The MassHealth Accountable Care Organization (ACO) program – more than a year in the making, approved by a complex federal waiver, and the focus of massive hospital, provider, and managed care restructuring – is set to go live March 1, 2018. In mid-November, MassHealth began its outreach campaign to approximately 300,000 individuals informing them of their ACO and Managed Care Organization (MCO) options. Throughout December, MassHealth will notify about 815,000 more who are expected to be part of the MassHealth ACO program. If MassHealth members do not make an active decision, MassHealth plans to “specially assign” individuals based on their primary care physician’s (PCP) affiliation with an ACO. PCPs not participating in an ACO will also still be available in the MassHealth MCO and existing Primary Care Clinician (PCC) programs.
Health systems participating in the MassHealth ACO program have been making large investments in new health information technology, re-deploying resources, and drawing up new contracts with their provider partners within the ACO as well as with MassHealth MCOs. In ACOs, the patient’s PCP practice is usually the central entity responsible for managing and coordinating care on behalf of the patient. One of the most significant changes compared to the past is that PCPs participating in ACOs will be exclusive to that single ACO.
November also saw MassHealth reaching out to providers to educate them so that they, in turn, can educate the MassHealth members who will undoubtedly have questions about their enrollment and provider options under the new program.
This new MassHealth website
helps enrollees learn about their new options. And this provider bulletin
provides a general overview of the ACO program and managed care choices including how it will affect members, access to care, enrollment rules, and ACO contact information.