Commonwealth Care Alliance Rhode Island LLC, known as CCA Health Rhode Island, recently announced it added WellOne Primary Medical and Dental Care to its network of community providers. This partnership will allow WellOne’s patients to access CCA Health Rhode Island’s full selection of coverage options and is part of CCA’s ongoing efforts to expand its provider network within Rhode Island.
Corey McCarty, senior vice president and general manager of CCA Health Rode Island, spoke about CCA’s provider network and patient care.
PBN: How does CCA Health Rhode Island seek to improve patients’ access to care through its provider network?
MCCARTY: CCA Health Rhode Island is a mission-driven health care services organization that offers high-quality health plans and care delivery programs specifically designed for individuals with the most significant needs.
The majority of our members are older adults and individuals who are eligible for Medicare or dually eligible for Medicaid. Managing and delivering care for this traditionally high-risk, high-need population requires a fully integrated, community-focused approach.
We need to ensure our care delivery network gives us the ability to meet members in the communities in which they live and work. This has been the driving force of our strategic effort to create a diverse network of provider partners who are best positioned to deliver the services our members need.
PBN: What are some challenges related to expanding CCA Health Rhode Island’s provider network and how have you been working to overcome those?
MCCARTY: We’re very pleased with the progress we’ve been able to make when it comes to expanding our provider network since we entered the Rhode Island market in 2021. In just two years, we have built a robust network that includes some of the state’s largest and most trusted provider groups, including Lifespan Physician Group, Care New England Health System, Brown Urology, University Orthopedics, Coastal Medical, Providence Community Health Centers, and many more.
Just recently, Burrillville-based WellOne Primary Medical and Dental Care joined our network. This was a particularly important addition to our network, as it provides enhanced coverage options for our members living in the northwest region of the state.
PBN: CCA Health Rhode Island recently launched a program with West Bay Community Action. How will patients benefit from this partnership?
MCCARTY: At the end of October, our team at CCA Health Rhode Island and the team at West Bay Community Action finalized our partnership to coordinate medical care and long-term services and supports.
LTSS services are essential programs that many individuals with chronic conditions need to live safely and independently in their own homes. These services may include housekeeping, grocery shopping, personal care and adult day programs.
This partnership is significant because it ensures a truly integrated approach to health care delivery. CCA Health Rhode Island’s care team and West Bay Community Action’s case managers will collaborate on care coordination activities to provide a seamless experience for shared members.
We’re proud to be the first health plan who supports individuals eligible for Medicare and Medicaid in Rhode Island to develop a formal partnership with an LTSS agency with the goal of sharing information so that we can develop a fully integrated care plan for each member that we share – and we look forward to building on this success in 2024 and beyond.
PBN: What is the importance of improving coordination for patients’ long-term services and supports?
MCCARTY: A lack of coordination and communication between health plans and LTSS agencies can lead to a poor member experience and may even impact a member’s long-term health and well-being. For example, when an individual with significant chronic conditions such as heart disease or diabetes is released from the hospital, they’re likely going to need a lot of LTSS support at home. As they’re recovering from their hospitalization, some patients may need help with grocery shopping, cooking, or laundry. Others may need help getting out of bed, showering, changing their clothes, going up and down stairs, and moving around their homes. For someone who needs this level of support, especially if they don’t have a caregiver, LTSS services are imperative to maintain their safety and to reduce the risk of another hospitalization.
In a perfect world, when someone is released from the hospital, their at-home services are ready to start on day one. Unfortunately, when health plans and LTSS agencies aren’t collaborating, these services aren’t always coordinated effectively because information isn’t always shared in a timely manner.
When health plans and LTSS agencies do communicate and develop an integrated care plan, these services are discussed and planned before an individual is even released from the hospital. The two organizations work together to evaluate and identify the patient’s needs and ensure that the right services are in place so that the individual can focus on what’s most important: recovering and getting back to their normal routines.
We have decades of experience in other states integrating traditional health care and LTSS services. Our collaborative approach to integrating the full spectrum of care, with the invaluable support of our community partners, has been proven to improve member satisfaction and clinical outcomes while also reducing waste and redundancies across the care continuum.
When we entered Rhode Island, it was our goal to bring our integrated approach to the state – and our work with West Bay Community Action is just one of many steps we are taking to create a care model that supports all aspects of an individual’s health and wellness.
PBN: What are some of the social factors you’ve noticed that have had the largest effects on patients’ health recently and how is CCA Health Rhode Island looking to address those?
MCCARTY: Social factors that impact care have been at the core of our nationally recognized care model, which puts the emphasis on addressing unmet social and behavioral health needs.
When we talk about these social factors, we’re talking about the myriad of nonmedical factors that play a role in an individual’s overall health. These include obvious, basic needs such as housing and food security, but the list of factors that could impact an individual’s health and well-being is exhaustive.
Do they have a car or access to alternative transportation to travel to and from appointments or a grocery store for food? Do they have high-speed internet in their homes to stay in touch with their providers and their loved ones? Do they have working air conditioners and heating systems to get through Rhode Island’s hot summer months and frigid winter ones?
These are the questions we are constantly asking as we’re developing individualized care plans for our members.
Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.
