In the largest change to Massachusetts Medicaid (MassHealth) in 20 years, the state has named the 18 accountable care organizations selected to care for 900,000 MassHealth members. Following a successful pilot program, the new MassHealth ACO program will roll out across the state in January 2018.
Thomas Barker, attorney at Foley Hoag, told Boston Business Journal that no other state is moving as aggressively as Massachusetts to shift its Medicaid program to accountable care - “this is the state saying we’re progressing along, we’re not slowing down.”
The MassHealth ACO program is a cornerstone of the state’s five-year 1115 Medicaid waiver that brings in $1.8 billion in Delivery System Reform Incentive Payments (DSRIP) for restructuring the current health care delivery system for MassHealth’s 1.9 million members.
There will be three MassHealth ACO models, reflecting the diversity in the Massachusetts delivery system. In two of the models, ACOs will partner with Managed Care Organizations (MCOs) while in the third model, ACOs will contract directly with MassHealth. All models redesign care in ways that:
- 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
- Provide clinical and cultural support for populations with behavioral health and long term service needs
- Allow for innovative ways of addressing the social determinants of health.
Marylou Sudders, Massachusetts Secretary of Health and Human Services: "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." Photo: Commonwealth of Massachusetts
Dan Tsai, Assistant Secretary, Director of MassHealth: "We know the current fee-for-service system leads to gaps in care and inefficiencies. 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."
Stan Hochberg, MD, Chief Quality Officer, Boston Medical Center: "Budget-type arrangements such as ACOs align incentives and strongly support meaningful investments in population health, care management, managing between acute visits, and addressing how housing and homelessness and other social determinants impact outcomes." Photo Credit: Boston Medical Center
Christina Severin, President & CEO, Community Care Cooperative: "The strategy is to address things that happen to people who live in poverty for a long time. For example, the chronic stress and exposure to trauma experienced by people living in poverty can often lead to issues with mental health and substance-use disorders. We are planning to implement a really different model of care that seeks to de-medicalize people’s needs as much as possible. Photo Credit: Community Care Cooperative
Eric Weil, MD, Chief Medical Officer, Center for Population Health, Partners HealthCare: "The direction health care needs to go is a direction where clinicians aren’t paid in a transactional fee for service manner. The creation of an ACO that manages patients over a period of time and based on total cost of care ... will change the way we deliver care to these MassHealth patients, and will change the way our patients receive services."
Photo Credit: Massachusetts General Hospital
Eric Dickson, MD, CEO, UMass Memorial Health Care: "Pay us for sickness and mistakes, and you’ll get sickness and mistakes. Pay us to keep people at home and healthy, and that’s what you’ll get. Less hospital and more community programs—asthma prevention in schools, community gardens, stopping falls at home. None of us want it the way it is now, and it’s perfectly designed to deliver those results until we change them."
Photo Credit: UMass Memorial
List of MassHealth ACOs selected for contract negotiation
- Atrius Health with Tufts Health Public Plans
- Baystate Health Care Alliance with Health New England
- Beth Israel Deaconess Care Organization with Tufts Health Public Plans
- Boston Accountable Care Organization with Boston Medical Center HealthNet Plan
- Cambridge Health Alliance with Tufts Health Public Plans
- Central Massachusetts Accountable Care Organization with Tufts Health Public Plans
- Children’s Hospital Integrated Care Organization with Tufts Health Public Plans
- Community Care Cooperative
- Health Collaborative of the Berkshires with Fallon Community Health Plan
- Lahey Health
- Mercy Health Accountable Care Organization with Boston Medical Center HealthNet Plan
- Merrimack Valley ACO with Neighborhood Health Plan
- Partners HealthCare ACO
- Reliant Medical Group with Fallon Community Health Plan
- Signature Healthcare Corporation with Boston Medical Center HealthNet Plan
- Southcoast Health Network with Boston Medical Center HealthNet Plan
- Steward Medicaid Care Network
- Wellforce with Fallon Community Health Plan
Boston Business Journal
Commonwealth of Massachusetts