Provider Reporting

MassHealth’s Provider Facing Reporting and Transparency Initiative

MassHealth is transitioning from fee-for-service, siloed care and into integrated, accountable care models. MassHealth is committed to provider facing reporting and data transparency to support providers in their journey towards accountable care. Therefore, MassHealth has launched a major initiative to provide data reports to requesting providers both before launch of ACO models and throughout the performance year. This initiative will include several phases; applications for Phase 1 reports closed on June 24, 2016. Later phases will present more opportunities for providers to receive data.

These data reports will offer providers insight into their financial, quality and care delivery performance as well as how they compare against their peer. These data reports will include data elements such as:

  • Member characteristics, including breakdown by rating category and specific diagnoses
  • Member panel distribution across various MassHealth managed care products
  • Member utilization patterns, including site of care
  • Trends in emergency department (ED) visits, inpatient hospitalizations, and re-admissions
  • Quality performance
  • Aggregate and detailed total cost of care (TCOC) performance

Phase 1 (applications closed June 24, 2016): Reports for the first phase of this initiative will be released starting in early July

Providers will be able to access three types of reports:

  1. Summary level report on quality and utilization performance,
  2. Claims extract report on historical utilization, and
  3. Member roster report on member panel composition.

For more information about the data reports, please see the Provider Reporting User Guide*.

For a sample report, see Round 1 Summary Level Report Sample*.

Later Phases: Subsequent rounds of reporting will build on the Phase 1 reports, and will include data books with details on ACO total cost of care targets and regular performance reporting throughout 2017 to support providers in ACO model implementation.

* Efforts are currently underway to convert the Provider Reporting User Guide and Round 1 Summary Level Report sample documents into an alternative accessible format. The Massachusetts Executive Office of Health and Human Services is committed to achieving meaningful accessibility to this online environment for all users, including users with disabilities. We recognize that this version of the Round 1 Summary Level Report Sample document may not work for all users. If you are a user with visual impairments who needs alternative access to the presentations, please contact us by email: MassHealth.Innovations@MassMail.State.MA.US.

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