Cambridge Health Alliance: Accountable Care Case Study

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This case study examines the Cambridge Health Alliance (CHA), a public safety-net health system, and its strategic responses to healthcare reform in Massachusetts. The analysis delves into CHA's adoption of an accountable care organization (ACO) model to maintain financial solvency and improve patient care. It explores the triggers for change, internal and external objectives, and the challenges faced by CHA, including financial sustainability, organizational change management, and resource limitations. The study highlights CHA's implementation of strategies such as establishing patient-centered medical homes, entering alternative payment arrangements, launching complex care management, and forming partnerships. The assignment reviews CHA's approach through the McKinsey 7S model and discusses the context of change, including the transition from a fee-for-service model to global payments, and the impact of Massachusetts healthcare market policies. The case study analyzes CHA's internal and external objectives for change, considering challenges related to financial sustainability, patient management, and workforce development, while drawing on relevant academic literature on organizational change and leadership.

Cambridge Health Alliance case study
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Table of Contents
INTRODUCTION ................................................................................................................. 4
CHANGE CONTENT: ...................................................................................................... 4
Change Process and Context of change..........................................................................6
Overall Change Perspective on CHA: ...........................................................................10
CONCLUSION...................................................................................................................11
References......................................................................................................................... 12
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INTRODUCTION
Cambridge Health Alliance (CHA) is a public safety-net health system. Its main aim is to
improve the health of patients it serves. For achieving the aim, it has begun to develop an
accounting care organization. With respect to the change in the policies and culture, healthcare
system has chosen some strategies for managing the change so that it can achieve its mission and
vision (Xu, Payne, Horner and Alexander, 2016). The main principles of the change isprinciples of
the change are to educate the employees and to manage the culture. The present essay is based on
the case study of Cambridge Health Alliance. It includes critical analysis with respect to the change,
its process and context. Along with it, file also includes overall change perspective with reference to
the CHA.
Activities BeginingBeginning Time End Time
PerparationPreparation for
Transformation
 Financial Structure
2009
2008
2011
2012
Transformation Strategies
 Changing the financial
model
 Building PMCH
 Transforming the
workforce and
culureculture
 Implementing
Complex care
management
 Creating effective
referral process
2010
2010
2011
2011
2012
2013
2015
2012
2014
2015
Establishing
prefferdpreferred tertiary and
Community Partnership
2012 2013
3
Preparationerpar
ation for
Transformation
(2009-2011)
Transformation
Strategies
(2010-2013)
Establishing
preferredEstablisi
ng Preffered
Tertiary and
Financial
structure
(2008-2012)

External stakeholders includesExternal stakeholders include government, suppliers, communities
and patients on the other hand internal stakeholders involvespatients’ on the other hand internal
stakeholders involve employees, doctors, board members and volunteers. Any change in the
working structure or organisational process affects both the stakeholders orboth the stakeholders
and any changes by external or internal stakeholders affects the working of the organisation in
either positive or negative manner.
CHANGE CONTENT:
According to the Heckmann, Steger and Dowling, 2016“Change in the organisation refers to
the review and modification of the management structures and other processes. Companies adopt
organisational change for maintaining and managing their work as per the requirement of market
(Heckmann, Steger and Dowling, 2016). On the other hand Snyder, 2016, has stated that “Change
in policy, law and regulations result to restructure the health care firm's structure and processing
which results to wastage of money, resources and time” (Snyder, 2016). In reference to it, changes
in the Massachusetts Healthcare Market and policy environment make CHA to change its overall
process and structure.
This change is a transitional change as it makea transitional change as it makes CHA to
replace all its existing processes with the new. This change is essential for working according to the
need of the market. On the other hand, the main reason behind the change is change in the
Massachusetts healthcare market and policy of environment. It is essential for the CHA to work
according to the changes for maintaining its position and brand reputation. In addition to this, scope
of change for the safety net healthcare is in the area of its financial structure, PMCH, services for
the patient, employee development and management of the patient care.
Scope of Change:
Andrew and Mohankumar, 2016, have explained that “Cost control policy passed by the
Massachusetts recommendpolicy passed by the Massachusetts recommends the state transition from
a fee for service model to the global payments. This change results to affect the working process of
4
Changin
g
the
Financial
Model
(2010-
2013)
Buildi
ng
PMC
H
(2010
-
2015)
Transf
orming
the
workf
orce
and
culure
Imple
menting
Co
mplex
ca
re
manag
Creati
ng
effecti
ve
referra
l
proce

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many social care organisations” (Andrew and Mohankumar, 2016). With respect to Fee for service
Meyer, Cross and Byrne, 2016, have asserted that “Fee for service is a type of payment model in
which services are unbundled and paid for separately. This model provides an opportunity to the
healthcare professionals for getting incentives as payment of them depends upon the quantity of
care” (Meyer, Cross and Byrne, 2016). Similarly Celik and Ozsoy, 2016, have found that “Some
health care organisations are not ready for this change because fee-for-service is related to the each
patient's service whereas global payment is related to the one amount for all care provided to a
patient irrespective of the amount of service used” (Celik and Ozsoy, 2016). In favour to this
statement, CHA, starts making efforts for leaving the policy regarding fee for service and adding
global payment. It uses integrated delivery system for bringing this change into its working
environment.
On the other hand Wahlin, Ponzer, Skrifvars, Lossius and Castrén, 2016, have asserted that
“Massachusetts make changes in the payment reforms for making total health spending equal to the
projected growth related to the economy of the state. With the help of new payment reforms, it
promoted the development of client centred medical homes ”homes” (Wahlin, Ponzer, Skrifvars,
Lossius and Castrén, 2016). With respect to this change, CHA needs more and additional resources
for developing patient centred care. Safety net providers like CHA faces various issues due to these
changes and there is no sign of relief for them. In contrast to it Allen, 2016, has declared that “Due
to the negotiation in the Medicaid 1115 demonstration waver, CHA receives some relief. It provides
an opportunity of incentive payments from fee-for-service to alternative payment arrangements for
the projects which are related to the safety net providers' transitions” (Allen, 2016). With reference
to this, CHA gets some relief but still it needs to change its working process, organisational
structure, culture, etc. as per the change in the policies.
According to the Vakola, 2016, “Change in market policies of the Massachusetts, make
CHA to change its interview style, job, staff, development of the workers, planning, strategies, etc.
With the help of these changes, public safety net health system can maintain its position and
manage its work in the present market ”market” (Vakola, 2016). On the other hand Neil, Wagstaff,
Weller and Lewis, 2016, have concluded that “Changes in the health care reform law of the
Massachusetts is for providing health insurance to the all residents. For this, law has established an
independent public authority called as Health Connector who works as an insurance broker” (Neil,
Wagstaff, Weller and Lewis, 2016). As per this, CHA needs to change its working style as it has
15% uninsured patients. Safety net healthcare needs to offer insurance to its clients with the help of
Massachusetts Health Connector.
Internal and External Objectives for change:
5

According to the Gunnarsdóttir, 2016, “Change in the market and financial polices results to
change the internal and external objectives of the organisations. With the change, health care needs
to change their objectives for getting success and growth” (Gunnarsdóttir, 2016). In favour to this,
CHA has also decided to change its internal and external objectives. With reference to the internal
objectives Rossignoli, Gatti and Agrifoglio, 2016, have stated that “According to the changes, CHA
needs to manage its culture, employees, their development, diversity management, job and many
more. So that, health care system can make its internal environment more effective ”effective”
(Rossignoli, Gatti and Agrifoglio, 2016). In favour to the diversity management Cross, 2016, has
said that “Approximate 40% of the service users uses different language in the CHA instead of
English. This figure shows that diversity is possessed by the safety net system and it is essential for
it to manage” (Cross, 2016). In contrast to it by giving more emphasis to the cultural management
Stavros, Nikolaos, George and Apostolos, 2016, have demonstrated that “Due to the change in the
Massachusetts' Health care policies, CHA needs to develop their workers for accepting new culture
and working procedure. It will also result to design more jobs as per the requirement of the Patient
care medical health” (Stavros, Nikolaos, George and Apostolos, 2016).
On the other hand Appelbaum, Calcagno, Magarelli and Saliba, 2016, have explained that
“With the internal objectives it is also essential to achieve the external objectives for maintaining
the position and brand reputation” (Appelbaum, Calcagno, Magarelli and Saliba, 2016). In favour of
this statement, CHA has its external objectives also which includes extra funding for
transformation, recruitment of government partners, enhancing market position and financial
sustainability.
Challenges
According to the Kuntz and Gomes, 2012, “Changes bring challenges and opportunities for
the companies. It depends upon the firms how they handle them for their success and growth”
(Kuntz and Gomes, 2012). In context to this Hayes, 2014, has stated that “Changes in the policies
regarding the health care market and environment results to bring lots of challenges and
opportunities for the safety net providers” (Hayes, 2014). With respect to this, CHA faces various
challenges due to the change which includes long term financial sustainability, management of
organisational change, reversing an annual operating loss, managing conflicting demands of
multiple initiatives, managing resource limitations and management of patients due to the change.
Along with this Leong and Anderson, 2012, have said that “It is difficult to manage the challenges
occurs dueringduring the policy change but CHA takes appropriate actions for handling these
challenges and make best out of them.” (Leong and Anderson, 2012).
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Change Process and Context of change
According to the McLachlin, 2012, “Change is a type of process rather than an event. It does
not occur suddenly or instantaneously as there is always a kick off meeting. Along with it, change
refers to the transition from current situation to the future” (McLachlin, 2012). On the other hand
Docherty and Nyhan, 2012, have said that “Change process is a continuous process and contain
sequence of steps which a project leader follows to apply change in working environment”
(Docherty and Nyhan, 2012). With respect to this, CHA forms a process for organisational change
and achievement of the internal and external objectives.
With reference to the context, CHA is at good position but facing various issues and they
need to improve for improving the qualities of the services. By making the change, safety-net
healthcare wants to improve its market position and to achieve its mission of improving the health
of communities it serves. By analysing and evaluating the present situation, CHA is ready for
implementing the change.
On the other hand, for achieving the improvement and mission, CHA needs to plan a process
properly. The process of the CHA includes the following model
McKinsey 7S Model:
This model is used by the CHA for developing its change process so that, it can achieve the decided
objectives and can work according to the policy and market change.
Strategy: Adger, Barnett, Brown, Marshall and O'Brien, 2013, have said that “Strategies used by the
CHA for implementing change into the working environment are establishing patient centred
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Illustration 1: McKinsey 7S Model
Source (The McKinsey 7-S Framework, 2016)

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medical home, entering alternative payment arrangements with managed care organisation,
launching complex care management and establishing partnership with the tertiary care institution.
Along with it, the major principle of the safety set health system is to educate and develop the
workforce and managing the culture” (Adger, Barnett, Brown, Marshall and O'Brien, 2013).
Structure: With respect to the change Biglan and Embry, 2013, have demonstrated that “The
organisational structure of the CHA is matrix structure. It takes decision to change the structure of
delivery system and financial models for achieving its mission regarding the improvement of
patient's health whomthat it serves. For transformation, CHA launch an organisational structure
which consists of 15 work groups whose key area is PMCH” (Biglan and Embry, 2013). In contrast
to it Xu, Payne, Horner and Alexander, 2016, have explained that “With the organisational structure,
CHA also give emphasis to the financial structure as it is facing pressure in this area. Main aim of
developing financial structure is to stabilize its long term finances” (Xu, Payne, Horner and
Alexander, 2016).
System: According to the Heckmann, Steger and Dowling, 2016, “The system that runs the CHA
areis financial, HR, communication and document storage. All these fields help the health care
organisation to operate its functions effectively” (Heckmann, Steger and Dowling, 2016). Similarly
Snyder, 2016, has stated that “For applying change it is essential for the CHA to make
transformation in its HR, financial and data storage systems” (Snyder, 2016).
Shared Values: Celik and Ozsoy, 2016, have declared that “The core values of the CHA isvalues of
the CHA are to develop its employees as per the new change in the policies, working structure and
culture. It main aim is welfare of the service users by providing them quality services” (Celik and
Ozsoy, 2016). As pet this, the values of the CHA is very strong which is clear from its dedication
towards the transformation with respect to the organisational growth and patient centred caring.
Style: Wahlin, Ponzer, Skrifvars, Lossius and Castrén, 2016, have demonstrated that “Leadership
style used by the health care organisation is democratic as it involves its staff members while taking
decisions which satisfies them” (Wahlin, Ponzer, Skrifvars, Lossius and Castrén, 2016). On the
other hand Allen, 2016, has argued that “Some employees of CHA says that its decision making
process is very slow, conflicting and posses lack of clarification. This makeThis makes workers to
think which authority is responsible for implementing the change and achieving the goals” (Allen,
2016).
Staff: Neil, Wagstaff, Weller and Lewis, 2016, have stated that “In 2010, CHA develops a
leadership academy for developing workers and enhancing employee engagement for apply the
transformation effectively and efficiently. This results to enhance the skills, abilities, capabilities
and knowledge of the staff members” (Neil, Wagstaff, Weller and Lewis, 2016). On the other hand
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Stavros, Nikolaos, George and Apostolos, 2016, have declared that “One of the new
competencycompetencies of the safety net healthy system is to increase the role of staff by
involving registration clerks and medical assistants. This giveThis gives rise to the number of jobs
and employees” (Stavros, Nikolaos, George and Apostolos, 2016). According to a nursing staff
member “It is the biggest cultural change to work with each other side by side instead of top down.
It results to manage the relations by proper cooperation and coordination” (Gunnarsdóttir, 2016).
Skills: According to the...., “For any kind of change or transformation it is essential for the
companies to develop the skills of their workers so that they can adjust themselves into that new
cultural environment” ((Rossignoli, Gatti and Agrifoglio, 2016)). With respect to this, CHA
provides various training programs for the staff members for developing their skills in the field of
team work, diversity management, health literacy, motivational interviewing, use of reports for
tracking results and access improvement. Along with it, health care also give focus to the
management skills which includes system thinking, problem solving, complexity management,
leadership, emotional intelligence and collaboration.
Process for implementing change:
Preparation for transformation:
According to Cross, 2016 “It is important to plan first before implementing and executing any type
of change into the working environment. Organisational change needs to be plan properly and
effectively so that it can provide expected results” (Cross, 2016) In favour of this, CHA plans the
transformation first by developing a vision of achieving its objectives till 2015. Due to the pressure
from the federal and satestate government, safety net provider takes decision to decrease and phase
out the governmental subsidies.
Along with it Stavros, Nikolaos, George and Apostolos, 2016 has stated that “The framework of the
transformation is depended upon Institute for Healthcare Improvement's triple aim. It main motto is
to improve the health of patients by lowering the costs ” (Stavros, Nikolaos, George and Apostolos,
2016). On the other hand Appelbaum, Calcagno, Magarelli and Saliba, 2016 has explained that “5
work groups are developed by the CHA in PCMH task-force for improving education,
compensation, performance metrics and care design” (Appelbaum, Calcagno, Magarelli and Saliba,
2016).
Financial Structure : According to Kuntz and Gomes, 2012 “The financial structure of the CHA is
difficult which causes pressure. It faces operating losses in nine of the past 11 years and for
improving this condition, CHA wants to restructure its working strategies. By the transformation,
CHA wants to stabilize its financial status for long term” (Kuntz and Gomes, 2012).
Transformation Strategy:
9

Changing Financial Model: Hayes, 2014 has examined that “With the change in policy
environment, In 2010 CHA increased its use of alternative payment models. With respect to it,
shared risk contract is made by the organisation which helps it in development of infrastructure for
managing global payments” (Hayes, 2014). On the other hand Leong and Anderson, 2012 has
asserted that “In 2013, CHA conducted Medicare Shared Saving programs which provides it an
opportunity to test global payment strategy ”(Leong and Anderson, 2012).
Building Patient- Centred Medical Home Capability:
In this, CHA develops steps regradingregarding the transformation goals and PCMH
transformation. According to Cross, 2016 “CHA develops a goal for transforming its primary care
sites to the PCMH. It results to meet a set of 149 standards in 5 areas which includes enhancing
access and continutiycontinuity, managing client population, planning care, providing self care
support and community resources to the patients their families and tracking care with proper
coordination” (Cross, 2016). In contrast to it McLachlin, 2012 has said that “Various strategies are
used by the CHA for PCMH transformation such as employee development, establishment of care
teams, increased data reporting, improving clients' experiences, etc” (McLachlin, 2012).
Transforming the Workforce and Culture:
For communicating the vision regarding ACO-PCMH, CHA uses various strategies such as
regular meetings, ACO-PCMH activities, work group meetings, etc. Docherty and Nyhan, 2012 has
demonstrated that “Safety net provider conducts training programs for developing management,
administrative and working skills among the workers. CHA conducts various surveys for
identifying the result of training and development programs” (Docherty and Nyhan, 2012). Along
with it, Adger, Barnett, Brown, Marshall and O'Brien, 2013 has found that “CHA minimizes its
emphasis on the productivity and maximizes financial incentives for providing quality care and
services to the patients” (Adger, Barnett, Brown, Marshall and O'Brien, 2013).
Implementation:
According to Biglan and Embry, 2013 “A Referral process is implemented by the CHA in
which patients can recievreceive most of the primary care within the organisation but can also use
substantial amount of specialty care from other health care firms ” (Biglan and Embry, 2013). On
the other hand, Xu, Payne, Horner and Alexander, 2016 has said that “The partnership of CHA with
the Beth Israel Deaconess medical centre results to obtain better pricing regarding the tertiary
services” (Xu, Payne, Horner and Alexander, 2016). With reference to the improvement Heckmann,
Steger and Dowling, 2016 has stated that “Tool developed by the CHA provides access to the health
of the entire patient population which results to determine the major medical morbidities”
(Heckmann, Steger and Dowling, 2016).
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Overall Change Perspective on CHA:
Changes formed in the Massachusetts' Healthcare Market and policy make CHA to change
its working process and organisational culture. For managing the changes, four strategies are
developed by the safety-net health system which results to provide both negative and positive
outcomes. These strategies help CHA in improving its financial status and quality services. Along
with it, training programs result to develop skills, capabilities and intelligence of the workers which
lead them to improve their performance (Andrew and Mohankumar, 2016). The changes bring lots
of challenges in the field of financial status, employee development, etc but it also brings
opportunities for the safety-net health system which includes extra funding, skill development,
financial development, increaseand increase in number of jobs and staff members.
With respect to the quality, this transformation helps CHA in increasing its quality of the
services for patients. Along with it, clients of the healthcare have good experience with respect the
services and care as compare to the other organisations. On the other hand, the rate of inpatient
admissions is reducing with a high speed as compare to the other safety-net providers. Similarly,
this transformation helps the CHA in improving its financial status and results to increase its profit
margin (Meyer, Cross and Byrne, 2016).
If I am at the charge in CHA then I recommend the following points to the CHA
 It should properly analyse its internal and external environment before planning the
strategies.
 It needs to analyse the resources properly and then plan accordingly for preventing from any
kind of issue.
 CHA should use one process from the global payment and referral management system for
reducing complexity.
 It should expand its team instead of relying on the more expensive staff for providing better
treatment, care and services to the patients.
CONCLUSION
From the above study, it is concluded that any change in the policy, law or regulation results
to affect the working of the organisations. It is essential for the CHA to design its new structure as
per the demand of the new policies so that it can maintain its market position and can reduce its
weak points. The four strategies used by the safety-net health system helps it in improving its
financial status, staff, jobs, working and cultural environment. There are some areas which need to
be improved by the CHA for better performance and results. It has further been recommended that
there is a need to carry out a proper analysis of internal and external environment so as to be able to
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use the resources in best possible manner. The need is also on ensuring towards team expansion
rather than relying on staff to work in an effective manner.
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