- Executive Office of Health and Human Services
Media Contact for MassHealth Launches Restructuring To Improve Health Outcomes for 1.2 Million Members
Elissa Snook, Media Relations Manager
MassHealth Launches Restructuring To Improve Health Outcomes for 1.2 Million Members
Boston, MA — Boston— Today, MassHealth launched its restructured health care delivery system with the implementation of seventeen Accountable Care Organizations (ACOs) statewide. ACOs are networks of physicians, hospitals and other community based health care providers that are responsible for the quality and total cost of care for their MassHealth members. ACOs work in close partnership with health care providers and community-based organizations and will improve service by better integrating care for members through strong, team-based care coordination with specialized supports for members with complex behavioral health or long-term care needs.
“In Massachusetts, we maintain our commitment to delivering access to high-quality, affordable health care to every resident in the Commonwealth,” said Health and Human Services Secretary Marylou Sudders. “Over the next five years, we are making significant investments in behavioral health, providing more than $400 million in wraparound services for individuals with mental illness, substance misuse and co-occurring illnesses.”
1.2 million MassHealth members may now choose their health care from:
- One of 17 statewide ACOs which will cover ~800-850k members;
- Two Managed Care Organizations (MCO) which will cover ~150-200k members; or
- MassHealth’s Primary Care Clinician (PCC) Plan which will cover ~150-200k members.
The remaining 650,000 MassHealth members are not eligible either because they have secondary health insurance coverage, or they are enrolled in other integrated programs including Senior Care Options, (SCO), One Care or Program of All-inclusive Care for the Elderly (PACE).
MassHealth members are automatically enrolled in an ACO based on their existing primary care provider (PCP) or selection of a PCP, with the ability to change their health plan for any reason for 90 days after enrollment. In addition to their PCP, members have access to robust networks of hospitals and specialty providers that participate in their plan. ACOs will be measured based on their members’ satisfaction with their care and accountable for providing preventative care, managing chronic diseases like diabetes, ensuring appropriate follow-up care after a medical or behavioral health hospitalization, and integrating behavioral and physical care.
ACOs will work closely with 27 Community Partners (CPs) statewide that were selected by MassHealth to provide specialty services and care coordination for members with complex behavioral and long-term care needs. ACOs and Community Partners will also screen members for issues such as housing and food insecurity, which impact health outcomes, and connect them to social services. The CPs officially launch in June 2018 and include:
- 18 Behavioral Health CPs which help coordinate care for approximately 35,000 MassHealth members with serious mental illness, substance use disorders, or co-occurring conditions.
- 9 Long Term Services and Support CPs that help coordinate care for approximately 20,000-24,000 MassHealth members with disabilities.
“Integrating the full health care needs of MassHealth members with complex health conditions is one of the most important goals in restructuring our MassHealth program,” said Assistant Secretary Dan Tsai, who oversees the MassHealth program. “Community Partners will work with ACOs to ensure members with disabilities, significant behavioral health needs, substance use disorders and co-occurring disorders are supported in their overall health care.”
Beginning today, MassHealth members have a minimum 30-day Continuity of Care period during which all existing prior authorizations, prescriptions and previously booked appointments are honored, and members can see all of their existing providers, even if any of those providers is not in the new plan’s network. In certain circumstances and conditions, the continuity of care period will be extended. For example, pregnant women can continue to see their current OB/GYN provider throughout their pregnancy and for six weeks postpartum.
MassHealth has directed ACOs and MCOs to work with members – particularly those with complex conditions – to ensure smooth and seamless transitions of care.
Over the past two years, MassHealth has actively engaged hundreds of stakeholders, from advocates to providers, to prepare for today’s launch including convening workgroups to inform the ACO program design, organizing a series of online webinars and in-person trainings for providers, participating in public listening sessions across the state and holding weekly check-in meetings with the health care community. ACOs are a major component of the state’s five-year 1115 Medicaid waiver, bringing in $1.8 billion in new federal investments to restructure the MassHealth system.
MassHealth members are encouraged to visit www.masshealthchoices.com or call MassHealth customer service center at 1-800-841-2900 for additional information. Health care professionals can find information on MassHealth's dedicated provider website.