KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Massachusetts To Introduce Managed Care Plan for Seniors Focusing on Preventive Care

To "eventually save millions of dollars" by keeping seniors out of hospitals and nursing homes, Massachusetts Gov. Mitt Romney (R) next month will open enrollment to 118,000 low-income seniors in a new managed care program that emphasizes primary, preventive and home-based health services, the Boston Globe reports. The program, Senior Care Options, will coordinate medical, psychiatric and social services that are currently offered to seniors who are dually eligible for Medicaid and Medicare, according to the Globe. Seniors who enroll in the program will be evaluated by a physician, nurse and geriatric social worker, who will draft a care plan that will be implemented upon seniors' and their family caregivers' approval. The health providers will draw upon services that are currently funded separately by Medicare, Medicaid and the state Executive Office of Elder Affairs. To attract seniors to the program, the plan this year will cover services that the state recently eliminated from Medicaid -- such as chiropractic care, dentures, eyeglasses and hearing aids -- and waive copayments for prescription drugs. State officials hope to enroll 4,600 seniors by June 2006 and 36,000 seniors within five years. The state has chosen the not-for-profit Commonwealth Care Alliance, the for-profit Senior Whole Health and the for-profit Evercare, a UnitedHealth Group subsidiary, to administer the program. While the costs initially will equal those under traditional coverage, the administration expects the program to save money in the long term. PACE, a similar state program for extremely frail seniors, has reduced health costs 5% to 7% and allowed 89% of seniors to receive care at home instead of in nursing homes, according to the Globe. David Stevens, executive director of the Massachusetts Councils on Aging, said, "If the program is working correctly, the client will be afforded all the services they're eligible for without having to hunt for them. But the program should be viewed as an experiment. When there's a profit motive involved, clients may come out on the short end." However, Dr. Robert Master, who developed PACE and heads the Commonwealth Care Alliance, said, "Rationing is not the strategy to save money. The strategy is to save money by emphasizing front-end care. We offer a lot more service, a lot more coordination and a lot more access to primary and specialty care" (Dembner, Boston Globe, 2/15).

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