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.
Dual Eligible | 2703 SPA | CPC | CPC+ | PCMH QHP | PCMH Legislation | Private Payer |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI) | Multi-Payer | Statewide |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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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 |
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Cigna Accountable Care Program - BayCare Health System | Commercial | Western Massachusetts | Cigna Collaborative Care Program |
Legislation | Status | Year |
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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. |
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 |