Study cites millions in savings via Mass. senior care plans

A health insurers’ group believes Massachusetts can save tens of millions of dollars a year if poorer senior citizens who would otherwise wind up in nursing homes were enrolled in a senior care plan rather than remain in a Medicare or Medicaid program.

The study, by the Massachusetts Association of Health Plans (MAHP), said the state would save about $111 million a year by using one of five such plans in Massachusetts, including one run by Worcester-based Fallon Health. The others are run by Commonwealth Care Alliance, Senior Whole Health, Tufts Health Plan and UnitedHealthcare. All but Commonwealth Care are MAHP members. MAHP represents 17 health plans, including Fallon, which cover more than 2.6 million Massachusetts residents.

“These plans place a high priority on meeting the needs of the state’s most vulnerable citizens, helping them stay in their homes and active in their communities and avoiding costly, long-term nursing home stays,” said Lora Pellegrini, president and CEO of MAHP.

Thirty percent of eligible individuals are enrolled in one of the five plans, which coordinate and integrate the services and benefits for low-income seniors who are covered by MassHealth and Medicare, according to a statement from MAHP. The rest receive care through separate fee-for-service Medicare and Medicaid programs.

The study results spelled good news for Fallon, according to Leanna Moran, executive director of its SCO program.

“I hope that this demonstrates to the state that the SCOs really want to be part of the solution in future planning,” especially with the increased health care needs of a growing senior citizen population, Moran said.

Fallon launched its SCO in 2010; it now has about 4,400 members. “This is a space we like to be in,” said Moran.

MAHP said the five plans cover about 40,000 Bay State residents, and they “consistently outperform their counterparts in other parts of the country on quality measures and member satisfaction,” Pellegrini said.

Nursing home care can cost between $9,000 and $10,000 a month in Massachusetts, according to data from the website Guide to Nursing Homes. That’s well above the national average of about $6,000 to $7,000, based on data provided by the federal government.

The MAHP said its study, developed by a national consulting firm that specialized in state-run Medicaid programs, examined the differences between the benefits of an SCO plan and the services provided to those who can receive care through the fee-for-service Medicare and Medicaid programs. The major differences included these two:

Saving money through integrated, coordinated care. SCO-developed programs have been shown to reduce or avoid hospitalizations, decrease duplicative care and improve patients’ adherence to medication regimens. This saves $65.9 million a year in nursing home stays and could save another $45.1 million if more seniors were enrolled.

Providing enhanced benefits to low-income seniors. An SCO eliminates cost-sharing for members under Medicaid and Medicare, while providing comprehensive dental coverage and assisting with transportation to medical appointments.

MAHP also cited a simpler process for health care providers, rather than dealing with the two separate, government-run programs. Care coordinators can also work closely with primary care physicians on needed care, as well as accessing a centralized record and an individualized plan of care.