KEY FEATURE. Interprofessional care teams provide integrated, high-touch care to patients in homes, primary care practices, and community settings, using flexible benefits that cover services not traditionally reimbursed by Medicare or Medicaid. TARGET POPULATION. Low-income adults under age 65 who are enrolled in both Medicare and Medicaid. WHY IT'S IMPORTANT. One Care: MassHealth plus Medicare is one of a few programs in the United States that seek to integrate medical, behavioral health, and social services for patients with serious mental illnesses, substance abuse problems, or debilitating disabilities. BENEFITS. After 12 months, Commonwealth Care Alliance health plan members enrolled in the One Care demonstration had 7.5 percent fewer hospital admissions and 6.4 percent fewer emergency department visits compared with the prior 12 months, and made greater use of long-term services and supports. CHALLENGES. Ensuring lump-sum payments from Medicare and Medicaid are adequate for meeting medical and nonmedical needs. Establishing community-based service networks to fill gaps in the care continuum.
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