MassHealth taps vendors to provide technical assistance to new ACOs

Massachusetts is looking to transition the state’s Medicaid program to an accountable care model.

Massachusetts’ Medicaid program has enlisted the services of outside firms to provide technical assistance to the state’s new MassHealth accountable care organizations and community partners.

An online marketplace has been created as a “one-stop shop” to help the MassHealth ACOs and community partners access technical assistance services from 47 vendors “intended to help them succeed in the new accountable care environment.”

Last year, 17 healthcare organizations across the state executed agreements to participate in a major restructuring of the MassHealth program. As of March 2018, the ACOs are financially accountable for cost, quality, and patient experience for more than 850,000 MassHealth members.

To help these ACOs increase efficiency, lower costs and improve outcomes, master contracts have been awarded by MassHealth to firms to help transition the state Medicaid program to an accountable care model.

Massachusetts negotiated a 1115 waiver with the Centers for Medicare and Medicaid Services that allows the state to use a managed care delivery system to deliver benefits to Medicaid recipients, and it includes a $1.8 billion investment over five years. The goal is to transform the basic structure of MassHealth, which the state says has not changed in the past 20 years.

“They are using the waiver programs to essentially recast MassHealth into a value-based purchasing program,” says Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, a non-profit services firm that was awarded a master contract to provide technical assistance to the new ACOs.

According to Tripathi, ultimately 80 percent of Medicaid recipients in Massachusetts will be in an accountable care type of arrangement with value-based purchasing kinds of payment structures. “It’s a pretty ambitious goal,” he adds. “It touches every hospital and large healthcare organization in the state.”

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Under the MassHealth Delivery System Reform Incentive Payment (DSRIP) Technical Assistance Program, master contract awardees provide support across nine domains, including care coordination and integration, healthcare IT/health information exchange, population health management and social determinants of health.

The vendors were selected for their expertise, experience and skill in providing technical assistance in areas identified by ACOs and community partners as current priorities, according to MassHealth. Funds will be used to improve electronic health records and ACO analytic capabilities.

“They’re taking the DSRIP dollars—which is about $1.5 billion combined for ACOs and community partners—and are using it to invest in the infrastructure,” notes Tripathi. “It takes a fair degree of investment by those organizations to really be able to perform in those new payment models.”

DSRIP is designed to support MassHealth’s transition to ACOs as well as funding to establish community partners to integrate behavioral health, long-term services and supports, and health-related social needs.

“There are 27 community partners that will partner with the ACOs to meet the needs of people in the MassHealth program that extend beyond just acute care,” adds Tripathi. “What they’ve done is created this web-like ecosystem across the state to take care of these patients.”

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