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Medicaid Accountable Care Organization (ACO)

The Challenge

The single largest expense in the Massachusetts state budget is the state’s Medicaid program, known as MassHealth. At more than $15 billion per year, MassHealth is approximately 40% of the state budget and growing.

Among MassHealth patients, those with the highest costs present a unique set of needs and challenges. More specifically, data have shown that high-cost MassHealth patients have a higher prevalence of behavioral health conditions, often compounded by unmet social needs, that drive utilization and cost and signal a need for targeted care management strategies.

In an effort to address both the health and quality of care of our MassHealth recipients, as well as control escalating costs, Mass General Brigham has joined the state’s efforts to restructure MassHealth provider payments from a traditional Fee-for-Service model to an Accountable Care Model (“ACO”) for MassHealth members – further incentivizing a focus on care quality.

Our Solution

On December 1, 2016, BWHC joined other Mass General Brigham entities - and 5 other health care organizations in Massachusetts - in the launch of the MassHealth Accountable Care Organization (ACO) Pilot. The pilot will run until December 2017, at which time the full MassHealth ACO project will begin. The MassHealth ACO at Mass General Brigham is called Mass General Brigham Care Connect and focuses on BWHC MassHealth PCC plan patients only.

Billed by the Baker Administration as "part of the most comprehensive restructuring of the Medicaid program in more than 20 years," the overall ACO program is part of a new five-year Medicaid waiver (the Federal 1115 waiver) that Gov. Baker negotiated with the Obama Administration. Financially, the pilot consists of shared savings and losses. For the pilot, there is no federal or state funding, but some Mass General Brigham funds will available to build out specific program components. However, there will be federal funds available to the state over five years for the full ACO

The overall goals of the MassHealth ACO will be twofold: 1) to identify the unmet medical and non-medical needs of our MassHealth PCC plan patients that are driving inappropriate health care utilization and costs and 2) to address those needs through the development and enhancement of our care delivery systems and community partnerships. Participation in this pilot will allow BWH to test and measure new, risk-based care delivery models while also leveraging the infrastructure and resources of existing programs (such as the Integrated Care Management Program and Behavioral Health Integration).

The Brigham and Women's Medicaid ACO pilot consists of approximately 7,000 MassHealth PCC plan patients, the majority of whom are cared for at 3 primary care practices: Brookside Community Health Center, Southern Jamaica Plain Health Center and The Phyllis C. Jen Center for Primary Care. These three pilot sites along with the emergency department will be the focus of intervention during the Medicaid ACO pilot period.

Results to Date

This pilot has just kicked off, results will be shared at a later date. Be sure to check back here for updates on this important project!


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