Health

20 HEALTH • Winter 2018 T his spring, the state ventured into a new system of medical care for MassHealth, the state's Medicaid insurance program, by giving patients options in one of 17 new groups that provide both care and insurance. Each of those so-called accountable care organizations are aimed at making health care more accessible to MassHealth patients and keep costs down, with incentives tied to quality measurements and cost thresholds. Source: State of Massachusetts In Central Massachusetts, that has meant new care systems for Reliant Medical Group and Fallon Community Health Plan. The two Worcester-based companies have partnered on one ACO, and Fallon works in two others, with Health Collaborative of the Berkshires to cover the westernmost edge of the state and with Wellforce, the company that oversees Lowell General Hospital and Tufts Medical Center, which covers much of the east- ern half of the state. "We're really encouraged so far," said Jonathan Chines, Reliant's vice president of payer contracting and net- work strategy. Reliant, which has a network of nearly 300 physicians, had a bit of a head-start on other ACOs, which include many of the state's biggest names in health care, including Partners HealthCare and Tufts Health Plan. Reliant and Fallon had already been working together under a man- aged care contract to help treat Medicaid patients. Their new ACO, which has around 30,000 patients, goes by the name Fallon 365 Care. "For Reliant, the program is less of a brand-new initiative as much as it is in some ways an evolution in what had been a productive relationship with Fallon in the last decade in a half," Chines said. Statewide, the accountable care organization program is still in its infancy, but the state is encouraged by its progress, said Elissa Snook, a spokeswoman for the Executive Office of Health and Human Services. The organizations have an enroll- ment of more than 860,000, and enrollment has been stable, Snook said, suggesting that members have embraced the new system. The state doesn't yet have data on the new system's financial perfor- mance, Snook said. There are signs that costs may be coming down in Central Massachusetts, at least. Reliant staff has combed through data and found, for example, that visits to emergency rooms by its patients are down. "We think measures like that really indicate the level of engagement of our patients," Chines said. Patients in Fallon 365 Care likely wouldn't notice too much of a differ- ence with the new system. They may carry a new insurance card, Chines said, but still receive their care with the same staff and at the same facili- ties. Most of the 30,000 participants in Fallon 365 Care were already receiv- ing their care at Reliant. For Reliant Medical Group, the new accountable care partnership with Fallon has improved patient care by integrating primary care more closely with behavioral health and substance abuse treatment, Chines said. Barriers that have often made it more difficult for patients to receive care in those specialty areas have largely gone away, he said. For Fallon, the accountable care organization system has brought the company to two very different areas of the state, said Michael Nickey, the insurer's executive director of MassHealth programs. Fallon is now in rural areas of the Berkshires, where many doctors' prac- tices may have just one or two doctors Allison Bernier, the vice president of the Central Community Health Partnership, said participants are still learning under the state's new MassHealth system. Keeping spending in check The state's budget for managed care under MassHealth, the state's Medcaid program, in the last five years: 0 $1B $2B $3B $4B $5B $6B 2015 2016 2017 2018 2019 $4.8B $5.9B $5.4B $5.6B $4.8B Budget (Numbers rounded) Central Mass. agencies partnering in new, familiar ways under MassHealth \\ By Grant Welker A NEW SYSTEM OF CARE P H O T O / G R A N T W E L K E R

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