Tufts Health Plan exec: Future of dual-eligible demonstration unclear

Tufts Health Plan's participation in the "ambitious" demonstration project known as One Care has highlighted the steep challenges of coordinating care for dual-eligible individuals, an executive writes in a recent blog post published by America's Health Insurance Plans.

One Care, which is jointly administered by the Centers for Medicare & Medicaid Services and the state's Medicaid program, MassHealth, offers "extensive services" aimed at improving care for individuals with disabilities who also qualify for Medicaid. But the project has come up against plenty of roadblocks, writes Christopher "Kit" Gorton, M.D., president of Tufts Health Public Plans.

For one, dual-eligible patients are often very difficult to reach and track, as many have unstable housing and thus move frequently. Even among those enrolled in the program, 30 percent of members "simply can't be found," he writes.

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The project has also seen high levels of opt-outs given the dual-eligible population's general wariness of the healthcare system, lack of understanding about the program and/or reluctance to change doctors.

In this struggle, One Care is not alone, as California's Coordinated Care Initiative for dual-eligibles recently adjusted its rules to stop automatically re-enrolling members when it found many were upset about being enrolled without their knowledge. In fact, the federal government has had trouble reaching its enrollment goals in several states participating in its multi-state effort to improve care for dual-eligible beneficiaries.

Now that the three-year One Care demonstration is coming to an end, Gorton notes that it's still unclear whether the program should be extended, as he believes the model still has a long way to go to evolve into a permanent, sustainable program.

But he still remains optimistic about such a program's ultimate potential, concluding that "we hope that lessons learned from the demonstration will inform the transition to a permanent program in which Tufts Health Plan would be proud to participate."

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