What is CHART? Established through Massachusetts’ landmark cost containment law, Chapter 224 of the Acts of 2012, The Massachusetts Health Policy Commission (HPC) developed the Community Hospital Acceleration, Revitalization, and Transformation (CHART) program to make phased investments in community hospitals to enhance the delivery of efficient, high-quality care. The goal of the program was to promote care delivery transformation to increase community hospitals’ ability to succeed in accountable care organizations (ACOs); to enhance access to behavioral health services and coordination between hospitals and community-based providers and organizations; and to reduce unnecessary hospital utilization. Beginning in the fall of 2015, the CHART program invested nearly $60 million across 27 Massachusetts community hospitals to develop and deploy innovative care models.
Which hospitals were CHART-Eligible? CHART eligibility was established through criteria specified in Chapter 224, as well as by regulation. Hospitals that received CHART funds included non-profit, non-teaching community hospitals with relatively low prices. Twenty-eight acute care hospitals received CHART Phase 1 funding. Thirty acute care hospitals, varying in size and affiliation and located across the Commonwealth, were eligible to receive funds in Phase 2 of the CHART Program.
What were the goals of CHART Phase 1? The HPC issued a Request for Proposals (RFP) in October 2013 to solicit responses from eligible community hospitals. Appreciating that community hospitals are diverse in size, geographic location, population need, financial health, affiliation with systems, and previous experience with investment funds, and accordingly have varied resource needs, the HPC established a phased approach to investments. CHART Phase 1 provided initial support for short term, high-need expenditures. Through these projects, the HPC assessed the capability and capacity of participating institutions, developing engagement, fostering learning, and building a foundation for system transformation. Projects included:
- Implementation of pilot models to improve quality of care and/or reduce cost
- Building capability and/or capacity to align with the goals of better health care at a lower cos
- Planning operational and business strategies that drive towards system transformation
What were the goals of CHART Phase 2? The HPC issued a Request for Proposals (RFP) in June 2014 to solicit responses from eligible community hospitals. CHART Phase 2 was intended to accelerate the transformation of CHART Hospitals through a focus on three outcome-oriented aims:
- Maximize appropriate hospital use
- Enhance behavioral health care
- Improve hospital-wide (or system-wide) processes to reduce waste and improve quality and safety
How Much Funding was Available? The HPC made a total of $10 million available for Phase 1, and up to $60 million available for Phase 2. Awards ranged from $65,000 to $500,000 in Phase 1, and up to $6 million per hospital in Phase 2.
CHART eligibility was established through criteria specified through regulation (958 CMR 5.00, below) and by Chapter 224. The three eligibility requirements that the HPC applied when determining which hospitals may receive funds are as follows:
(1) those that are not a major teaching hospital;
(2) those whose relative prices are lower than the statewide median relative price; and,
(3) those that are non-profit.