The ‘One Care’ Program at Commonwealth Care Alliance: Partnering with Medicare and Medicaid for Dual Eligibles

Sarah Klein
Martha Hostetter
Douglas McCarthy
Case Example
December 2016

This resource is a case study of Commonwealth Care Alliance (CCA), a Boston-based Medicare Advantage plan and care delivery network that seeks to integrate medical, behavioral health, and social services for patients with complex needs. The case study focuses on CCA’s participation in the One Care MassHealth plus Medicare demonstration, which tests whether providing lump-sum payments to deliver comprehensive, well-coordinated care leads to improved outcomes and lower costs.

  • Through the demonstration, CCA serves low-income adults under age 65, including those with serious mental illnesses, debilitating disabilities, and catastrophic health problems such HIV/AIDS. Many of its members make use of long-term services and supports.
  • The health plan relies on interdisciplinary care teams to identify gaps in care and coordinate services. Mobile care teams engage hard-to-reach members in their homes or streets using flexible benefits that cover services not traditionally reimbursed by Medicare or Medicaid, including substance abuse treatment.
  • CCA seeks to avert costly hospitalizations and emergency department use, for instance by dispatching paramedics to patient homes to provide after-hours urgent care and by establishing crisis stabilization units that offer an alternative to inpatient psychiatric care.
  • After 12 months, health plan members enrolled in the demonstration had 7.5 percent fewer hospital admissions and 6.4 percent fewer emergency department visits compared to the prior 12 months.
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Key Questions Answered
  • How can a program help patients who are dually eligible for Medicaid and Medicare?
  • What’s the evidence that such a program can improve outcomes and save costs?
Level of Evidence
What does this mean?