MassHealth Innovations

We at MassHealth commit ourselves to a sustainable, strong program for our 1.9 million members. Our goal is to transform the basic structure of MassHealth, which has not changed for the past 20 years.

Currently, MassHealth pays providers on a fee-for-service basis for each visit, procedure, or test. This can result in uncoordinated care and high costs. In March 2018, MassHealth is launching a new system of provider-led organizations called Accountable Care Organizations, or ACOs. These entities are provider led organizations that coordinate care, have an enhanced role for primary care, and are paid based on care outcomes verses the volume of services provided. In addition, we are making changes to our managed care organization (MCO) program to align with these new goals. These new entities will work with Community Partners, community-based organizations that provide care coordination to ACO and MCO members. To make this happen, we negotiated a new 5-year 1115 waiver with the federal government. This includes $1.8 billion of investment over 5 years.

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