Delivery of Care

On the health care highway, we need more than a billboard

Commonwealth Care Alliance, after a delay, provides answers to questions from ConvergenceRI?

Image courtesy of Commonwealth Care Alliance website

Corey McCarty, far right, poses for a photograph with a large check marking a $25,000 donation by Commonwealth Care Alliance to Food on the Move.

By Richard Asinof
Posted 6/27/22
After a delay, Commonwealth Care Alliance answers questions about their expansion into the Rhode Island health care market.
What is the current financial risk for nursing homes operating in Rhode Island? Why is Rhode Island seen as an attractive expansion destination for health care companies? What are the strategies the state can deploy to control the rising costs of prescription drugs for Medicare, Medicaid, and commercial insurers? How will voters translate their concerns about health care issues into electoral preferences in September and November?
All too often, patients are treated as if they are on a conveyor belt on the highway of health care, where the entrance and exit ramps are difficult to navigate, and the tolls become more and more expensive. The expansion of Commonwealth Care Alliance into the Rhode Island market, focused on the Medicare Advantage market and the dually eligible market, reveals that Rhode Island’s demographics, with its high ratio of “old old” residents – people 80 years and older – is seen as a lucrative market.
With a falling birthrate, a high poverty rate, more than one-third of the state on Medicaid, a health care workforce crisis, caused in larger part by a failure to increase Medicaid rates for providers, a high unmet demand for behavioral and mental health services and a lack of providers, what makes Rhode Island so attractive to health care companies?

PROVIDENCE – On Wednesday, May 25, Lifespan and Commonwealth Care Alliance sent out a news release announcing a new agreement to expand coverage options for Lifespan patients. The news release itself was a joint release, coming from both Lifespan’s Kathleen Hart and Chris Raia from Duffy & Shanley, on behalf of Commonwealth Care Alliance.

Under the new partnership, CCA “will provide CCA Rhode Island members with access to Lifespan’s comprehensive system of hospitals, behavioral health services and primary care networks,,” the news release said.

The news release continued, saying that CCA “currently offers two Medicare Advantage plans and one Dual Eligible Special Needs plan in Rhode Island,” which would now become available to Lifespan patients. “The plans are designed to support a holistic approach to care that addresses both chronic conditions and multiple social or medical health needs.”

Based in Boston, CCA defines itself as "a multi-state integrated care system influencing innovative models of complex care nationwide."

The new partnership between Lifespan and Commonwealth Care Alliance seemed to mark a significant change in direction for Rhode Island’s largest health system, in the wake of the failed merger with Care New England and the departure of former president and CEO Dr. Timothy Babineau.

In another sign of a thaw, if that is the right word, in Lifespan’s willingness to engage beyond its protected turf, Lifespan recently announced that the health system was now joining with the Hospital Association of Rhode Island.

[Editor’s Note: Just the fact that ConvergenceRI had received the news release about the new alliance between Commonwealth Care Alliance and Lifespan was somewhat remarkable, given that ConvergenceRI had been frozen out of receiving news releases from Lifespan for years.]

ConvergenceRI exchanged emails with Duffy & Shanley’s Chris Raia, who said he would be happy to connect Corey McCarty, CCA’s general manager in Rhode Island,, with ConvergenceRI. On May 27, ConvergenceRI then sent a series of questions to Raia for McCarty to answer, with a tentative deadline of Wednesday, June 8, for the responses.

Raia emailed back: “Richard – Thank you for sending these. We will aim to provide responses, as well as a headshot, next week.”

[Editor’s Note: McCarty was hired in May of 2021 as general manager for CCA in Rhode Island. He was recently named board chair of Meals on Wheels of Rhode Island.]

Raia said in an email that he was unable to meet the June 8 deadline, and instead, asked for delay to June 14. When June 14 came and went, and ConvergenceRI inquired about the status of the responses, Raia apologized again, and in a phone call, promised that the responses would be forthcoming by June 21.

Numerous attempts by ConvegenceRI to reach Raia by both phone and by email did not result in a response.

Editor’s Note: In the original version of this article, published on Monday, June 27, ConvergenceRI included the questions without answers, with the promise that if and when the answers were received, they would be published.

On Tuesday morning, June 28, ConvergenceRI received responses from Duffy & Shanley’s Chris Raia for Commonwealth’s Care Alliance’s Corey McCarty.  And, as promised, ConvergenceRI is publishing them. This kind of comprehensive dialogue is exactly what ConvergenceRI had envisioned in pursuing the story.

ConvergenceRI: How does Commonwealth Care Alliance view the Rhode Island health care market in terms of opportunities for expansion?

McCARTY: Commonwealth Care Alliance [CCA] is a national, multi-state healthcare organization with proven expertise in complex care coordination and delivery. CCA has earned national recognition for our innovative model of care that improves quality and health outcomes while reducing the overall cost of care, and for our demonstrated success in improving care for individuals with significant health needs, including those with disabilities or chronic conditions.

CCA has been active in Rhode Island since late 2020, building a network of clinical team members and administrative support personnel, while also meeting with leaders in Rhode Island’s public health sector. We officially entered the Rhode Island market this past January with a range of Medicare plans designed to support a holistic approach to care that addresses both chronic conditions and multiple social or medical health needs.

We made the decision to expand to the Rhode Island market because there is a clear demand for choice in Rhode Island when it comes to healthcare for individuals with significant needs, and we believe our model is well-suited to fill that demand and make a positive impact in the lives of Rhode Islanders.

ConvergenceeRI: Were you a bidder to secure a contract for the Managed Care Organization market in Rhode Island? Now that the initial re-procurement has been halted, are you planning to reapply?

McCARTY: Yes, Commonwealth Care Alliance was a bidder for this vitally important contract, and we plan to resubmit our proposal once the procurement process is back under way. By enhancing the patient and provider experience, while providing cost savings for the state, we believe our care model and our proven experience in managing and delivering care for individuals with significant needs present a solution for Rhode Island’s Medicaid program that hasn’t yet been brought forward.

ConvergenceRI: What are your strengths when it comes to managing health care populations receiving coverage under Medicaid?

McCARTY: CCA’s model of care is at the core of our mission, and it is a model that is consistently recognized as one of the best in the country at finding and engaging traditionally hard-to-reach individuals. As of the end of 2021, CCA served nearly 61,000 individuals across four states [Massachusetts, Rhode Island, Michigan and California], representing a 145 percent increase in membership over the last five years.

CCA’s uncommon care model has been proven to improve health and quality outcomes while decreasing overall costs of care.  Key components include:

  •          Community focus to ensure the most appropriate site of care. Our plans aim to address unmet social determinants of health, behavioral health and medical needs; integrate environmental and community supports; coordinate long-term services and supports; and provide acute care via a community paramedicine program or our crisis stabilization units.
  •          Seamless integration of care coordination, care delivery and care partnership, Our plans aim to eliminate gaps in care by coordinating social determinants of health needs such as transportation, Rx management and more; and delivering comprehensive medical and behavioral health care. Our SCO and One Care plans integrate services across Medicare and Medicaid, so our members who are dually eligible for both programs have a unified, whole-person care experience.
  •          Innovation to address members’ unmet needs, We utilize advanced predictive analytics for data-informed decision making and augment direct care with virtual care, telehealth, video conferencing and remote patient monitoring.

We believe that in bringing that proven model to Rhode Island, we are in a position to help individuals who most need help. As we continue to grow our presence in the state and build on partnerships with organizations like Lifespan, the Rhode Island Public Health Institute and others, we are confident CCA’s track record of success will resonate here in the Ocean State.

ConvergenceRI:What would you like to see implemented as ways to protect current Medicaid members when the federal emergency COVID ends, possibly as early as July 15.

McCARTY: As of this writing, information from the federal government and the Centers for Medicare & Medicaid indicate that the federal emergency will likely be in place until at least mid-October, but now is absolutely the time to prepare.

During this so-called “unwinding” period, it is going to be crucial for the state and the healthcare community at large to double down on its efforts to reach potentially impacted individuals, and clearly communicate their options and what specific actions they need to take to ensure their coverage remains intact, whether through renewing their Medicaid coverage or transitioning to another form of coverage.

This will require a combination of consistent communications efforts as well on-the-ground, community-level interactions with populations who are traditionally harder to reach. It will also be important to make the renewal process as streamlined as possible.

Success during this period will be made possible through cooperation between the state government and Rhode Island’s expansive network of insurers, providers and other public health organizations dedicated to improving the health of the state’s residents. Our entire healthcare community came together to navigate problems during the COVID-19 pandemic, and we’ll need to come together once again as we work toward the “post-COVID” reality.

While this situation will likely present a challenge for the healthcare industry across the country, I believe Rhode Island is fortunate to have a tight-knit, diverse public health sector, as well as strong, health-focused leadership in the state government, that puts us in a good position to successfully navigate it.

ConvergenceRI: Are you in favor of increasing Medicaid rates of reimbursement for providers in RI?

McCARTY: Yes, we are in favor of increasing Medicaid rates of reimbursement for providers in Rhode Island. We believe that providers need to be adequately paid for the quality of care that they are providing to their patients.

ConvergenceRI: In managing dually eligible clients, what does Commonwealth Care Alliance believe are the most important strategies for care for nursing home residents who already have a determination of care?

McCARTY: Across the board, our goal is to help all the individuals we serve improve their health, live independently, and avoid unnecessary trips to the hospital or emergency department. When it comes to members who require Nursing Facility [NF] levels of care, it’s especially important to ensure they are receiving the care they need, when and where they need it.

It is critical for residents of nursing homes to have a team of care managers that are connected to and working collaboratively with nursing facility’s team to prevent situations that could result in a visit to the hospital.

At a systems level, CCA’s close connections with community-based organizations, combined with our on-the-ground community health teams, make us aware of existing supports available in the community – and put us in a position to help these traditionally higher-risk individuals avoid unnecessary hospital visits.

ConvergenceRI: What kinds of investments would Commonwealth Care Alliance like to see made in community-based mental health and behavioral health services?

McCARTY: There are significant inequities in our current healthcare system, especially when it comes to behavioral health, substance use disorder, food and housing insecurity and other social determinants of health. While the impact of the COVID-19 crisis shined a spotlight on these inequities, they have been realities in healthcare since well before the onset of the pandemic.

The conversation around mental health and behavioral health services starts with access. Every single Rhode Islander, regardless of their background, income, or level of insurance, deserves access to affordable, high-quality and convenient mental and behavioral care. Unfortunately, though, either because they can’t find it or they can’t afford it, far too many individuals aren’t receiving the mental health services and supports they need.

At CCA, we support behavioral and mental health needs through our model of care. A community-based behavioral health clinician is a part of a CCA’s members interdisciplinary care management team and often serves the role of providing bridge therapy while they help members coordinate ongoing behavioral health resources within the community. Our behavioral health clinicians also support members after they are discharged from an inpatient stay related to behavioral health or substance use disorders, and our 24/7 Clinical Response Unit includes a behavioral health resource that is used to triage our members’ clinical needs.\

We are also proud of the various innovative solutions we’ve launched related to behavioral and mental health. Through Winter Street Ventures, CCA’s wholly owned venture capital accelerator, we’ve been able to identify, accelerate, and bring to scale innovations that advance CCA’s core mission. For example, we created CCA crisis stabilization units [CSUs], which offer members with behavioral health disorders a therapeutic alternative to inpatient psychiatric admissions that keep them in the community. We also brought instED®, one of the nation’s first comprehensive mobile integrated health solution that responds to patients’ urgent care needs by providing high-intensity care in the comfort of the patient’s home, to Rhode Island earlier this year.

As we continue to work toward post-COVID normalcy, we as an industry and we as a country will have to step up and recognize the need to address these social determinants more holistically and do it system-wide. A big piece of that is committing to the hard work of understanding exactly where the inequities are, and developing and executing solutions that address them. That’s what we are working on every day, and it’s what we’ll continue to work on in the years to come

The need for answers
The summer promises to be a busy time for health care in Rhode Island, when the needs for transparency in a disrupted health care market become even more important.

• OHIC published the requested commercial health insurance rates submitted by commercial health insurance plans in the individual, small, and large group markets, with a virtual public town hall to be held on Thursday, July 7, to hear public comments.

The proposed rates, not surprisingly, call for increases of ranging from 6.8 percent to 9.6 percent in the individual market, from 9.2 percent to 12.3 percent in the small group market, and 7.0 percent to 13.4 percent in the large group market. Translated, the cost of health insurance will be rising significantly next year.

Both OHIC and the R.I. Attorney General’s office promised a thorough review of the rate increases.

• The corporate dance for a future financial partner for Care New England appears to be underway, with the potential that Mass General Brigham may once again be seeking to acquire the second-largest health system in Rhode Island, according to news reports.

• If the federal government decides to end its COVID emergency declaration in mid-July, it will precipitate a massive eligibility purge of current Medicaid members, which in Rhode Island could translate into as many as 50,000 Rhode Islanders losing their Medicaid coverage. There were 347,977 Rhode Islanders enrolled in Medicaid as of March 31, according to Kristin Sousa, R.I. Medicaid Director.

• The first COVID vaccination shots for children between 6 months and 5 years of age will be distributed to community providers by the R.I. Department of Health, on Monday, June 27, according to sources. The demand for vaccinations will be an important metric to see how parents of young children are responding to the efforts by state health officials to ramp down the state’s response from the pandemic to the endemic stage.

• The failure by the R.I. General Assembly to include in its FY 2023 budget funding for Medicaid coverage of abortions, in the wake of the U.S. Supreme Court decision to overturn Row vs. Wade on Friday, June 24, will continue to reverberate in Rhode Island, changing the dynamic of political conversations approaching the September primary and the November election.


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