Coping with Costly Care

Fallon Community Health Plan and two other Massachusetts health insurers are preparing to launch an insurance experiment aimed at controlling the medical expenses of some of the state’s poorest, sickest residents – about 90,000 adults age 21 to 64 in nine counties who are covered by both the Medicare and Medicaid insurance programs.

The goal is to determine whether detailed management and coordination of those patients’ health care can lower their high bills. The plans will receive a set amount of money from Medicare and Medicaid to coordinate all of a patient’s care, ranging from medical equipment to hospital visits to personal care attendants. Fallon plans to borrow a page from its NaviCare plan, which was created for dual-eligible patients who are 65 and older. Each patient will be assigned a “navigator” – the plan will likely have about 90 navigators – who will coordinate services for that patient.