Pull up a chair as I speak with Chris Palmieri, President and CEO of Commonwealth Care Alliance, a Massachusetts community-based healthcare organization serving the dual eligible population — members who are both Medicare and Medicaid beneficiaries. He previously led Remedy Health Partners and before that the health plans of the Visiting Nurse Service of New York Commonwealth Care Alliance (CCA) serves over 30,000 members through a network of contracted providers, and its OneCare plan has achieved recognition as the top-rated Medicare/Medicaid plan nationwide, three years running. CCA also owns a health service delivery analytics and health IT incubator and accelerator called Winter Street Ventures.

We talked about tailoring care for CCA’s medically-complex patient population, and dealing with the barriers to care that they encounter. CCA’s approach to increasing patient engagement and moving care out of the emergency room and physician’s office (where appropriate) includes leveraging commercially available voice technology — everything from outbound phone calls by staff to the use of voice technology (e.g., Amazon Echo) and smart pillboxes which can help improve medication adherence for patients taking as many as twenty medications daily.

Chris described a very successful pilot that CCA is now scaling:

Imagine at 8 o’clock in the morning your parent needs to wake up and take their medications, or they need to get dressed because a doctor’s appointment is coming up later in the day. And transportation is going to pick them up. These devices now will say, Good morning David. Or Good morning Mrs. Harlow. How are you today? And the consumer will respond and it will continue based on a personalized series of questions that on the back end is aided by artificial intelligence and start to have an iterative conversation with the consumer which will ultimately help them meet their very specific care goals and become an access point of communication for the consumer.

CCA pilots technologies being developed by companies in the Winter Street Ventures incubator (which opened its doors in 2016) – in three phases:

(1) A user acceptance test with five consumers “and we integrate the product, program or service into the consumer’s life for a very short period of time to see if this is something that the consumer would accept, something that they would consider leveraging or using.”

(2) A 50-consumer pilot for 90-180 days. “We monitor and study the usage and interaction based on agreed-upon goals with the entrepreneur. We collect extensive data and then we are able to give the entrepreneur that data for a fee — we typically exchange the fee for some ownership in the company if it ultimately becomes a company.”

(3) A broader test, with as many as 500 consumers.

If all three phases go well, the next step could be an investment in the company, becoming involved as a typical VC would be, with a seat on the company board, and entering into a commercial relationship with CCA. Having CCA as a customer is a strong validation signal for a startup, which can lead to additional investment and customer relationships.

Chris is focused on scaling the CCA model to serve more consumers in Massachusetts – the patient population served by CCA has doubled in the three or so years since Chris came aboard, and he expects that the population could double again over the coming three years. He is also looking at bringing the CCA model to other geographies.

CCA is addressing social determinants of health – including food and housing security. Food security includes a program that provides medically tailored meals to consumers. Housing security means having CCA help ensure that consumers are accessing all of the housing assistance programs available to them and also maintaining access to heating and cooling in consumers’ homes, since (for example) maintaining an appropriate temperature can be so important for health of elders with COPD or other chronic conditions. Overall, maintaining consumers in the community makes sense for so many reasons – and it is also much more expensive to care for patients in institutions than in their homes.

Chris is passionate about seeking greater patient engagement in their own care and he sees that as achievable in the next five years, starting with something simple (or, rather, something that should be simple) – price transparency. If pricing were clearer, that would help consumers in thinking about how they access healthcare services and being more involved in their own care.

CCA is working at many levels and in many different ways to improve the health of dual eligible consumers, and the lessons learned in this challenging environment will be instructive for all of us.

I spoke with Chris as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. Listen to our radio station online, or ask your smart speaker (Amazon Echo or Google Home): “Find Tune In station HealthcareNOW Radio.” You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunesStitcheriHeartRadio). Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

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