Serving Vulnerable Populations: Commonwealth Care Alliance’s Senior Care Options and One Care Plans

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The Challenge: How Can Integrated Managed Care Plans Best Serve Vulnerable Populations?

Individuals who are dually enrolled in Medicare and Medicaid are highly vulnerable and incur significant healthcare costs. These individuals often have low incomes, experience high rates of chronic conditions, and have significant needs for long-term services and supports (LTSS). Integrated care aims to address the needs of this population by improving coordination of the services they receive. However, the most effective strategies for achieving this service integration are not yet fully understood.

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Our research focused on Commonwealth Care Alliance (CCA), an integrated care plan serving about 48,000 dually eligible individuals in Massachusetts. CCA offers two plans: the Senior Care Options (SCO) plan for older adults and the One Care Plan for younger dually eligible individuals. Researchers aimed to examine CCA’s care model and plan operations, and to gather members’ perspectives on the plans.

Key Findings


Findings from key informants, including individuals involved in various aspects of internal plan management and external individuals knowledgeable about the plans:

  1. Origin: CCA has been shaped by its roots as a provider-led organization developed in collaboration with consumers within the supportive and progressive Massachusetts policy environment.
  2. Culture: CCA’s organizational culture focuses on addressing the health needs of its members and helping them avoid institutionalization. To achieve these goals, CCA provides flexible benefits and promotes access to social determinants of health.
  3. Teamwork: Flexible teams and collaboration are central to the CCA model. In addition to a care partner (a clinician), teams may include a behavioral health specialist, a community health worker, or an independent LTSS coordinator.
  4. Behavioral Health: CCA plans feature a high level of behavioral health integration. Behavioral health specialists may serve as the primary point of contact for some plan members with behavioral health needs. The plans collaborate with community-based organizations serving this population and, in some cases, delegate responsibility for care management to these organizations under the health home model.
  5. Community-Based Organizations: CCA’s provider network includes a variety of community-based organizations, a crisis stabilization unit, and a community paramedic service called instED, which offers urgent care in members’ homes.

Findings from Focus Groups with CCA Plan Members

  1. Satisfaction: CCA plan members expressed high satisfaction with their plan; nearly all respondents said they would not switch plans if given the opportunity to do so.
  2. Access: Members consistently praised the quality of their medical care and their ability to access that care.
  3. Non-Medical Benefits: Members appreciated the plans’ non-medical benefits, including support for social determinants of health and access to long-term services and supports.
  4. Care Partners: The relationships between plan members and care partners varied. Some members—particularly those with long-standing care-partner relationships—reported positive experiences, while others reported negative experiences, primarily due to high staff turnover.
  5. Behavioral Health Support: Members with behavioral health needs expressed gratitude for the help they receive through CCA.
  6. Communication: Communication issues significantly impacted member satisfaction, both positively and negatively.

Challenges

  1. Small Scale: Key informants described challenges related to the plan’s small scale, which they felt limited its resources and increased risk.
  2. Information Infrastructure: The plan’s information infrastructure was regarded as a significant challenge.
  3. Future: Concerns about the plan’s future stemmed from the ending of the Centers for Medicare & Medicaid Services’ Financial Alignment Initiative, staffing shortages, and potential Medicaid cuts.

How to Use These Resources


The following reports provide detailed and summary accounts of Commonwealth Care Alliance’s integrated managed care plans, their behavioral health innovations, the perspectives of key informants, and the experiences of plan members. The reports also highlight related research on integrated care.

Together, these resources aim to help aging and disability advocates, policymakers, and the public better understand innovations in integrated care for individuals who are dually eligible for Medicare and Medicaid. We hope the reports will prepare readers to participate in the design and implementation of integrated managed care plans in their own states.

LeadingAge members can utilize the reports to gain a deeper understanding of resident needs and effectively integrate plan elements into their service delivery.

Reports

These materials report on Commonwealth Care Alliance’s Senior Care Options and One Care Plans. These plans serve about 48,000 highly vulnerable individuals enrolled in both Medicare and Medicaid (known as dual eligibles).

Key Informant Perspectives on Commonwealth Care Alliance’s Senior Care Options and One Care Plans

This report analyzes key informants’ views on CCA’s model of integrated care, factors that influence plan operations, and the plan’s other strategies for serving members.

Read the executive summary  

Read the full report  

Member Experience in Commonwealth Care Alliance’s Senior Care Options and One Care Plans

This report analyzes member experiences with CCA’s integrated care plans, incorporating the perspectives of its varied membership.

Read the executive summary  

Read the full report  

Behavioral Health in Commonwealth Care Alliance’s Senior Care Options and One Care Plans

Behavioral and physical health services have traditionally been delivered through separate systems, with minimal coordination between the two. This report describes how Commonwealth Care Alliance employs a range of mechanisms to better serve members with behavioral or substance use concerns.

Read the executive summary  

Read the full report  

Qualitative Evaluation of Commonwealth Care Alliance’s Senior Care Options and One Care Plans

This report describes the qualitative methods used by the research team to collect and analyze the data used for the CCA evaluation project.

Read the full report  

Integrated Care Models for People Dually Eligible for Medicare and Medicaid

This review synthesizes the literature on integrated care models serving individuals dually eligible for Medicare and Medicaid, including both older (aged 65 and over) and younger (aged 21–64) adults.

Read the literature review  

Project Team and Partners

This project was conducted by the LeadingAge LTSS Center @UMass Boston, with support from Arnold Ventures.

Research Team:

Research Assistants:

  • Sophia Casale
  • Alanna Frost
  • Jeein Jang
  • Mengshi Liu
  • ConstanzaTamara MattaGallero
  • Maryssa Pallis

Spanish-language Facilitator:

  • Sofia Ladner

This study was conducted between June of 2023 and June of 2025. In April 2025, CCA was acquired by CareSource, a nonprofit managed care organization.