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Care Model Focus Initiative (CMFI) for the MassHealth One Care Program

In January 2022, MassHealth will begin the Care Model Focus Initiative (CMFI) for One Care.

Announcement of the Care Model Focus Initiative (CMFI)

December 17, 2021 – Stakeholder announcement

Background

One Care is the integrated care capitated program that started in October 2013 for persons with disabilities (between the ages of 21-64 at time of enrollment), who are eligible for full benefits through both the Medicaid (MassHealth) and Medicare programs.

The overall focus of this program is to combine federal and state dollars to implement a model of care that delivers integrated, person-centered services to enrollees to maximize physical and behavioral health outcomes and independence for persons with disabilities. One Care objectives are to:

  • Create a comprehensive, person-centered view of each individual’s goals and needs, informed by the enrollee, including how their environment presents barriers or supports them to live independently.
  • Provide a broad range of health care services, including medical services, behavioral health services, and long-term services and supports that support a member's health and ability to live independently in the community.
  • Use a capitated financial structure paid by Medicare and Medicaid to contracted health plans that promotes innovation and flexibility in a member's care.

One Care is administered and funded through a joint contract among MassHealth, the Centers for Medicare and Medicaid Services (CMS), and participating health plans. Starting January 1, 2022, the participating health plans are Commonwealth Care Alliance (CCA), Tufts Health Unify, and for its first year in the program, UnitedHealthcare Connected. Currently there are approximately 32,000 enrollees in One Care plans.

Care Model Focus Initiative (CMFI)

Entering the ninth year of One Care, we are at an important inflection point in the program with the start of new contracts and the expansion of the program’s reach and scale. MassHealth appreciates the efforts to date of our present and future health plans, consumer advocates, providers and all other stakeholders in One Care that have carried the program through to this point.

In furtherance of its longstanding commitment to the One Care program, MassHealth is taking this opportunity to redouble our efforts to ensure that the One Care model works as intended now and in the future. MassHealth is launching the Care Model Focus Initiative (CMFI) to re-assess, re-clarify and re-focus on the Care Model for One Care, the centerpiece of the program.

The purpose of the CMFI is to intensify efforts to identify and take the action steps that will result in greater alignment, clearer expectations, and increased focus on performance around key aspects of enrollee experience, service delivery, and program accountability in One Care. CMFI will include assessment of how we are doing and how we might further enhance program execution along the domains of:

  • Person-centered care
  • Care team roles and composition
  • Assessment process/timing
  • Individualized Care Plans
  • Care coordination (including LTSS and BH)
  • Member experience and satisfaction
  • Member protections
  • Communications to and from members
  • Health equity for One Care members
  • Care Model performance indicators

In the CMFI, MassHealth will form a working core team and certain sub-groups to delve into the Care Model domains to assess what challenges exist that need more attention, prioritize areas of needed improvement, identify action steps needed to improve, and establish deliverables and timelines for those activities. We will also look at what is working well and explore ways to expand on those things.

The CMFI is intended to be a time-limited, highly focused continuous improvement effort that includes the perspectives, inputs, and the work of the key partners that determine the success of One Care. In the coming weeks, MassHealth will provide additional details on the makeup of the CMFI core team, criteria for selection of participants, and process for application. We look forward to the engagement of enrollees, health plans, the Implementation Council, advocates, and our MassHealth internal teams, in drilling down to continue and improve upon the important work of One Care.

Robin Callahan will serve as Coordinator for the Care Model Focus Initiative. Robin can be contacted at Robin.callahan2@mass.gov for input, questions, or concerns about CMFI. Additional details regarding CMFI core team participation will be posted on COMMBUYS in the coming weeks.

Thank you in advance for supporting our continued focus on One Care.

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