A New Care Paradigm Slashes Hospital Use And Nursing Home Stays For The Elderly And The Physically And Mentally Disabled

SYSTEM Commonwealth Care Alliance, a not-for-profit health care system based in Boston, Massachusetts, offering a full spectrum of medical and social services for older people and the physically and mentally disabled. KEY INNOVATION Providing individualized primary care, coordination, behavioral health, and social support services in the home and community through multidisciplinary teams, thus reducing the need for hospitalization and nursing home placement for the elderly and disabled. COST SAVINGS Sharply reduced use of nursing homes by eligible older people led to an average growth in total medical spending of just 2.1 percent from 2004 to 2009, sharply below fee-for-service rates. For disabled patients, monthly medical costs were $3,601 in 2008, compared to $5,210 for Medicaid fee-for-service patients. QUALITY IMPROVEMENT RESULTS In 2009 Commonwealth Care Alliance scored in the ninetieth percentile or above on Healthcare Effectiveness Data and Information Set measures for comprehensive diabetes care, monitoring patients on long-term medication, and access to preventive services. CHALLENGES The alliance seeks integrated global payments with appropriate risk adjustment from multiple payers; needs to build adequate financial reserves to satisfy insurance regulators; has to shore up struggling primary care physician practices to serve as a foundation for its programs; and struggles to recruit a multilingual, multidisciplinary workforce to serve a multilingual population.