Boston in summer smog.
Here are some of the issues.
1. The three insurers in the program, called One Care, lost a combined $54 million in 18 months.
2. The goal of One Care, meant 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.”
3. The three nonprofit insurers in One Care have so far enrolled fewer than 18,000 people.
4. Boston-based Commonwealth Care Alliance lost more than $40 million on the program, Watertown-based Tufts Health Plan nearly $1 million and Worcester-based Fallon Health about $13 million.
5. The financial challenges are forcing Fallon to drop out of One Care at the end of this September. As a result, Fallon plans to lay off 45 employees, leaving the state to reassign Fallon’s 5,400 members to other plans.
6. The participating payers attribute One Care’s financial losses to the difficulties of managing care for people with exceedingly complex lives: Many patients are homeless; many don’t speak English, and most have problems with addiction or mental illness.
7. Taxpayers will be required to cover much of the program’s financial losses — when healthcare spending is already straining the Massachusetts budget.
8. Insurers and state officials assert that it’s too early to tell whether One Care is improving members’ health.