Providers say program for low-income elderly isn't being promoted
MetroWest Daily News
By Michael Morton/Daily News staff
Jan 14, 2011
Private agencies handling a special program for low-income elderly in MetroWest and other parts of Eastern Massachusetts say the initiative can improve care and save taxpayer money, but only if the state promotes it.
To enroll in Senior Care Options, residents must be at least 65. They must also qualify for MassHealth (state Medicaid) by having limited assets and annual income of no more $10,000 for an individual.
But among 110,000 eligible residents, only 15,000 have signed up.
"This program sells itself - if people know about it," Lois Simon of Commonwealth Care Alliance in Boston said during an editorial meeting yesterday with other providers and the Daily News.
Created in 2004 through legislation filed by state Sen. Richard Moore, D-Uxbridge, Senior Care Options is run by four providers. Commonwealth Care Alliance and Fallon Community Health Plan in Worcester are not-for-profit organizations, while Evercare in Waltham and Senior Whole Health in Cambridge are not.
The voluntary program works like this: Participants put away their Medicaid and Medicare IDs in lieu of a card issued by one of the special providers. The providers receive payments from the two government programs, assuming costs for all regular services and providing additional ones such as extra home help and vision and dental care.
The providers work with teams of doctors, nurses and geriatric social workers to make sure medical appointments are kept and healthy diets and habits maintained, among other interventions.
Members of the target group tend to have multiple health problems and are the costliest population for Medicare and Medicaid, providers said. But the coordinated care delivered by staff and contractors keeps hospital trips down and participants out of nursing homes as long as possible, saving money and giving a better experience, providers say.
"It really does improve the quality of life for these people," said Pamela Gossman, executive director of Senior Whole Health.
The state's elder affairs and health and human services offices called Senior Care Options innovative and confirmed early evidence that showed that the program has delayed nursing home admissions. But a spokeswoman attributed the modest participation rate to the multiple options open to older Medicaid recipients.
Still, the providers, while steering clear of a mandate, question why the state can't promote the program more during Medicaid signups. They noted the regulations they face when it comes to advertising on their own.
"What they've done so far has been very inadequate," Gossman said of the state.
The program is regulated by the state and federal governments, and providers said they use evidence-based guidelines in care. Participants can opt out on a monthly basis, providers said, but fewer than 1 percent do so.
With state leaders talking about legislation to change the way health care is delivered - a more coordinated system with payments based on overall patient care and outcomes rather than the number of procedures and visits - Senior Care Options providers said they hope they are not squeezed out.
They also think they can provide a model for further reform.
"This is it," Fallon spokeswoman Christine Cassidy said. "This is absolutely it."
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