Promising State “Duals” Pilot (One Care), Late and Losing Carriers

Pioneer has long advocated for reforming the way that healthcare is delivered to those on both Medicaid and Medicare. In fact the idea won the 2012 Better Government Competition.

Winners of the 2012 Better Government Competition from Mike Dean on Vimeo.

This morning State House News Service reported that the state has finalized agreements with three carriers in the newly renamed “One Care” program.

PLANS TO SERVE “ONE CARE” PROGRAM FOR THOSE WITH COMPLEX HEALTH NEEDS: Three health plans have signed contracts to participate in a new pilot aimed at serving adults with disabilities who receive both MassHealth and Medicare benefits.   The Patrick administration announced Tuesday that its integrated health care pilot, called One Care, will better coordinate care for those between the ages of 21 and 64 who are eligible for benefits under both programs.   Plans participating in One Care are Commonwealth Care Alliance, Fallon Total Care, and Network Health, with an estimated 90,000 individuals eligible to enroll in the program beginning in October 2013.

While the program is moving forward, implementation has hit some troubling early bumps.

Limiting Options: The state originally limited the number of carriers to serve as integrated care organizations (ICOs) to five. If beneficiaries had been given real choice, the state would have been more flexible in the options available, allowing for-profit companies to be involved. Pioneer has heard of at least one company being told by MassHealth that they would not contract with such companies. As a result, they did not apply to be an ICO.

Carriers Opting Out: Only 3 of the original 5 carriers have signed onto the One Care program.

Delays: The program has also been delayed. It was originally slated to begin April 1, 2013. That date has now slipped to October 1.

ModernHealthcare has reported that, “The delays have stemmed not only from disagreements over the overall funding the pilot will provide to insurers, but also over concerns that the underlying financial incentives were insufficient to encourage insurers to improve patients’ health.”

These early set backs have given us serious concern that the program will fail to meet its full potential. Pioneer will keep an eye on the program as the formal roll out begins.

Learn more about the program here.

Find me on twitter: @josharchambault