Cambridge Health Alliance


Profiles In Health Innovation: Better Care, Lower Cost

The March issue of the journal Health Affairs is devoted to various experiments in health care that are actually working: producing better medical outcomes at a lower cost.

The introduction to this edition quotes Don Berwick, who at the moment is fighting, probably fruitlessly, for his job as administrator of the Centers for Medicare and Medicaid Services. “There’s never been a better time to be an innovator in health care,” Berwick tells Health Affairs. (Unless, of course, you’re a recess appointment facing seething Republicans. Then it’s best not to be innovative.)

Anyway, the innovations profiled here span the country, from “medical homes” in Vermont to new kinds of end-of-life conversations in California. Two are local and have been featured previously by CommonHealth:

The first is Bob Master’s Commonwealth Care Alliance, which we profiled last year. Here’s what Health Affairs has to say:

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.

The other local example is the asthma program at Cambridge Health Alliance:

Key Innovation: Partnering with the public health system and drawing on other community resources to improve patients’ health and reduce their need for acute care. The alliance’s Childhood Asthma Program has dramatically reduced hospitalizations and emergency department visits through optimal medication management for children. Teams of registered nurses and community health workers make home visits to help parents reduce or eliminate asthma triggers. The alliance is taking similar approaches to reducing obesity, managing diabetes, and improving complex care among the patients it serves.

Cost Savings: The alliance says that the asthma program has shown a return on investment of about $4 for every $1 invested.

Quality Improvement: Results For children in the asthma program, annual pediatric asthma-related admissions to alliance hospitals dropped 45 percent and annual pediatric asthma-related emergency department visits fell by 50 percent in the period 2002–09. In another program, Healthy Living Cambridge Kids, the prevalence of healthy weight increased by 2.4 percentage points (), a 5 percent change, and the prevalence of obesity decreased 2.2 percentage points (), a decline of 11 percent, among the cohort followed for three years.

Breaking News: Cambridge Health Alliance, Network Health In Partnership Talks With Tufts

Jim Roosevelt of Tufts Health Plan

Cambridge Health Alliance and its managed care partner, Network Health, are talking to Tufts Health Plan about a “potential partnership,” in which Tufts would have a majority stake in the small insurance plan which covers 170,000 low and moderate-income residents who get free or subsidized insurance through the state.

WBUR’s Martha Bebinger reports:

Network Health is owned by Cambridge Health Alliance (CHA) and has recently been one of the few profitable parts of that network.

The deal would give CHA some much needed cash for Cambridge Hospital and help its health plan expand. The deal would let Tufts expand into the Medicaid market. Tufts CEO James Roosevelt, Jr. says the talks with Network Health are “completely separate from any conversations with (its proposed merger partner) Harvard Pilgrim Health Care.

Here’s the letter from Dennis Keefe, CEO, Cambridge Health Alliance, to employees:

TO: CHA Employees
FROM: Dennis Keefe
Date: February 23, 2011
RE: Important Announcement

Months ago, when I confirmed that we were exploring the possibilities of forming partnerships with other institutions I promised that I would try to inform you of developments when I could and asked that you ignore any rumors until you hear something directly from me.

Well, now I have something exciting to report and I think you’ll find it good news.

In addition to discussions about delivery system partners, we have been exploring strategic and financial partnerships for Network Health. We are currently at a stage in discussions with one potential partner, Tufts Health Plan that may result in us reaching a definitive agreement by which Tufts would make a significant ownership investment in Network Health, our managed care plan. While details are still being worked out, Tufts would likely become a majority owner of Network Health while CHA would retain an ongoing ownership interest.

If consummated, this partnership meets the criteria we set months ago to help guide our search for a partner and has many short-term and long-term benefits to both CHA and Network Health. While we have had multiple conversations with potential partners, the Tufts proposal rose to the top and contained the most beneficial elements including alignment of our respective missions, a local history, and commitment to the citizens and state agencies of Massachusetts. Continue reading

Help On The Way For Safety Net Hospitals, BMC and CHA

The federal government rides in with a $435 million aid package for Massachusetts hospitals that treat predominantly poor patients, with the largest chunk going to Boston Medical Center, The Boston Globe reports.

The plan, negotiated with Governor Deval Patrick’s administration over the past seven months, includes $180 million for BMC and gives Cambridge Health Alliance, which runs the state’s only public hospital, an extra $163 million in federal Medicaid funding over two years.

The money, except for the Cambridge Health Alliance portion, must clear a remaining hurdle before it is transferred into the hospitals’ coffers. The federal government will provide $335 million, but Massachusetts must come up with about $100 million. The state Legislature must authorize the use of the state funds, language that has been held up as part of Republican objections to a larger spending bill.

Safety Net Hospitals Holding Their Breath

Boston Medical Center

The state’s two main “safety net” hospitals for the poor and uninsured — Boston Medical Center and Cambridge Health Alliance — are facing a dire financial crisis. WBUR’s Martha Bebinger reports:

Boston Medical Center (BMC) and Cambridge Health Alliance (CHA) are working their State House and Capitol Hill contacts furiously as the end of the month approaches. The state’s two largest safety net hospitals must close their books and both need substantial federal assistance to end the fiscal year in a stable place. BMC chief Kate Walsh, who was in D.C. to press her case last week, says she’s hopeful the money will come through within days.

Cambridge Health Alliance will break even if the feds approve a Medicaid waiver amendment worth $86 million this year. The Cambridge Hospital network is staying afloat, in part, with revenue from patients enrolled in its health plan, Network Health.

The Medicaid request includes $90 million for Boston Medical Center. If this money doesn’t come through, BMC would be in violation of an agreement with bond holders who could then require additional cuts at the hospital.
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