Payment & Care Delivery Innovation (PCDI) for Providers

Effective April 1, 2023, new MassHealth health plans will be available to MassHealth members. There will be 17 MassHealth Accountable Care Organizations (ACOs). ACOs are MassHealth– managed health care plans that are:

• made up of integrated networks of physicians, hospitals, and other community-based health care providers;  

• accountable for the quality, cost, and member experience of care for ~1.3 million MassHealth members; and   

• responsible for providing high-value, cross-continuum care across a range of measures. Current MassHealth health plan options are available at MassHealthChoices.com 

ACOs are groups of doctors, hospitals, and other health care providers who give coordinated, high-quality care to MassHealth members. This way, MassHealth members get the right care at the right time. 

There are two types of ACOs members can enroll in: Accountable Care Partnership Plans or Primary Care ACOs. In both, ACOs are led by providers, not just administrators. Primary Care Providers (PCPs) are at the center of the member’s care. Providers work with members directly and know their needs. PCPs will have a bigger part in working with members to make decisions about care in an ACO than in other types of health plans. 

There are two types of ACOs.

• Accountable Care Partnership Plans 
• Primary Care ACOs 

Accountable Care Partnership Plans

In this type of ACO, a network of PCPs works with just one MCO to create a full network that includes PCPs, specialists, behavioral health providers, and hospitals. PCPs plan and coordinate care to meet the needs of the member.

Primary Care ACOs

In this type of ACO, a network of PCPs has joined together into an ACO to provide integrated and coordinated care for members. The ACO contracts directly with MassHealth and uses the MassHealth provider network of specialists and hospitals. Members who enroll in a Primary Care ACO receive behavioral health services through the Massachusetts Behavioral Health Partnership (MBHP). 

MassHealth continues to offer Managed Care Organizations (MCO) and the Primary Care Clinician (PCC) Plan to its members. 

Managed Care Organizations (MCOs)

MCOs are health plans run by insurance companies. These plans provide care through their own provider network which includes PCPs, specialists, behavioral health providers, and hospitals. Care coordinators are employed by the MCO.

Primary Care Clinician (PCC) Plan

In the PCC Plan, primary care providers are called primary care clinicians (PCCs). The MassHealth network of PCCs, specialists, and hospitals delivers services. The Massachusetts Behavioral Health Partnership (MBHP) provides behavioral health services.