The Baker-Polito Administration announced today that 17 health care organizations across the state have executed agreements to participate in a major restructuring of the MassHealth program. Effective March 1, 2018, Accountable Care Organizations (ACOs), networks of physicians, hospitals and other community based health care providers, will be financially accountable for cost, quality, and member experience for over 850,000 MassHealth members.
“Today’s ACO agreements will directly lead to better and more coordinated care for MassHealth members across the Commonwealth,” said Governor Charlie Baker. “Under the new agreements, ACOs will be held accountable for the cost of their services and overall health outcomes of their patients. These changes, coupled with our nation-leading level of coverage and the $50 billion federal Medicaid waiver our administration successfully secured last year, will help ensure that Massachusetts continues to lead the country in affordable, quality health care.”
“Under the new ACO model, health care providers will be paid to improve the care coordination and health outcomes for MassHealth members,” said Massachusetts Secretary for Health and Human Services Marylou Sudders. “As part of the ACO program’s focus on quality, MassHealth will be tracking member experience and is committed to improving the care members receive.”
The ACO program supports MassHealth’s commitment to:
- Improve quality and member experience and integrate the full spectrum of care including medical care, behavioral health and long term services and supports (LTSS),
- Provide clinical and community based support for populations with behavioral health and long term health care needs,
- Shift incentives to hold providers accountable for quality and total cost of care for a population of patients,
- Invest in primary care and community workforce development,
- Allow for innovative ways of addressing social determinants of health, and
- Expand access to substance misuse disorder treatment, including treatment for co-occurring disorders.
“The ACO program represents a significant change in the way we contract and partner with providers,” said Dan Tsai, Assistant Secretary and Director of the MassHealth program. “Historically, MassHealth has operated under a fee-for-service model that leads to gaps in care and inefficiencies. Under this new model, MassHealth will be partnering with provider organizations directly to deliver coordinated, quality care to members. ”
The ACO program is a major component in the state’s five-year innovative 1115 Medicaid waiver, bringing in $1.8 billion in new federal investments to restructure the current MassHealth system. ACOs will receive more than $100 million in new investments throughout the remainder of 2017 to support the transition of health care providers providing value-based care. Funds will be used to:
- Enhance care coordination and management efforts through formal partnerships with certified Behavioral Health and LTSS Community organizations,
- Improve electronic health records and ACO analytic capabilities,
- Reduce avoidable inpatient and emergency department utilization, and
- Implement other key initiatives for ACOs to improve health outcomes and member experience under the new payment models.
Since December 2016, six ACOs have been participating in the MassHealth ACO Pilot program covering approximately 160,000 members.
Member enrollment in ACOs will be based upon their relationship with their current primary care provider to ensure continuity of care. All ACO models support MassHealth’s commitment to invest in community based organizations, referred to as certified community partners for behavioral health and long term services and supports. These organizations will be announced by the end of August, once the procurement process has been completed.
The following is the full list of approved MassHealth ACOs:
- 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
- Children’s Hospital Integrated Care Organization with Tufts Health Public Plans
- Community Care Cooperative, an organization of 13 federally qualified health centers.
- 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
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.
The development and implementation of the ACO program is being supported by Funding Opportunity Number CMS-1G1-12-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
