A Sign of Medicaid Improvements to Come?


In 2006, Massachusetts instituted a plan requiring its residents to have health-insurance coverage, whether from their employer or self-paid. This program is the model for the Affordable Care Act (ACA - also known as "Obamacare"). Two years earlier, the state began a program  to promote coordinated health care and social services for "dual eligibles" - those qualifying for both Medicare and MassHealth (what Medicaid is called in Massachusetts). Called Senior Care Options (SCO), the plan is free to participants - no premiums, copayments or deductibles are involved. And the results reported so far show it's another health innovation worth attention.

The program is intended to reduce hospital readmissions and to help seniors still living in their homes stay in their homes. It emphasizes a holistic approach similar to that of the accountable care organizations championed by the ACA. While MassHealth (Medicaid) foots the bill, the program is administered regionally by private insurers (some of which are also Medicare Preferred providers). And, while it isn't an HMO, each regional SCO effort is formed around networks of participating service providers. (AARP's Public Policy Institute took its own look at the Massachusetts plan, along with a similar Arizona offering in a 2010 report.)

For example, participants in the Tufts plan work with a care coordinator who will do an intake interview in a patient's home, checking the patient's overall health, prescriptions and living conditions. That coordinator becomes a central point of contact, making primary-care and specialist appointments, following up with pharmacists and other related professionals.

This kind of arrangement could be just as helpful for caregivers as it is for plan participants. Considering my own experience during the four years I managed my father's care, having a single point of contact who was dealing with appointment desks for me - and advocating for home-based physical and occupational rehab services on Dad's behalf - could have cut my own bureaucratic responsibilities considerably. Those caring for someone remotely could benefit even more, knowing someone nearby was keeping up with the details of prescriptions and transportation to appointments.

As mentioned, the Massachusetts program is only available to those who already qualify for both Medicare and Medicaid (Dad didn't meet the financial threshold for MassHealth until he'd spent down most of his savings in nursing home bills). But within that group, it has been shown to reduce the risk of needing nursing home care by 42 percent. A May 2012 op-ed in the Boston Globe written by executives from two of the organizations providing services states the program is saving the state $52 million a year - and that 88 percent of participants are living in the community, despite having to be frail enough to qualify for nursing-home care under MassHealth guidelines.

A number of other states also offer similar special-needs plans (SNPs), with requirements and benefits that may differ from those in Massachusetts. What plans are offered where your loved ones live? Have you had any experience, good or bad, with their services? Let us know.

Photo by 401(k) 2013 courtesy of Creative Commons.

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