MassHealth’s 1115 waiver authorizes $1.8 billion over five years for new Delivery System Reform Incentive Program (DSRIP) funding. DSRIP funds support the restructuring of MassHealth’s delivery system to promote integrated, coordinated care and hold providers accountable for quality and total cost of care.
Specifically, DSRIP will support MassHealth’s transition to Accountable Care Organizations, including funding to establish Community Partners to integrate behavioral health, long term services and supports and health-related social needs, and funding to support statewide investments to efficiently scale up statewide infrastructure and workforce capacity in support of MassHealth restructuring.
DSRIP funding is a one-time federal investment that began at the start of State Fiscal Year 2018 and will end after five years. Over the course of the five years, DSRIP funding will phase down as programs become sustainable and reliance on the payments declines.
MassHealth is investing the DSRIP funds in three major initiatives: Accountable Care Organizations (60%, $1 billion), Community Partners/ Community Service Agencies (30%, $547 million), and Statewide Investments (6%, $115 million). Additionally, MassHealth utilizes DSRIP funding (4%, $73 million) to support robust implementation and oversight of the DSRIP program.
If you have any thoughts or suggestions for consideration in MassHealth’s restructuring process, please submit them to MassHealth.Innovations@MassMail.State.MA.US
MassHealth is investing the $1.8 billion DSRIP funds in the following initiatives:
- Accountable Care Organizations (60%, $1 billion) – ACOs are a network of primary care providers who work in partnership with hospitals, specialists, LTSS providers, and state agencies to coordinate all of a member’s care. ACOs focus on improving this coordination, better engaging members in their care, and on integrating behavioral health care, medical care, long-term services and supports, and health-related social services. ACOs are accountable for the quality, member experience and cost of care for members.
- Community Partners/Community Service Agencies (30%, $547 million) – CPs and CSAs are community-based health care and human service organizations that provide specialized wraparound supports and care coordination for MassHealth members with complex long term medical and/or behavioral health needs who are enrolled in ACOs, Managed Care Organizations, or the Adult Community Clinical Services (ACCS) program, which is administered by the Department of Mental Health.
- Statewide Investments (6%, $115 million) – SWIs are a set of direct state investments intended to efficiently scale up statewide infrastructure and workforce capacity in support of the ACO and CP programs. SWIs are directed toward efforts to efficiently scale up statewide infrastructure and workforce capacity in support of MassHealth restructuring (e.g., workforce development, technical assistance) and high priority health issues (e.g., Emergency Department boarding, accommodations for members with disabilities)
"Our restructuring will improve health care for 1.9 million MassHealth members and ensure a strong health care program now and in the future." - Marylou Sudders, Secretary of Health and Human Services.
Accountable Care Organizations (ACOs)
60% ($1 billion) of DSRIP funds will be invested in Accountable Care Organizations (ACOs). ACOs are networks of primary care providers who work in partnership with hospitals and specialists to coordinate all of a member’s long term services and supports, medical, and behavioral health care. ACOs:
- Are rewarded for value – better health outcomes and lower cost – not volume.
- Strengthen members’ relationship with their primary care provider, who engage members in their care and coordinate to help them navigate all the services they need.
- Focus on better coordinating care and engaging members in their care to improve health outcomes and reduce preventable costs (e.g., avoidable hospitalizations).
- Integrate all care a person needs, including behavioral health and physical health care, especially in the primary care setting, as well as long-term services and supports.
- Develop innovative approaches to address social needs (e.g., housing, food insecurity) that impact health.
- Are accountable for the quality, member experience and cost of care for members.
There are currently 17 approved ACOs, which launched on March 1, 2018. More information about ACOs can be found here.
"The ACO program represents a significant change in the way we contract and partner with providers. Historically, MassHealth has operated under a fee-for-service model that leads to gaps in care and inefficiencies. Under this new model, MassHealth will be partnering with provider organizations directly to deliver coordinated, quality care to members.” - Dan Tsai, Assistant Secretary and Director of the MassHealth program.
Community Partners (CPs) and Community Service Agencies (CSAs)
30% ($547 million) of DSRIP funds will be invested in Community Partners (CP) and Community Service Agencies (CSA). Of that $547 million, approximately $539 million will be invested in CPs and approximately $8 million will be invested in CSAs.
CPs are community-based behavioral health (BH) and long term services and supports (LTSS) organizations that provide highly specialized wraparound care coordination supports to members with certain complex BH and LTSS needs who are enrolled in ACOs, MCOs, or the Adult Community Clinical Services (ACCS) program. CPs actively outreach and engage individuals and families; assess needs, provide options and refer to services; and help navigate long term services and supports, medical, behavioral health, and health-related social services. DSRIP funding for CPs will support care coordination activities as well as infrastructure and capacity building. There are currently 27 CPs, which launched on July 1, 2018. More information about CPs can be found here.
CSAs are community-based organizations that primarily provide pediatric BH care coordination supports as part of the MassHealth Children’s Behavioral Health Initiative. CSAs do not receive DSRIP funding for care coordination activities, as those activities are funded through existing channels. However, 17 of the CSAs are currently receiving DSRIP funding for infrastructure and capacity building to strengthen their ability to connect with medical providers.
6% ($115 million) of DSRIP funds will be invested as Statewide Investments (SWI). SWIs are intended to ensure the success of ACOs and CPs by expanding statewide healthcare infrastructure and workforce capacity, and by providing direct technical assistance.
SWIs are broken out into three categories:
More information about SWIs can be found here.
"The (1115) waiver allows us to implement a nationally-leading model of accountable, coordinated care which better serves members and recognizes the importance of integrating social services and community-based expertise into delivering health care." - Dan Tsai, Assistant Secretary for Health and Human Services who leads the MassHealth program.
In October 2018, the Center for Medicare and Medicaid Services (CMS) approved MassHealth’s protocol for a $149 million Flexible Services Program as a component of the DSRIP program.
The Flexible Services Program may pay for health-related nutrition and housing supports for certain ACO members. The Flexible Services Program supports the broader MassHealth goal of addressing the health-related social needs of its members as part of the ACO program.
Massachusetts’ DSRIP Protocol was initially approved on May 15, 2017, and is effective July 1, 2017, through June 30, 2022.
To read the DSRIP Protocol and approval letter, please visit the MassHealth page on the Centers for Medicare & Medicaid Services (CMS) website.
DSRIP Executive Summaries – Accountable Care Organizations
Use the links below to review ACO executive summaries.
DSRIP Executive Summaries – Community Partners
Use the links below to review CP executive summaries.
DSRIP Executive Summaries – Community Service Agencies
Use the links below to review CSA executive summaries.