Provider Manual

Introduction

This section introduces Commonwealth Care Alliance and describes its Mission, Vision, and Approach to giving the highest quality health care.

What Is Commonwealth Care Alliance?

Commonwealth Care Alliance, Inc. is a not-for-profit care delivery system committed to the provision of integrated health care and related social support services. Created in 2003, Commonwealth Care Alliance is a "consumer-governed" organization offering a full spectrum of medical and social services for people with complex needs covered under Medicaid and for those "dually eligible" covered by both Medicaid and Medicare, including:

Older adults (aged 65+)
Individuals with serious physical, cognitive, or chronic mental illness

Commonwealth Care Alliance is organized as a "consumer-governed care system" to ensure that the empowered consumer voice is built into all of our activities. The fact that the founding partners of Commonwealth Care Alliance are Community Catalyst, Health Care For All, and Boston Center for Independent Living attests to this commitment, and thus fundamentally breaks new ground for the role of advocacy.

Commonwealth Care Alliance contracts with a select group of primary care physicians whose commitment to their patients, as well as communities that they serve, is beyond comparison.

Commonwealth Care Alliance believes it is important to recognize the value of community caregivers and to respect the relationship forged in trust between members and member caregivers.

Our Mission

Commonwealth Care Alliance's mission is to provide the best possible care, tailored individually to the needs of all elders as well as to people across the age spectrum with special health care needs throughout the state of Massachusetts, by bringing to scale proven clinical strategies that improve care and manage costs, within a team-based, consumer-directed, prepaid, care delivery program.

Our Vision

It is our vision to bring people with complex medical and behavioral health needs high quality and personalized care resulting in improved health and better self-management of chronic illness.

Our Approach

Although the characteristics of the varied populations to be served by Commonwealth Care Alliance are quite different, experience has demonstrated common care system principles that are key to improving care and managing costs. These principles, can be summarized as follows:

A "top to bottom" clear exclusive mission to serve vulnerable populations
Specialized administrative and clinical programmatic expertise
Selective primary care networks
New approaches to care management and care coordination that support primary care clinicians through a team approach involving nurse practitioners, nurses, behavioral health clinicians and/or non-professional peer counselors
24 hour/7 day a week personalized continuity in all care settings at all times
Selective networks of physician specialists, agencies, community based vendors, and institutional long term care services
Flexible benefit designs and management that render the term "covered service" irrelevant
Promotion of empowerment and self-management strategies
Full integration of medical, behavioral health and long-term care services
State of the art clinical information technology support for the entire care system

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Last Updated 1/1/12

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