MassHealth Partners with 18 Health Care Organizations to Improve Health Care Outcomes for Members

12 Jun 2017 8:40 AM | Brian Kelley (Administrator)

Press release June 8, 2017

BOSTON – The Baker-Polito Administration announced today that 18 health care organizations across the state have been selected to participate in MassHealth’s Accountable Care Organization (ACO) program beginning January 2018.  The 18 ACOs, networks of physicians, hospitals and other health care providers will work together to provide integrated  health care for their patients with the goals of improving their health and containing costs.  These ACOs are expected to cover over 900,000 MassHealth members and include approximately 4,500 primary care providers.

"Our administration was pleased to secure an innovative Medicaid waiver worth over $50 billion for the Commonwealth and it has allowed us to begin making the first major overhaul of MassHealth in 20 years,” said Governor Charlie Baker. “The restructured Accountable Care Organization program will promote integration and coordination to benefit patients, while holding providers accountable for their quality and cost.”

“We are pleased with the overall quality and depth of the health care providers that are joining us in restructuring MassHealth’s current fee-for-service payment system,” said Massachusetts Secretary for Health and Human Services Marylou Sudders.  “All of the ACOs selected will integrate their efforts with community-based health and social service organizations to improve behavioral health, long-term supports and health-related social needs for MassHealth members as appropriate.”

The ACO program is a major component in the state’s five-year innovative 1115 Medicaid waiver that brings in significant new federal investment to restructure the current health care delivery system for MassHealth’s 1.9 million members.   The waiver provides $1.8 billion in new federal investments, referred to as Delivery System Reform Incentive Payments (DSRIP), to support the transition of health care providers providing value-based care.

"We know the current fee-for-service system leads to gaps in care and inefficiencies,” said Dan Tsai, Assistant Secretary and Director of the MassHealth program. “The ACOs we selected demonstrate a strong commitment to improving care for the members they serve and will be held to high standards for quality and access of care.”

Since December 2016, six ACOs have been participating in the MassHealth ACO Pilot program covering approximately 160,000 members and have already demonstrated early successes.  For example, Partners Healthcare ACO is connecting members with home and community based services to avoid costly hospitalizations wherever possible, and to bring primary care services to members in their homes.  MassHealth anticipates that the positive results demonstrated by the Pilot ACO program will continue with the full implementation and investments under this reform.

There are three ACO models giving providers a range of options to reflect the diversity in the Massachusetts delivery system.  Two of the models include ACOs partnering with Managed Care Organizations (MCOs) to improve care for members, while in the third model ACO providers will contract directly with MassHealth. All models support MassHealth’s commitment to:

  • Expand substance misuse disorder treatment,
  • Invest in primary care and community workforce development,
  • Invest in Community Partners for behavioral health and long term services and supports. MassHealth is currently in the process of certifying Community Partners and anticipates entering contract negotiations in August 2017,
  • Provide clinical and cultural support for populations with behavioral health and long term service needs, and
  • Allow for innovative ways of addressing the social determinants of health.  

When fully implemented, ACOs will be the way the majority of MassHealth members receive care.  Member enrollment into ACOs is tied to their relationship with their current primary care physician to ensure continuity of this important relationship.   Members who wish to opt-out of the ACO enrollment may do so within 90 days of being enrolled in a plan.  MassHealth will also maintain the traditional managed care organization (MCO) program and is in the process of re-procuring it this year. In addition to partnering with ACOs, MCOs will continue to serve MassHealth members not enrolled in ACOs.

Additional information on MassHealth’s planned restructuring and payment reforms for its 1.9 million members may be found on the MassHealth Innovations website at www.mass.gov/hhs/masshealth-innovations.

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For more information,
please contact Arleen Coletti
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