Massachusetts

As a leader in health care reform and innovation, Massachusetts is dedicated to transforming its payment and delivery systems to transition away from FFS to a system of value-based purchasing stragtegies. MassHealth, the state Medicaid program, is expanding value-based purchasing strategies for Managed Care Organizations and aims to expand this initiative to include global payments by MCOs to integrated care organizations and other integrated providers, and transition primary care provider payment methodologies into alignment with Patient-Centered Medical Homes. 

In 2012, Massachusetts enacted Chapter 224 of the Acts of 2012 to slow the growth in state health care costs, improve quality of care and patient outcomes, and increase transparency and oversight of provider and payer price and cost data. The law builds on the momentum in the private market by providing for the development of processes for the certification of organizations as accountable care organizations and patient centered medical homes. In addition, the law creates a “Model ACO” program through which organizations can be designated as “Model ACOs” and receive priority from MassHealth, the Group Insurance Commission, and the Health Connector.

 

CHIPRA: 
Yes
MAPCP: 
No
Dual Eligible: 
Yes
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
6,595,300
Uninsured Population:
4%
Total Medicaid Spending FY 2013: 
$13.2 Billion 
Overweight/Obese Adults:
58.0%
Poor Mental Health among Adults: 
35.8%
Medicaid Expansion: 
Yes 

Delivery System Transformation Initiatives (DSTI)

The Delivery System Transformation Initiatives (DSTI) program is a performance-based incentive payment program to support and reward safety net hospitals for investing in delivery system transformation projects that advance the triple aims of better care, better population health, and lower costs. In addition, DSTI supports safety net providers’ investments in the infrastructure and capacities necessary to prepare for the transition away from fee-for-service payments toward alternative payment arrangements that hold providers accountable for the quality and cost of care.

Blue Cross Blue Shield Massachusetts - Alternative Quality Contract

Established in 2009 by Blue Cross Blue Shield Massachusetts (BCBSMA), the Alternative Quality Contract (AQC), is described as an innovative global payment model that uses a budget based methodology, which combines a fixed per-patient payment (adjusted annually for health status and inflation) with substantial performance incentive payments (tied to the latest nationally accepted measures of quality, effectiveness, and patient experience).

Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI)

The Patient Centered Medical Home Initiative (PCMHI) is a three-year public-private partnership to support primary care practice transformation. PCMHI began in April 2011 with 46 competitively selected primary care practice sites from across the Commonwealth and a multi-payer group of Massachusetts health plans working collaboratively in the three year demonstration support primary care practice transformation. The project concluded on March 31, 2014. 
 
The overall goals include: 

One Care: MassHealth plus Medicare

One Care: MassHealth plus Medicare is designed to improve coordination of services provided to dual eligibles ages 21-64; the majority of whom have extremely complex medical care needs.

North Shore Physicians Group Medical Neighborhood Demonstration - Massachusetts

This award is part of the Health Care Innovation Awards program, a Department of Health and Human Services initiative investing up to $1 billion to test promising new approaches that aim to improve health care and lower program costs for recipients of Medicare, Medicaid and the Children's Health Insurance Program (CHIP).

The Doctor's Team Will See You Now

on lun, 2014-02-17 00:00   lisabeth
Why Visit One Doctor When Some Offices Offer a Medical Entourage?

A visit to the doctor may mean seeing someone else instead. An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions.

Story Date: 
February 17, 2014
News Author: 
Laura Landro
Source Link: 
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Building Medical Homes

on mar, 2014-01-14 00:00   staci

The waiting room is full, as it is most mornings at Boston Health Care for the Homeless Program’s main facility on Albany Street in the South End. The patient, an older-looking man with a baseball hat tugged down hard on his head, walks up to the front desk and says in a blunt, raspy voice, “I want to see a nurse on the orange team.”

And we thought, “It’s working!”

Story Date: 
January 14, 2014
News Author: 
Jim O'Connell
Monica Bharel
Judith Steinberg
Source Link: 
Read More

Primary Care Behavioral Health Program

The Bedford-Edith Nourse Rogers Memorial VA Medical Center has a Primary Care Behavioral Health program missioned to integrate mental health services into primary care settings as a means to treating the person as a whole by fostering joint relationships between mental health and primary care providers and allowing participants to work side-by-side in their delivery of care.

Pagine

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