Senior Care Options Turns 10: A Time to Reflect and to Celebrate
June 12, 2014 § 1 Comment
By Dr. Robert J. Master
On June 1, 2004, Commonwealth Care Alliance began caring for our very first enrolled Senior Care Options (SCO) members. The program’s 10th birthday is a milestone truly worthy of reflection and celebration.
Today, we look at the Senior Care Options program as a mature program that has positively affected the lives of thousands of elders and their families living in low-income communities all over Massachusetts. We take pride in the positive outcomes that the program has consistently achieved.
And some of us are blown away when we consider the magnitude of the Senior Care Options program contribution to “building community,” through the creation of thousands of jobs, by the transfer of tens of millions of previously ineffective Medicare and Medicaid dollars each year from hospitals and institutions to the communities where our members reside.
A Leap of Faith
While it is satisfying to reflect on such positive results, it is important to remember that the scaled care delivery transformation elements and the underpinning set of values that are the Senior Care Options program were once nothing more than “a leap of faith.” As some perhaps do not know, Senior Care Options began after eight tortured years of planning between CMS (then known as the Health Care Financing Administration) and the Medicaid programs of Massachusetts, Minnesota, and Wisconsin, to create the nation’s first large scale demonstration to integrate Medicare and Medicaid financing. The hope was that integrated Medicare and Medicaid prepaid financing could spawn new models of care delivery that improved continuity, enhanced independence, reduced hospitalizations, substituted for nursing home placements, and bend the overall cost trend for our public payer’s most poorly served, vulnerable and medically complex beneficiaries.
Ten years ago, these goals seemed very ambitious and, in the view of many, unachievable. Also, ten years ago, there was absolutely no language to accurately describe what Commonwealth Care Alliance aspired to be in order to achieve these goals. We did not aspire to be an “HMO.” We saw “managed care organization” strategies as part of the problem, and we certainly were not going to be a “health plan insurer.” So when we launched Senior Care Options, the undertaking at times did have the feel of a quixotic journey into the unknown.
Fast forward to the present, we can now say that Commonwealth Care Alliance achieved all these goals in ways that exceeded our wildest dreams. Along the way our SCO program became nationally recognized by policy makers and politicians alike as “best in class.” As a consequence, to a far greater degree than perhaps warranted, our SCO program contributed to shaping a cornerstone of the Affordable Care Act (ACA): the Duals Demonstration that started with us last year and is now planned to roll out in 20 states over the next three years.
Today there is a language that describes us and the ACA’s aspirational vision of what a transformed care delivery system should look like with terms such as “Accountable Care Organization,” “Patient-Centered Medical Home,” “Health Home,” and “Population Management” that are now used regularly by clinicians and policymakers everywhere. To an extent that would have seemed delusional in 2004, we can confidently assert today that our Senior Care Options program is the best example in the US of what these terms really mean.
On to Bigger Challenges
Now, we’re on to bigger challenges as we have expanded to take on the One Care populations. But we should not forget where it all started, and what in fact was accomplished. So ten years from now, let’s look forward to the 20th birthday of Senior Care Options and the 10th birthday of One Care with the hope that we can say then what we can say of our SCO program today: “We made the lives of thousands of people immeasurably better. We strengthened their communities, and we actualized a vision of care and values transformation for others to follow”
Happy 10th birthday, Senior Care Options!
Tagged: Affordable Care Act, Centers for Medicare and Medicaid Services, Commonwealth Care Alliance, Dr. Robert J. Master, Dual Eligibles, Massachusetts health care reform, Medicaid, Medicare, Senior Care Options