MANAGED CARE got a bad reputation in the 1990s. At its best, though, this method of organizing healthcare saves money while enhancing the quality of patients' lives. In Massachusetts, the Commonwealth Care Alliance, which bills itself as a nonprofit care delivery system, is succeeding in its five-year-old experiment on whether treatment can be coordinated and improved for people with complicated medical histories.
"I wouldn't be here. I'd be stuck in a nursing home or a chronic care hospital," said Paul Kahn, 62, of Newton, as he praised the care that enables him to lead an active life at home despite being crippled by a neuromuscular disorder since childhood. For the last few years he has been dependent on a ventilator to breathe. Yet because of a coordinated care system akin to what the alliance offers, he has been living independently since 1979, has married, and has written 20 plays. He has rarely spent time in the hospital.
Kahn has been the beneficiary of coordinated care systems established by Dr. Bob Master. Years ago Master realized that the best way to treat chronically ill patients is to provide them with nursing and social-work services where they live, and only send them off for complicated medical procedures when strictly necessary.
Master cofounded Boston's Community Medical Group in 1988 to provide this kind of care, using a team of physicians, nurse practitioners, social workers and physical therapists. Kahn is a patient.
Payments to treat the chronically ill, many of them very poor, come from a variety of sources, not all of them geared to Master's early-intervention approach. The Commonwealth Care Alliance (no relation to the state's Commonwealth Care insurance plan) is intended to make payment as seamless as treatment. Master helped set up the alliance as part of an effort called Senior Care Options, which combines Medicaid and Medicare funds in a single payment stream.
The alliance is one of three health plans in the state involved in Senior Care Options, and it has the most integrated model of care. The alliance generated a $1.3 million surplus in 2005-2006 and would like to use the money to expand the program. This would be a worthwhile investment to serve more patients beyond the current 2,500.
The alliance has generated interest at the Harvard Business School, where Professor Michael Porter had a case study written about its work. "It offers a model for high-quality, high-value care delivery," said Jennifer Baron, the coauthor. Paul Kahn knows that it's helped keep him on the go despite the difficulties of his life.
