State calls for applications for groups to manage health care for ‘dual eligibles’
The Patrick administration on Tuesday put out a call for bids from organizations interested in managing the health care of about 111,000 low-income people in the state who have complex and costly medical needs.
The group includes people age 21 to 64 who are disabled and have been covered by both the government Medicaid and Medicare programs, in an arrangement that can be confusing for patients, strain communication among providers, and lead to fractured care.
“This initiative will improve health outcomes for some of our neediest residents,” Governor Deval Patrick said in a press release. “By emphasizing integrated, community-based care, Massachusetts will again lead the nation in providing comprehensive, cost-effective care.”
The project, announced last year, is expected to save up to 2 percent for the state and federal programs, which in 2010 spent about $3 billion in Massachusetts on this group, commonly referred to as “dual eligibles.” That means there are billions of dollars up for grabs by groups interested in becoming what the state is calling “integrated care organizations.” Likely bidders include provider groups and insurers, particularly those that already serve a Medicaid population, and organizations that now oversee care for disabled seniors under the state Senior Care Options program.
The organizations selected would begin enrolling patients in January, for coverage to begin in April 2013. Dual eligible people can choose an organization serving the county in which they live or will be automatically enrolled, unless they opt out of the program. No more than five organizations will be selected to serve each county. The organizations could be for-profit or nonprofit.
The organizations must develop a network of providers and create care teams that include people specifically focused on making sure people have long-term support services, such as at-home assistance for daily activities or transportation.
“We view this as a once-in-a-generation opportunity to provide services that give voice to the priorities of the disability community,” Dennis Heaphy, co-chair of the coalition Disability Advocates Advancing Our Healthcare Rights, said in an interview Tuesday. “Right now there is no voice.”
Heaphy said there have been moments since the state began working on this project that he and others have considered opposing the change. It is risky to put the care of people with complex needs into the hands of yet unknown organizations, he said, but the coalition recognizes that the current system is broken.
If the project harms people with disabilities, he said, “we will, en masse, have folks disenroll from the project.”
Heaphy said the organizations selected should focus on investing in preventive care over the long term to avoid hospitalizations, not on cutting services to turn a profit. The state plans to monitor the groups based on dozens of metrics related to access to care and quality of medical and mental health services.Chelsea Conaboy can be reached at firstname.lastname@example.org. Follow her on Twitter @cconaboy.