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 Outcomes
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

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.

Active 2012

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 

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