Massachusetts program for poor, disabled suffers major financial loss: 8 things to know

A pilot program designed to manage care for some of the poorest and sickest residents in Massachusetts has sustained deep financial losses since its launch in 2013, according to The Boston Globe.

Here are eight things to know about the program and its financial losses.

1. The three insurers in the program, called One Care, lost a combined $54 million in 18 months, according to the report, which cites information from the Massachusetts Executive Office of Health and Human Services. 

2. According to The Boston Globe, the goal of One Care, which is designed to coordinate services for 100,000 poor and disabled adults under 65 who are covered by both Medicaid and Medicare, is "to control costs and improve care by putting patients into a single, integrated health plan with a coordinator to help them navigate services." The program also includes expanded dental, vision and mental health benefits.

3. But so far, the three nonprofit insurers in One Care have enrolled less than 18,000 people. 

4. Boston-based Commonwealth Care Alliance lost more than $40 million on the program, Watertown-based Tufts Health Plan lost nearly $1 million and Worcester-based Fallon Health lost about $13 million.

5. The financial challenges have prompted Fallon to drop out of One Care at the end of September. As a result, Fallon plans to lay off 45 employees, leaving the state with the task of reassigning Fallon's 5,400 members to other plans, according to The Boston Globe.

6. The participating payers attribute One Care's financial losses to the difficulties of managing care for people with exceedingly complex lives, according to The Boston Globe. For instance, many patients are homeless. Many patients don't speak English. And most have problems with addiction or mental illness, the report notes.

7. Per the state's agreement with One Care insurers, taxpayers will be required to cover a considerable amount of the program's financial losses — at a time when healthcare spending is already straining the Massachusetts budget, according to the report. The state will also cover some of the losses insurers sustained, the report notes. Daniel Tsai, assistant secretary for the state's Medicaid program, known as MassHealth, said in the report that state officials are looking at raising reimbursement rates to help insurers cover costs in the months and years ahead. However, the federal government also would have to approve such an increase.

8. Insurers and state officials contend it is premature to tell whether One Care is improving members' health, according to the report.


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