Winter 2015: A great test for the Commonwealth Care Alliance model of care

March 5, 2015 § Leave a comment

With record snowfall, frigid temperatures, and countless transportation nightmares, this winter has posed serious problems for healthcare delivery in Massachusetts.

For Commonwealth Care Alliance (CCA), the miserable weather and poor travel conditions could have been particularly catastrophic. That’s because CCA cares for frail elders and people with disabilities, and regular home visits with these individuals are central to CCA’s model of care.

Still, CCA managed to provide steady support throughout the recent stretch of bad weather through strategic allocation of clinical resources to ensure that needs were met and  by calling on Personal Care Assistants (PCAs) and paramedics to fill gaps in coverage.

Close relationships make it work
The success of these strategies, according to CCA leaders, is based on the design of the company’s programs, which stresses close relationships between clinicians and members. Because CCA employees truly understand the medical and emotional needs of the members they serve, the organization was able to adjust schedules and prioritize care in ways that ensured everyone got the support they needed.

Shona Gibson, Clinical Director, Commonwealth Care Alliance Clinical Group, says that “with of our model of care, we know our patients well. The fact that we have relatively intimate relationships with the patients we have, this is all to the good in a situation like this.” Regarding transportation and scheduling, CCA’s Member Services staff reported no serious issues with members getting to necessary appointments, although some visits have been cancelled or rescheduled.  According to Wendy Skelton, Associate Clinical Director at CCA’s clinical affiliate, Commonwealth Community Care, “from what I’m hearing, no one has gone without needed care.”

For the most part, clinical personnel have been on the road, working hard to see members. Still, getting around the region has been difficult. Skelton explains that, in many cases, clinicians have had to park further away from members’ home than usual and have had to make arrangements for temporary parking.

Gibson relates the story of one nurse practitioner who has gone “the extra mile” and more to keep her appointments: “Because she’s had to park so far away from where her patients are, she’s been taking some lengthy walks. In fact, she wears a pedometer, and she told me walked 12 miles in two days going to see patients!”

Overall, Gibson reports that “our staff did an amazing job manning the phones and anticipating everything they can anticipate.” These “little, logistical” matters are very important, she says, and they “highlight the tight operations that we run on a daily basis.”

Calling in PCAs and paramedics
Because not all logistical issues can be solved, Skelton says that CCA has increased its use of Personal Care Assistants (PCAs) to visit with members. PCAs provide physical assistance with daily living activities, and they have been crucial in attending to members’ needs in recent weeks.

Sigrid Bergenstein, an RNP from Commonwealth Community Care, relates the story of a personal care assistant named Cassandra that shows just how valuable PCAs have been this winter:

Cassandra is the personal care assistant for my patient; Mr. T who is totally dependent on her for assistance in all activities of daily living, because of blindness and paralysis due to advanced Multiple Sclerosis. Mr. T lives alone, without any family members who can step in to help in an emergency. During the recent snow storms, Cassandra really has gone above and beyond to keep Mr.T safe and sound at home and prevent an almost certain hospitalization. Cassandra is a single mom with a toddler. Her husband is in Haiti, unable to join her because of immigration complexities. Because Mr. T’s needs were so great, during the blizzard, Cassandra worked 48 consecutive hours, sleeping on Mr. T’s couch for two nights, leaving her child with family or a babysitter for all of this time.

In addition to PCAs, Skelton reports that CCA has been using paramedics in the evening hours to keep member appointments and deal with immediate medical concerns. These specially trained paramedics are part of a mobile integrated health pilot program that CCA is conducting in partnership with the ambulance company EasCare.

Through the weeks of bad weather, CCA’s transportation, scheduling, and coverage strategies – supported by the organization’s unique model of care – ensured that every member got the attention they needed. According to Gibson, the trust, understanding, and regular communication between clinician and member that are at the heart of the CCA model “really make it possible for us to meaningfully triage patients’ needs, and that’s critically important in a situation where you just can’t get to everybody.”

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