Earlier, I wrote how I enjoy the misery of others—only I take care to remain sympathetic to people who don’t have it coming to them.
I’m thinking! I’m thinking! (As Jack Benny used to say.)
A first-in-the-nation program aimed at controlling costs and improving health care for some of Massachusetts’ poorest and sickest residents has sustained deep financial losses since its launch in 2013, dealing a setback to the state’s efforts to control rising medical spending through more coordinated care.
The three insurers in the pilot program lost a combined $54 million in 18 months, according to a recent report from the Executive Office of Health and Human Services. And as losses mount, insurers and state officials say it is too early to tell whether the program is improving the health of its members.
“This is a very expensive experiment — at public expense,” said Al Norman, executive director of Mass Home Care, a network of nonprofit agencies monitoring the program. “I don’t think we can say a lot about health outcomes, but there’s a whole lot of spending going on here.”
Good line! I wish I’d said it. (“You will,” as they said of Milton Berle.)
The goal of One Care is to control costs and improve care by putting patients into a single, integrated health plan with a coordinator to help them navigate services. The program also includes expanded dental, vision, and mental health benefits.
Sounds reasonable. And you say it didn’t work?
But so far, the three nonprofit insurers in One Care have enrolled fewer than 18,000 people. Boston-based Commonwealth Care Alliance lost more than $40 million on the program. Fallon Health of Worcester lost about $13 million. Tufts Health Plan of Watertown lost nearly $1 million.
The financial challenges are so severe that Fallon plans to drop out of the program at the end of September, laying off 45 employees and leaving the state scrambling to reassign its 5,400 members to other plans.
In a statement, the insurer said it “very reluctantly” decided to exit because the program was “not economically sustainable.”
“Not economically sustainable.” So? When’s that ever stopped big government?
The state will cover some of the losses insurers sustained. Daniel Tsai, assistant secretary for the state’s Medicaid program, known as MassHealth, said state officials are considering raising reimbursement rates to help insurers cover costs in the months and years ahead, but the federal government also must approve such an increase.
Enough snarkiness (for now). There’s a very good reason thir program blew through all cost expectations: these people are old and sick. And old. And sick:
Insurers attribute the program’s financial losses to the difficulties of managing care for people with exceedingly complex lives. Many patients are homeless. Many don’t speak English. Most have problems with addiction or mental illness. Finding the patients and persuading them to join the program can be immensely challenging. “This is a population that has really lived in the shadows of our society,” said Commonwealth Care Alliance president Lois Simon.
One Tufts patient illustrates the complexity and expense of caring for a population often living with health problems that go unaddressed for years. The man was homeless, and checked in and out of detox facilities. With help from the One Care program, he controlled his alcohol addiction and found an apartment. Then he needed dental work and help monitoring his weight and diabetes.
“All of the resources to meet these people’s needs are scarce and expensive resources,” Gorton said. “All of these people are way more complex than the typical members we see.”
Oy. “Complex” is a euphemism for homeless, addicted, nuts, and illiterate in English. And old. And sick. Who thought that came cheap? The phrase “shadows of our society” makes me suspicious of their citizenship status, hence their qualification for any of these services. Without more evidence, however, I’ll keep that to myself.
No, these misérables do not tickle my funny bone. Their “complex” lives depress me. But for the state government to think they could stick private insurers with the bill—to the point where some threaten to quit—that’s pretty funny. Nice try. Your government at work.