One Care: On target for members and providers

June 18, 2014 § Leave a comment

By Leanne Berge, Senior Vice President, One Care Program, Commonwealth Care Alliance

Some in the healthcare press have suggested that the Massachusetts opt-out rate for the One Care demonstration is too high. At this early stage in the demonstration, it’s not clear what an acceptable opt-out rate should be, but there are many signs indicating that the One Care  opt-out rate will not prevent the program from being a success.

For the three Massachusetts health care organizations that began offering  One Care plans in October 2013 (Commonwealth Care Alliance (CCA), Fallon Total Care, and Network Health), the overall  opt-out rate for qualified dual eligibles is about 20%. That rate is relatively low considering that individuals are being asked to switch from a plan they might be comfortable with to a new and unfamiliar program.

And, while it’s true that some Medicare-Medicaid dual eligibles who qualify for One Care have opted out, most have done so because their provider is not yet in the One Care network. As with any plan, if your doctor does not participate, you might not join. But doctors are signing on, and networks are improving.

Meeting expectations for members, doctors
For signs that One Care is on track, consider the experience of CCA. During the first three months of the CCA One Care program, active enrollment was twice as much as expected. Since then, enrollment with CCA has continued to be strong, with the plan meeting targets relative to expectations.

At CCA, we have more than met our goals for signing up doctors, and we have achieved network adequacy standards. In most areas of the state, there is significant choice for our members. In fact, there is even more choice in our One Care program than you would find in some managed care organizations. Still, we continue to expand our network, so even if an individual’s provider is not in our network today, there’s a good chance they will be in the future.

The right mix of members?
Another concern raised about One Care focuses on the “mix” of members in the program. Some have suggested that the opt-out rates may produce a group of members that skews toward more or less sick, which would alter the cost-savings and clinical results of the demonstration. To date, however, the Massachusetts One Care program has a broad mix of members in terms of acuity and levels of disability, which should produce meaningful results.

We’re “early in the game” with One Care, but member enrollment and network expansion numbers point to a successful demonstration. The jury is still out concerning the program’s impact on clinical outcomes and cost savings, but we’re confident that the demonstration is on track to help us find ways to improve care for this important and vulnerable population of dual eligibles.


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