Health

16 HEALTH • Winter 2017 How a MassHealth makeover could set a new standard for care \\ By Emily Micucci I t's an experience known to many. You show up in the emer- gency room with an acute medical problem, and are bom- barded with questions about your health, from medica- tions taken to surgeries received. You may be subject to tests that you've recently under- gone, because the provider seeing you doesn't have access to your medical history. It's an added step at a time when you want answers and relief, and it isn't cheap. ACCOUNTABLE CARE There are a number of ways health- care systems and physician groups are trying to tackle this problem, but it's difficult to do in a healthcare delivery system that lacks cohesion. For Medicaid patients in Massachusetts, the experience will soon begin to change. On March 1, 2018, a large portion of people covered by MassHealth, the state Medicaid insurance program, will be transitioned into a new system of healthcare delivery that is intended to improve their care while making the program economically sustain- able. Designed by the Baker Administration, the new MassHealth Accountable Care Organization pro- gram will end fee-for-service pay- ments for providers treating MassHealth patients. Fee-for-service care has historically dominated the U.S. healthcare system, but it doesn't provide much incentive for providers to manage the cost of care as well as the quality. Meanwhile, Accountable Care Organizations, which have been piloted by both the federal and state governments within government-funded insurance pro- grams, hold providers accountable for delivering cost-effective healthcare, with incentives tied to certain quality measures and cost benchmarks. An ACA feature The ACO concept was written into the Affordable Care Act, though other managed care networks that provide similar incentives to providers have long existed within the commercial insurance space. Half a dozen ACOs have been participating in the MassHealth ACO pilot program since December 2016, accounting for 160,000 patients. But now, 850,000 patients will become part of a MassHealth ACO, a sizeable chunk of the program's 1.9 million members. The new MassHealth ACO program funnels $100 million to providers, to be used for a variety of initiatives, such as improving care coordination with behavioral health providers, improving electronic health records and analytic Seventeen healthcare companies are involved in the transition of MassHealth away from fee-for-serve and toward accountable care. Dr. Michael Older, a gastroenterologist at Ayer's Nashoba Valley Medical Center, which is participating, is shown here. MassHealth budget The state Medicaid program has been a major contributor to healthcare spending growth in recent years. Sources: Blue Cross Blue Shield of Massachusetts Foundation; Massachusetts Budget and Policy Center; Mass.gov 0 $5B $10B $15B $20B FY15 MassHealth budget FY16 FY17 FY18 $14.7B $14.7B $15.4B $16.6B P H O T O S / C O U R T E S Y

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