Evan checked into our Community Respite Unit in Dorchester seeking treatment for manic depression and bipolar disorder. Since his belongings previously had been stolen from him, the only things he carried were a brace for his injured knee and anxiety from the added burden of looking for a place to sleep each night.
People like Evan are the face of One Care, a Massachusetts demonstration program launched in October 2013. One Care members tend to have severe physical or mental health issues. They suffer from multiple chronic health conditions, some have significant physical or developmental disabilities, and many struggle with behavioral health problems and substance abuse. Some are homeless; some are homebound.
And for far too long, they did not have the kind of care that most of us take for granted.
One Care is the first plan of its kind in the nation, born out of the Affordable Care Act and designed to help some of the most medically complex, socially challenged people in our community. It is open to individuals aged 21-64 who are eligible for both Medicare and MassHealth. While small in numbers, they account for the majority of public insurance health care spending. So we all have a stake in how they get their care and in the kind of care they get.
News reports about the One Care program have focused on the financial and operational difficulties involved in bringing care to these vulnerable people. That’s understandable. The numbers look alarming.
But Commonwealth Care Alliance and the two other health plans involved in One Care understood, from the beginning, that participation came with risks and challenges. We’ve always been aware that we would need to make significant investments in clinical operations, staff expansion, technology, and administrative supports to make the program work.
Folks like Evan live challenging lives. The issues they face require a high degree of collaboration among medical and behavioral health care providers, as well as community-based agency personnel. At the core of the One Care model of care is an interdisciplinary team that works together on goals that a member like Evan sets with them.
But that work takes time. People like Evan have often had very negative experiences with the medical care system in the past. So care begins with a focused effort to establish a meaningful relationship and trust – key ingredients needed ultimately to avert preventable emergency room visits and hospitalizations.
Once that trust is established, we try to address an array of unmet needs that often require support services: stable housing, reminders to take medicines, transportation to medical appointments. This, too, takes time and resources, but the benefits over the long haul hold great promise for reducing costs and controlling the growth of medical care expenditures overall. Worthy investments require time to pay dividends.
So far, 18,000 people have enrolled in One Care, and they are largely pleased with the care they’ve received. According to the MassHealth Member Experience Survey released in May, 80 percent of enrollees reported being satisfied with the program, and 82 percent plan to stay in One Care.
They deserve a program that continues to deliver. There is no precedent for what One Care is trying to do, and little question that the traditional health care model for these most complex cases needs to change. For the sake of Evan and others like him, we shouldn’t derail a groundbreaking program before it has a chance to fully work.
Lois Simon is president of Commonwealth Care Alliance, one of the health plans participating in Massachusetts’ One Care initiative.