Health

16 HE ALTH • Summer 2019 Aer less than a year, Central Mass. ACOs appear to benefit patients, providers and insurers • By Susan Shalhoub PHOTOS/FILE Early positive returns T hough the true numbers won't be reported until this fall, the early word from Central Massachusetts accountable care organization (ACO) partners is they are happy with the way the MassHealth restructured system of care delivery has been established, implemented and integrated. ACOs were championed by Gov. Charlie Baker and others throughout the healthcare world as a way to curb rising costs while improving the qual- ity of care. Essentially, an insurer compensates a provider for keeping an entire population of people healthy, rather than simply treating individuals when they get sick. The early returns are positive in Central Massachusetts, in part, because the region had strong foundations and took an easier road in incorporating the new structure compared to other parts of the state. Worcester insurer Fallon Health had a built-in advan- tage working with provider Reliant Medical Group in Worcester, said Michael Nickey, vice president of state programs for Fallon. "These two have a very intertwined history … It was much more efficient setting up with these folks, who had patients we already knew," Nickey said. "With Reliant, we are all rowing in the same direction." A bonus for the Reliant Medical Group/Fallon Health ACO – Fallon 365 Care – was both had similar values to MassHealth. Reliant has a strong IT infrastructure as well. And so far, the ACO is on track. "We've been monitoring our own financial performance, which is one piece of the puzzle," said Jonathan Chines, Reliant's vice president of payer contracting and network strate- gy. "The information we have is more qualitative at this point, but in general we expect generated cost savings for Reliant and state Medicaid. It's too early to say what the magni- tude of that savings will look like, Chines said, but the new system has allowed the medical group to prevent a lot of emergency-room visits, which he calls a win-win. "It's a cost to MassHealth and the taxpayers that you'd like to avoid," he said. "It's also – for a lot of patients – not the appropriate place to get treat- ment," like if those patients need to start on a medication-assisted treat- ment for opioid abuse, for example. Reliant has about 260 physicians over 20 locations in 11 communities. The news is good statewide, too, said MassHealth Assistant Secretary Dan Tsai. "As the program completes its first year of implementation, MassHealth and its 17 ACO organizations, have made progress in improving member care, strengthening the important connection between members and pri- mary-care providers, and integrating behavioral health with physical health," Tsai said. Having doctors and other healthcare providers more focused on keeping entire populations healthy, as opposed to treating people only when sick, is the main purpose behind accountable care organizations. Here, providers at Milford Regional Medical Center work on care. Michael Nickey, vice president of state programs, Fallon Health Jonathan Chines, vice president of payer contracting and network strategy, Reliant Medical Group

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