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Opinion

The Podium

Leading the way in accountable care

These days, there is no hotter concept in the health care world than that of the Accountable Care Organization, a more coordinated approach to health care. The Centers for Medicare and Medicaid Innovation recently designated five organizations in Massachusetts as Pioneer ACOs.

We are as anxious as anyone to see how these ACOs begin to better coordinate care for their Medicare populations. But the truth is the real pioneers in providing coordinated care and coverage for seniors have been the Senior Care Options and Program for All Inclusive Care for the Elderly, which are thriving in Massachusetts. In fact, they are setting the example for the rest of the country.

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SCO and PACE programs work with “dual eligibles” — elderly people who are covered by Medicare and who are also eligible for Medicaid, meaning they tend to be the frailest and most vulnerable among us. You might be surprised to know that dual eligibles account for more than 50 percent of total Medicaid spending and about a quarter of Medicare spending. We are talking hundreds of billions of dollars. In 2010 it was $250 billion.

But just as Massachusetts pioneered health reform for the nation, so have we pioneered the ACO model in our SCO and PACE programs. And we know from our experience that you can both improve the health and quality of life of these individuals while keeping them at home and out of the hospital to a greater extent than would happen without the individualized care plans that each SCO and PACE member receives. Care plans are tailored to each member and his/her family situation and work with outside agencies to assure appropriate home and community based services for each member.

It’s no mystery and in some respects it seems like a no-brainer. If you have a primary care provider and a care team specifically focusing on your individual health and social services needs, it stands to reason that you have a greater chance of staying at home and living independently rather than continually going in and out of a hospital or a nursing home. In fact, one could argue, it’s how health care should be provided to everyone. Maybe, eventually, the ACO model will accomplish that goal.

Whether that happens in the long run, it’s exactly what the SCO and PACE programs deliver to seniors and others now. Today in Massachusetts about 22,000 individuals get their care in this coordinated manner.

And it works. The six Massachusetts PACE programs help save the Commonwealth more than 52 million dollars a year by having frail elders enrolled in PACE instead of fee-for-service MassHealth. The Massachusetts PACE programs also have helped 88 percent of their program participants to continue living in community settings despite the fact that all participants must be frail and needy enough to qualify for a nursing home level of care in order to be eligible to enroll in the PACE program.

Meanwhile, according to an independent study conducted by JEN Associates, the SCO program reduces nursing home placements by almost 30 percent.

By integrating comprehensive health care and community-based services, such as personal care, daily living assistance and transportation, SCO and PACE provide individualized, all-inclusive coordinated care and coverage to seniors and others that help maintain health and independence.

We don’t want to take anything away from the other organizations that are designing these new models. But we do think it makes sense to learn from what works, particularly with a similar population.

We invite anyone who wants to see what we do and how we do it to come experience what SCO and PACE have already modeled for future ACOs.

Lois Simon is president of the Commonwealth Care Alliance. Tom Reiter is executive director of the executive director of the Elder Service Plan at Cambridge Health Alliance.

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