Steward Disrupts Care for 900 Seniors

CAMBRIDGE, Oct. 3, 2012 – Steward Health Care System has abruptly cancelled a contract between its employed physician group and Senior Whole Health (SWH), creating a major disruption and potential health issues for about 900 frail and vulnerable elders who have both Medicare and MassHealth benefits. The affected elders, many of them non-English speaking, are located largely in Boston, Brockton, Taunton, Fall River and New Bedford, and on average are 78 years old.

In a letter to SWH, one of the state's Senior Care Options (SCO) plans, Steward said that its Steward Medical Group would no longer contract with SWH as of Jan. 1, 2013. Steward gave no reason for its action, which involves 173 primary care physicians (PCPs) who care for about 900 SWH members, as well as 349 specialists. The patient number represents approximately 5 percent of the total statewide SCO membership. Many of the affected physicians have been contracted with SWH since 2004 when they were part of the Caritas Medical Group. Steward purchased the entire Caritas Christi Health Care network in 2010.

"Our primary mission is to provide quality, comprehensive, coordinated care for frail, vulnerable and often non-English speaking elders who would have trouble navigating today's complicated health care system on their own. SWH has succeeded in improving their quality of life and reducing nursing facility placements and preventable hospital admissions. With this action, Steward has at best caused a major disruption in the lives of these elders. At worst, the disruption will create challenges that could impact their health," said Pamela Gossman, the president of SWH.

Gossman said that while SWH is working with the affected elders to help them through the transition, they ultimately will have to choose between a care team divided by Steward's action – their existing PCPs or their existing SWH support teams. Those teams include a Nurse Care manager, Community Resource Coordinator, and Geriatric Support Services Coordinator from their local elder agency who works with the physician to provide coordinated, comprehensive and seamless care. It is precisely this kind of coordinated care that has led to the success of the SCO model, Gossman said. "Steward has forced these elders to make a choice between their Steward primary physician, another local primary physician, and the care team they have come to know, trust and rely on to take care of them," she said.

The SCO program was designed to keep elders living independently at home. SCO providers like SWH cover all of the services reimbursable under Medicare and MassHealth. Members have an individualized care plan, 24-hour access to care, and support services such as home care, adult day care, and family caregiver support. Membership is voluntary. SWH is one of four SCO providers authorized to operate in Massachusetts and has been recognized for its quality of care.

According to a study commissioned by MassHealth (http://www.mass.gov/eohhs/docs/masshealth/sco/mh-program-evaluation-nf-entry-rate20042005.pdf), SCOs have reduced nursing home admissions for long-term custodial care by almost half. A University of Massachusetts Medical School survey of SCO members (http://www.mass.gov/eohhs/docs/masshealth/sco/umms-sco-interview-report.pdf) found that they "were quite happy with the program, the services they received, and the personnel who provided them."