'A Way To Save Medicaid Dollars' by John Baackes

A well-kept secret in the arcane world of health care policy is an innovative program that is both taking better care of poor seniors and saving Medicaid dollars. That it’s a secret is the problem.

In 2004, Mass Health began offering poor seniors the option of joining a Senior Care Options plan (SCO). The objective was to provide a comprehensive care management plan that consolidated the benefits of Medicaid, Medicare Part D and, for those who qualified, Medicare Part A and B.

The anticipated outcome was less use of costly nursing home care, reduced acute care hospital stays and more economical home care and community-based services. Read my op-ed about the benefits of SCOs or that of Douglas Brown.

A recent study commissioned by MassHealth found that SCO members use nursing homes for long-term custodial care at half the rate of Mass Health beneficiaries on the Mass Health Standard. At present enrollment levels, Medicaid is saving $70 million in avoided nursing homes costs annually. The state’s share is one half of that. If the state were able to achieve 100 percent participation from the eligible population, the resultant Medicaid savings would be staggering.

The problem is that only 10 percent of the eligible population is participating in SCOs. Reaching this population cannot be done through the usual channels because of its demographic – poor, often non-English speaking and sometimes illiterate.

Rep. Peter Koutoujian has filed legislation that would solve this problem by passively enrolling eligible seniors in a SCO. Of course, it includes an opt-out provision and would probably need to be phased in to avoid overwhelming the state’s three SCOs.

Once enrolled, seniors love the plan. We have a 99.5 percent retention rate. And at a time when the state continues to struggle with a budget crisis, passive enrollment is a painless way to achieve significant savings.

John Baackes is CEO of Senior Whole Health, the largest SCO in Massachusetts.