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.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Multi-Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI)	Multi-Payer	Statewide

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Atrius Health - CMS Pioneer ACO	Medicare	Eastern, Central Massachusetts	CMS Pioneer ACO
Beth Israel Deaconess Physician Organization - CMS Pioneer ACO	Medicare	Eastern Massachusetts	CMS Pioneer ACO
CHIPRA Massachusetts Medical Home Initiative	Grant	13 practices across the state	CHIPRA Quality Demonstration Grant
CMS Health Care Innovation Award - Vinfen Corporation	Grant	Boston area	CMS Health Care Innovation Award (Round 1)
CMS State Innovation Model Test Award - Massachusetts	Grant	Statewide	CMS State Innovation Model (SIM)
Delivery System Transformation Initiatives (DSTI)	Medicaid		Medicaid Section 1115 Waiver
Greater Boston Aligning Forces for Quality Initiative (AF4Q)	Grant	Boston	Aligning Forces for Quality
Massachusetts Alliance for Complex Care (MACC)	Grant	Boston area	CMS Health Care Innovation Award (Round 2)
Mount Auburn Cambridge Independent Practice Association (MACIPIA) - CMS Pioneer ACO	Medicare	Eastern Massachusetts	CMS Pioneer ACO
North Shore Physicians Group Medical Neighborhood Demonstration - Massachusetts	Grant	Salem	CMS Health Care Innovation Award - PCMN Demonstration
One Care: MassHealth plus Medicare	Medicare, Medicaid	Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties	CMS Dual Eligible Demonstration
Partners HealthCare - CMS Pioneer ACO	Medicare	Eastern Massachusetts	CMS Pioneer ACO
PCORI Funding Award - Brigham and Women's Hospital	Grant	Boston area	Patient-Centered Outcomes Research Institute (PCORI) Programs
Steward Health Care System - CMS Pioneer ACO	Medicare	Eastern Massachusetts	CMS Pioneer ACO

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Aetna Patient-Centered Medical Home (PCMH) - Massachusetts	Commercial	Western Massachusetts	Aetna Patient-Centered Medical Home Program
Blue Cross Blue Shield Massachusetts - Alternative Quality Contract	Commercial	Statewide	Blue Cross Blue Shield Value-Based Care Program
Cigna Accountable Care Program - BayCare Health System	Commercial	Western Massachusetts	Cigna Collaborative Care Program

State Legislation

Legislation	Status	Year
Chapter 224 of the Acts of 2012 Chapter 224 of the Acts of 2012 was enacted 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.	Enacted	2012
SB 2774 Providers and insurers, including MassHealth, will be required to increase spending on behavioral health and primary care by 30% over three years. Calendar year 2019 spending will serve as the baseline; provider and insurer performance against the target will be based on expenditures through calendar year 2024. The legislation does not prescribe how providers and insurers must achieve the target, instead leaving decision-making to the discretion of the individual provider and insurer organization. Providers and insurers will be required to report their progress on an annual basis through existing processes overseen by the Center for Health Information Analysis (CHIA) and the Health Policy Commission (HPC).	Was Not Enacted	2022
S. 770 For the 3-year period ending with calendar year 2024, the aggregate primary care expenditure target for each of the 3 years shall be equal to a 30 per cent increase above aggregate primary care baseline expenditures, and the primary care expenditure target for each of the 3 years shall be equal to a 30 per cent increase above primary care baseline expenditures.	Was Not Enacted	2022
SD 2233 S. 750 would establish a multistakeholder Primary Care Board with a goal of increasing primary care spend to 12-15% of overall health care expenditures. The bill would also require all insurers in the state to offer a prospective, per member per month Primary Care 4 You payment to all primary care practices. The payment would be adjusted for clinical and social risk and practice capacity. Monthly prospective payments would be paid from a Primary Care Trust, rather than individual plans.	Introduced/Under Consideration	2023
Section 19, Chapter 224, Acts of 2012 Establishes a Center for Health Information and Analysis (CHIA) charged with a range of duties, incuding analyzing health costs and utilization in the Massachusetts. On September 20, 2022, CHIA subsequently released the first report on primary care and behavioral health spending in Massachusetts.	Enacted	2012
H. 1250 This broad health equity bill includes provisions requiring the Massachusetts Health Policy Commission to establish targets for primary care and behavioral health spending targets and provide analyses of progress toward those targets.	Pending	2023