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New Provider Payer Partnerships for Mass Health

Mass Health is redesigning its managed care offerings for patients for 2018 by fostering new partnerships between providers and Medicaid plans, called Accountable Care Organizations (ACOs).  An ACO is a model for healthcare that uses a provider led organization to better integrate and manage members’ care for improved quality and lower cost.  Lawrence General Hospital and Greater Lawrence Family Health Center (GLFHC) have formed the Merrimack Valley ACO that will include most other primary care providers in our PHO.  Together with Neighborhood Health Plan (NHP), they have applied to become a Medicaid ACO.  The state is reviewing all applicants now with contracts being offered and finalized this spring and summer so that patients can choose their managed care option during the October - December open enrollment period.  Start-up and innovation costs are supported through federal and state funding for delivery system reform. Despite the activity and uncertainty in Washington on a new health care plan, the state is expecting the ACO formation effort to continue.   

The landscape in our community will likely be changing for 2018 enrollment with fewer Medicaid Managed Care Organization options and perhaps multiple new ACO options for patients. Primary care providers can participate in only one ACO, so patients will likely choose our ACO in order to stay with their current PCP.  As with the Medicare Pioneer ACO, providers will share risk on managing total medical expense and quality for enrollees, but through the close partnership with NHP, there will also be new opportunities for shared decision making on programs and funding for initiatives.     

Under the leadership of Dr. Pracha Eamranond, Lawrence General Senior Vice President, Medical Affairs and Population Health, and Dr. Joseph Gravel, GLFHC CMO, a clinical integration committee has begun identifying needs of the population and ways to address them.  Some of the key aspects that will lead to success in improving the efficient care of the Medicaid population include keeping care local, developing primary care supports in care management and to meet quality metrics, cross-community collaboration for behavioral health, substance abuse and other services, health information integration, guidelines for appropriate use of home health and PCA services, physician and patient engagement. The work the PHO has done to define a local specialist and post-acute network, focus on key quality improvement areas, develop important use cases for information integration and promote PCP-Specialist collaboration has been foundational for moving into the Medicaid ACO environment. Stay tuned for more information during the next few months on our Medicaid ACO efforts.   

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