The article “Health plan’s losses mount” (Page A1, Aug. 3) fails to capture the positive impact of One Care on the thousands of adults with disabilities who are enrolled in the program. Moreover, I object to how the article portrays the higher costs of the program.
As both a One Care member and disability advocate, I have personally benefited from the integrated care and enhanced services the program provides. After a recent surgery, I was discharged from the hospital to my home. If not for the flexibility in spending permitted in One Care, I would likely have been compelled to spend a month or more in a skilled nursing facility. One Care enabled me to receive the care I needed at home, at substantially decreased cost.
One Care members require more care than assumed in the reimbursement rates, which may be why one insurer, Fallon Health, is withdrawing. However, that is not because One Care is an “expensive experiment,” as one observer is quoted as saying, but rather because the complex medical needs of the population are not reflected in the financing structure.
MassHealth and federal regulators have committed to addressing the inadequacy of the rates. Are more data needed? Absolutely. But the model is better than the fee-for-service system. Our focus should be on making the program sustainable and adequately funded, and on supporting the 5,400 members who will need to transition from Fallon to other options.
The writer is cochairman of Disability Advocates Advancing Our Healthcare Rights and cochairman of the Massachusetts One Care Implementation Council.