Fallon MassHealth and APMs
*	A large at risk provider group manages 52% of FCHP’s MassHealth population
*	Provider assumes risk share on the majority of medical expenses
*	There is no cap on surplus share for any of the risk pools
*	There is a downside cap on hospital risk pool losses which protects the provider from significant deficits
*	The provider  works to keep I/P admissions and lengths of stay down; most referrals within provider’s own medical group; and use the lowest cost providers without compromising quality
*	Arrangement has resulted in better MLR and high quality scores, #1 NCQA ranked Medicaid plan

Implementing APMs at Fallon Health
*	Assessing Provider Readiness
*	Size and stability of patient panel
*	Provider scope (primary care, specialty care, hospital, etc.)
*	Ability to coordinate care with Fallon Health’s Clinical Dept.
*	Participation in a Joint Oversight Committee
*	Group must have a Medical Director and an EMR system
*	APM variations
*	Full risk model for large provider organizations
*	Focused provider arrangements on specific types of services such as lab or radiology
*	Aligned incentives with subcontractors