Boston Medical Center Health System to Shift MassHealth Patients to Accountable Care Organization Model

(Boston) – June 8, 2017 – The Commonwealth of Massachusetts has elected to enter into contract negotiations with Boston Medical Center (BMC) Health System on its proposal to enroll low income children and adults covered by MassHealth (Medicaid) in an Accountable Care Organization (ACO) model of care. Slated to begin in January, the ACO is designed to improve care and slow the rapid growth in MassHealth costs.

BMC Health System is one of several new MassHealth ACOs approved by the state. BMC Health System and its BMC HealthNet Plan have been approved to create a total of four ACOs, one in Boston and three others throughout Massachusetts. MassHealth patients served by Boston Accountable Care Organization, which includes Boston Medical Center, its physician practices, most of its licensed and affiliated community health centers, and a number of other providers, will comprise one ACO. In addition, BMC HealthNet Plan will develop an ACO in partnership with Signature Healthcare Corporation in Brockton; Southcoast Health in New Bedford, Fall River and Wareham; and Mercy Medical Center in Springfield.

BMC Health System President Kate Walsh said that the organization’s longstanding patient and community-centered approach, understanding of MassHealth cost drivers, and its commitment to innovative, new approaches to improve care has made BMC HealthNet Plan an attractive partner for Signature, Southcoast and Mercy health systems. “We’re looking forward to combining our experience and talents to improve care for MassHealth patients and reduce costs for the Commonwealth,” said Walsh.

Moving MassHealth patients to an ACO model is an important step in sustaining the Medicaid program at a critical time. MassHealth equals nearly 40 percent of the entire state budget, and costs are rising rapidly. The problem is likely to be compounded by proposed federal budget cuts to the Affordable Care Act.

Under the new ACO model, care and reimbursement will be structured to include everything patients need to stay healthy. This includes both outpatient and inpatient services as well as community-based services for behavioral health, substance use disorders, rehabilitation, home health, adult day care, and long-term services and supports.

“As the largest safety net hospital in Boston and one of the largest MassHealth managed care insurance plans, we have a 150-year tradition of providing a full spectrum of health care, prevention and disease-management services for underserved and non-English-speaking patients. We also have deep experience in tackling tough health care and socio-economic challenges like addiction, violence, homelessness and hunger. In an ACO, these social determinants of health will be recognized as key components of keeping our patients healthy – and we’ll be paid for it,” Walsh continued.

“If we succeed, and I’m confident we will, the end result will be a stronger and financially sustainable MassHealth program that delivers better care and better health for thousands of adults and children who are depending on us for the care and services they need and deserve,” concluded Walsh.

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