Briefing: Fallon Total Care

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A joint venture between the state and federal agencies that administer health care to low-income and special needs residents, known as One Care: MassHealth Plus Medicare, will launch Oct. 1 after two years of planning. And Worcester's Fallon Total Care, a subsidiary of Fallon Community Health Plan, will be leading the charge as one of three Bay State insurers selected to provide coverage under the One Care pilot program.

What's The Purpose Of One Care?

It's designed to reduce the cost and administrative hurdles related to insuring patients who are eligible for coverage through Medicare and Medicaid. Massachusetts was one of a handful of states approved by the federal Centers for Medicare and Medicaid to create a program that fulfills this purpose.

In Massachusetts, officials decided to gear One Care toward people between the ages of 21 and 64 with disabilities — a population among the most complicated and costly to insure, according to Robin Callahan, deputy Medicaid director for policy and programs at the Massachusetts Office of Medicaid.

“This population has a wide range of needs, and the needs are covered in different ways for Medicare and Medicaid,” Callahan said. “(One Care) allows them to be managed as one program.”

How Did Fallon Get Involved?

Fallon Total Care launched earlier in 2013 and was designed specifically to insure patients eligible for One Care. The state picked Fallon for One Care because it has historically been involved with insuring a similar population of seniors.

Callahan said Fallon and the two other One Care insurers, Commonwealth Care Alliance and Network Health, had the right infrastructure in place to participate, and the cost to offer the plan to members was feasible for them.

How Will One Care Play Out In The Coming Year?

Fallon Total Care began enrolling members this month, according to CEO Mary Ritter. She said Fallon expects to enroll between 8,000 and 10,000 members in Worcester, Hampshire and Hampden counties in its inaugural year.

“We weren't really starting from scratch and I think that was a significant advantage,” Ritter said.

Ritter said there are roughly 90,000 Massachusetts residents that may be helped by One Care.

But One Care plans are not available in all parts of the state. Barnstable, Berkshire, Bristol, Dukes and Nantucket counties do not have providers. n