Is MassHealth ready to enroll children and adults with complex physical, intellectual and behavioral health needs into the new network of Accountable Care Organizations (ACOs) starting March 1? Based on the MassHealth ACO databook, in FY 2015, there were approximately 131,000 managed-care eligible children and adults represented in the Rating Category II category for persons with disabilities.
If the DAAHR forum held in Boston on January 23rd is any indicator, the answer is no or at least not yet. Extending this question to the level of ACOs, the answer is the same - no, not yet.
At the DAAHR forum attended by many consumers, advocates and leadership from MassHealth, there was a considerable amount of confusion, anger and fear expressed. Concerns raised by consumers included loss of access to hospitals, specialists, primary care providers and medications. Several participants spoke about the years it took them to assemble their care teams, and how changes to their situations could be potentially life-threatening.
A number of questions were raised that MassHealth could not answer with any satisfactory response. These included questions about misinformation provided by the MassHealth information line, when and how ACOs might be reaching out to consumers regarding their unique network needs and/or what streamlined process might be available to people with complex needs to protect them from potential harm that might result from being locked into an ACO.
The two-hour forum did not provide enough time for in-depth conversation about the new Long-Term Service and Support and Behavioral Health Community Partner system. Nor was their time to have any meaningful discussion about the impact of the Third-Party Administrator on consumer access to Long-Term Service and Supports. Also missing from the conversation, and all conversations is what this Walmarting of the healthcare delivery system will mean to people on MassHealth. As MassHealth pushes for expansion of One Care and SCO, and moves forward with consolidation of large hospital-driven insurance and delivery systems across the state: what is the future of consumer control, choice and dignity of risk?
DAAHR looks forward to grappling with MassHealth to protect consumer choice, control and dignity of risk, at this larger systems level, but for now our most immediate concern is working with policymakers to minimize harm to consumers with complex physical, intellectual, developmental and behavioral health needs before the impending March 1 ACO deadline. Our first priority is making sure people with the highest levels of medical, behavioral health and LTSS needs have access to the information required to make informed choices that do not require them to put themselves at risk of harm because of narrow provider networks or their being locked into ACOs that do not meet their needs. As for the ACOs, DAAHR will be setting up more forums around the state so that ACOs can hear your concerns. It's important that both MassHealth and the ACOs hear firsthand why commercial insurance practices are not appropriate for people with complex needs.