CCA Story | « JHPPL News and Notes

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