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 

CHIPRA Massachusetts Medical Home Initiative

To implement a medical home model of care, NICHQ is leading a 29-month Learning Collaborative (5 year initiative). Thirteen practices from across Massachusetts were selected to participate in the Collaborative. Each site will have its own Practice Transformation Facilitator to lead the adoption of medical home characteristics accompanied by the help of a Massachusetts Department of Public Health Care Coordinator. The three components to the CHIPRA Massachusetts Medical Home Initiative include: 

CMS State Innovation Model Test Award - Massachusetts

The Massachusetts model builds upon the state's history of health care innovation and multi-stakeholder engagement, its work to expand coverage, and recent legislation that commits the Commonwealth and all of its payers and providers to an ambitious transformation of the health care delivery system.

CMS Health Care Innovation Award - Vinfen Corporation

The Vinfen Corporation in partnership with Bay Cove Human Services, North Suffolk Mental Health, Brookline Mental Health, and Commonwealth Care Alliance, received a CMS Health Care Innovation Award in 2012.

Cigna Accountable Care Program - BayCare Health System

Under the program, Baycare Health Partners monitors and coordinates all aspects of an individual's medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists.

Greater Boston Aligning Forces for Quality Initiative (AF4Q)

Beginning first with diabetes, pediatric asthma and hypertension, AF4Q plans to build and implement a sustained effort to improve ambulatory care and avoid preventable ED and hospital use. All three conditions have high rates of prevalence in the Greater Boston area, with higher rates of incidence in minority populations.

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