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Fallon Health to leave state managed care pilot

One of the three health insurers participating in a state pilot program to control health care costs for low-income people with disabilities is dropping out of the program for financial reasons.

Fallon Health of Worcester said Wednesday that it tried to find a way to stay in the program but ultimately decided participating was “not economically sustainable.”

Fallon manages care for 5,400 patients through the program. The other insurers participating are Commonwealth Care Alliance and Tufts Health Plan.

The aim of the program, called One Care, is to reduce the high costs of medical care for people covered both by Medicare, the government program for seniors and the disabled, and Medicaid, the government program for the poor. But the effort has proved more complex and expensisve than expectied, the Globe previously reported.

Fallon said it will leave the program effective Sept. 30, adding that the decision has no impact on its other insurance products.

“After careful consideration and a thoughtful, comprehensive assessment of our experience, we have decided reluctantly to end our participation in the commonwealth’s One Care demonstration program,” Bob Nolan, a Fallon spokesman, said in a statement.

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Michelle Hillman, spokeswoman for the Executive Office of Health and Human Services, said the state remains committed to the program and will work with Fallon to find new coverage for the members affected by the change.


Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.