As it rolls out the biggest changes to its Medicaid program in two decades, the state has enlisted six health care provider networks to start testing a new model of delivering and paying for medical care.
The organizations plan to launch pilot programs on Thursday that will cover about 160,000 residents signed up for Medicaid, known here as MassHealth. They include some of the state’s biggest hospitals and hospital systems: Partners HealthCare, Steward Health Care System, University of Massachusetts Memorial Health Care, Boston Medical Center, and Boston Children’s Hospital. A new organization called Community Care Cooperative — a network of community health centers — also is participating.
MassHealth is the joint state-federal program that provides health coverage to 1.9 million individuals and families with low or no incomes. Providers who serve MassHealth patients typically bill the state for every service they provide. Under the pilot programs, they will be paid set budgets for care. If they come in under budget, they can keep some of the savings. If they exceed the budget, they will be responsible for some of the losses.
The six providers are setting up accountable care organizations, or ACOs, which are networks of doctors, hospitals, and other health care facilities that collectively manage care for a group of patients. Such models are aimed at encouraging health care providers to help patients manage their illnesses, resulting in fewer hospital admissions. Patients included in the pilot may not notice many changes at first, but over time their providers are likely to roll out new services to help manage care.
The concept isn’t new – many hospital systems already use accountable care for patients on Medicare and commercial insurance.
“ACOs will work closely with community-based health organizations to better integrate care for behavioral health, long-term services and supports, and health-related social needs,” Marylou Sudders, secretary of health and human services, said in a statement. “We look forward to learning from this one-year pilot as we restructure the Medicaid program.”
Earlier this month, Governor Charlie Baker’s administration received federal approval to move MassHealth from the current fee-for-service system to accountable care. Administration officials say the changes are necessary to rein in soaring costs and provide quality care to MassHealth recipients.
State health officials assigned 160,000 MassHealth members to participate in a pilot program, notifying them through letters. The members don’t have to change their doctors, and they can choose to opt out of the pilot at any time, officials said.
Full implementation of the accountable care system is scheduled to begin in December 2017.