MassHealth contracts with two Managed Care Organizations
Boston Medical Center Health Plan and Tufts Health Public Plans will care for up to 200,000 members
Boston – The Baker-Polito Administration announced today that MassHealth has selected and signed contracts with Boston Medical Center Health Plan (BMCHP) and Tufts Health Public Plans (Tufts) to manage primary, behavioral, pharmacy and specialty care for approximately 150,000 to 200,000 members in the MassHealth Managed Care Organization (MCO) program. The new MCO contracts are effective March 2018 for a five-year period through December 2022 and combined are valued at approximately $1 billion a year.
MassHealth is restructuring its health care delivery system through the implementation of 17 Accountable Care Organizations (ACOs) that are expected to cover nearly 900,000 MassHealth members effective March 2018. In addition to ACOs, members will also have the choice of selecting coverage from one of the newly selected MCOs or through MassHealth’s Primary Care Clinician Plan. Together, the three programs will cover approximately 1.2 million MassHealth members.
“The selected health plans will complement our ACO program and our commitment to improve the quality and experience of care for MassHealth members while providing administrative savings to the Commonwealth,” said Marylou Sudders, Secretary of the Executive Office of Health and Human Services. “MassHealth members will have several strong options to select from and we appreciate the participation of the Commonwealth’s health care providers and plans.”
For the first time since the MCO program began in the 1990’s, MassHealth structured a competitive procurement resulting in fewer MCOs that offer greater scale, administrative cost savings and high quality of care for members. In the December 2016 procurement solicitation, MCOs were asked to bid on quality, member experience, ability to deliver on a range of programmatic requirements, and efficiency of overhead and administrative costs. Six MCOs bid on the contract, and BMCHP and Tufts were selected for the quality of their programmatic responses as well as for reducing administrative (non-medical) costs for MassHealth.
“The outcome of our MCO procurement is another important step in our MassHealth restructuring efforts,” said Assistant Secretary Dan Tsai, who oversees the MassHealth program. “We are pleased that the majority of current MassHealth MCOs will also continue to serve our members as part of the ACO program through their partnerships with ACO providers.”
The two MCOs selected will be responsible for supporting efficient care delivery, utilization management, and ensuring that members receive high quality care. BMCHP will be available to members across the state, and Tufts will be available to members throughout most of the state, with the exception of the southern region. The new MCO contract gives MassHealth additional tools to enhance performance and contract management of its contracted health plans and sets enhanced expectations for screening for care needs and caring for complex populations. Similar to the ACO program, members enrolled in MCOs will also be eligible to receive care coordination through the Community Partners program. Community Partners are MassHealth-designated community-based organizations that have expertise in the community-based management of members with complex behavioral health or long term service needs.