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.
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.
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