MassHealth Fact Sheet – FY10 H.1
 Care Management and Medical Homes 

Overview

$10M investment and $25M savings


The Care Management and Patient-Centered Medical Home Initiative seeks to create a more 
efficient and effective model of health care delivery that addresses three major health care 
system issues: 1) care fragmentation; 2) challenges associated with the increasing prevalence of 
chronic disease; and 3) a potential shortage of primary care physicians.
Enhanced care management and the patient-centered medical home model have the potential to 
improve quality for members, while increasing efficiencies in care delivery and ultimately 
decreasing health care expenditures. 
Improved care coordination, through both an enhanced care management structure and medical 
homes, supports a reduction in care fragmentation and unnecessary use of services, and 
prevention of avoidable conditions.  

The Care Management and Medical Home Initiative will test a model to transform the quality of 
and payment for primary care practices in the Commonwealth. 


FY10 Policy Initiatives

The Care Management and Medical Home initiative involves the development of an enhanced 
care management structure to meet the needs of high-cost members most likely to benefit from 
care management interventions.  

In addition, this initiative also implements a Medical Home demonstration at 50-100 PCC Plan 
primary care practices state-wide, with the intent to roll out the model more broadly in future years 
based on evaluation results. Investments will be made in training, infrastructure and financial 
support. 

The initial phase of the Medical Home demonstration will begin with PCC Plan enhancements for 
certain community health centers and primary care practices serving focus subpopulations: 
children in the custody of the Department of Children and Families and high-need members. 

The initiative will have a positive impact on members and primary care providers by improving the 
quality of care delivered and aligning payments to support enhanced care coordination.

There may be a reduction in hospital and specialist use due to improved primary care and care 
management, but these specialty providers also benefit from improved care coordination.