Massachusetts Secretary for Health and Human Services Marylou Sudders announced the next steps in the MassHealth program’s transition from the current fee-for-service system towards coordinated and integrated care to improve members’ health and contain costs under its innovative five-year 1115 waiver.
The MassHealth program is launching its new Community Partners model with two procurements: community based providers: with expertise in Behavioral Health and with Long Term Services and Supports. MassHealth will make significant investments in the Community Partner program, with $401 million over 5 years to Behavioral Health organizations to provide comprehensive and active care management to adults with serious mental illness and/or Substance Use Disorders (SUD) and $145 million over 5 years to organizations providing active care coordination for people with complex health needs requiring long-term services and supports which include physical disabilities, traumatic brain injury, intellectual or developmental disabilities..
These procurements follow the recently received proposals from twenty health care organizations to serve as ACOs. ACOs critical components of the most comprehensive restructuring of the state’s MassHealth program in more than 20 years. ACOs are organized groups of doctors and other health care providers working together to care for their patients.
Together, Community Partners and Accountable Care Organizations (ACO)s will deliver integrated, comprehensive care for the whole person and improve member health outcomes. Community Partners will receive funds for care coordination activities, infrastructure and capacity building.
Under MassHealth’s federal waiver, ACOs are eligible for $1.8 B of Delivery System Reform Incentive Payments (DSRIP), which will allow these organizations to invest in primary care providers, infrastructure, and capacity building. ACOs are required to partner with Community Partners for management of complex Behavioral Health and Long-Term Services and Support populations. MassHealth anticipates announcing selected ACOs in May 2017.
ACOs are compensated under an alternative payment methodology that includes shared savings as well as risk for shared losses and will be rewarded for improving our members care while keeping costs under a target. Full ACO implementation is anticipated in December 2017.
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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