MassHealth announced payment rate increases for One Care, Massachusetts’s CMS-backed financial alignment demonstration, Sept. 22. This should come as a relief for the program’s two participating plans, Commonwealth Care Alliance and Tufts Health Plan.

Although the Massachusetts demo has been plagued with problems, including Fallon Health’s planned exit from the program Sept. 30 due to financial worries, the state continues to express faith in the initiative, and this capitation rate revision is another vote of confidence in the overall success of care coordination.

“We are pleased that we were able to stabilize the One Care program through a more sustainable and adequate set of payments that better reflect the needs of this complex population,” Dan Tsai, assistant secretary of MassHealth, said in a statement. “We believe integrated care models are the way to improve quality of care [in] the population served by the program.”

Over the next two years, Medicaid will provide $29.8 million in funds, and Medicare will contribute $17.8 million. The exact rates have yet to be announced and will vary per plan based on member mix, member risk adjustments and overall plan performance.

Commonwealth Care Alliance, which currently serves 61.7% of duals enrolled in the Massachusetts demo, is pleased that CMS has acknowledged the difficulty in meeting the needs of the complex population under the current payment structure.

“This is really good news,” CCA President Lois Simon said in the state’s press release. “We believe the steps CMS and MassHealth are taking to strengthen the financial framework of the One Care plan will enable the plans to successfully provide the array of services members need, including intensive case management for many.”

The state is also working with CMS to extend the duals demo through 2018. According to DUAL’s September update, One Care currently serves 17,337 duals.

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