MassHealth Accountable Care Organizations
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1 MassHealth Accountable Care Organizations Suzanne Curry Associate Director, Policy & Government Relations Presented for: National Association of Social Workers Massachusetts Chapter October 27, 2017
2 Health Care For All o Statewide consumer health advocacy organization o Policy/coalitions o HelpLine ( ) o Outreach o Health Law Advocates: o Community Catalyst:
3 What is MassHealth? o MassHealth = Massachusetts Medicaid + Children s Health Insurance Program (CHIP) o ~1.8 million members, including low-income adults and children, people with disabilities, seniors o Can provide primary or secondary coverage
4 MassHealth Enrollment Source: BCBSMA Foundation
5 1115 Medicaid Waivers o Federal HHS Secretary can waive certain Medicaid provisions under the Social Security Act o States can apply for approval for demonstration projects o Use federal Medicaid funds in ways that are not otherwise allowed under federal rules o Make changes in eligibility, benefits, cost-sharing, provider payments, etc. o Federal government approved comprehensive MassHealth 1115 waiver extension in November 2016 o Delivery System Reform Incentive Program (DSRIP) ACO program
6 DSRIP Waiver Main Components o ACOs o Community Partners o Flexible Services o Statewide Investments
7 1115 Waiver: DSRIP Program Accountable Care Organizations (ACOs) Certified BH & LTSS Community Partners (CPs) Flexible spending to address social determinants of health Statewide investments
8 Source: Community Catalyst
9 Source: BCBSMA Foundation
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11 o ACOs o MCOS o PCC Plan MassHealth Member Options
12 ACO Options Atrius Health with Tufts Health Public Plans Baystate Health Care Alliance with Health New England Beth Israel Deaconess Care Organization with Tufts Health Public Plans Boston Accountable Care Organization with Boston Medical Center HealthNet Plan Cambridge Health Alliance with Tufts Health Public Plans Children s Hospital Integrated Care Organization with Tufts Health Public Plans Community Care Cooperative, an organization of 13 federally qualified health centers Health Collaborative of the Berkshires with Fallon Community Health Plan Lahey Health Mercy Health Accountable Care Organization with Boston Medical Center HealthNet Plan Merrimack Valley ACO with Neighborhood Health Plan Partners HealthCare ACO Reliant Medical Group with Fallon Community Health Plan Signature Healthcare Corporation with Boston Medical Center HealthNet Plan Southcoast Health Network with Boston Medical Center HealthNet Plan Steward Medicaid Care Network Wellforce with Fallon Community Health Plan
13 BMC HealthNet Plan Tufts Health Together MCO Options
14 PCC Plan Full network of MassHealth providers
15 Timeline o November 12-December 22, 2017: Preliminary notices sent to MassHealth members o March 1, 2018: New ACO and MCO options start o March 1-May 31, 2018: Member plan selection period
16 Community Partners MassHealth definition: Community based organizations, collaborating with ACOs to provide care coordination and care management supports to individuals with significant behavioral health issues and/or complex long term services and supports needs BH CPs will serve up to 35,000 members LTSS CPs will serve up to 24,000 members
17 Flexible Services o Flexible services funding will be used to address health-related social needs by providing supports that are not currently reimbursed by MassHealth or other publicly-funded programs o ACOs can use a portion of their DSRIP funds to pilot innovative approaches to social service integration within MassHealth ACOs o Only available for MassHealth members enrolled in an ACO
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20 Statewide Investments For example: o Primary care o Technical assistance to ACOs & CPs o Workforce development & training
21 Implementation is Everything
22 Thank you! Questions?
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