MassHealth ACO Program Outreach & Education

Overview of the MassHealth ACO Program

As reported earlier, the MassHealth ACO program begins March 1, 2018. MassHealth ACOs will be accountable for all managed care eligible services, including physical health, behavioral health, and prescription drugs.  In later years, it is expected that long-term care services and community-based supports will be introduced.  Seventeen ACOs will participate in three types of ACO models: Accountable Care Partnership Plans (13), Primary Care ACOs (3), and MCO Administered ACOs (1).  It is expected that more than 815,000 lives will be in the MassHealth ACO program.  These individuals will be those who are younger than 65 years of age, have MassHealth as their primary coverage, and are not on Medicare or covered by other insurance.

MassHealth also recently re-procured its Managed Care Organization program.  Whereas today there are six MCOs serving MassHealth members, beginning March 1 there will be just two. One of the reasons for this reduction is because many of the MassHealth members today will now be in the ACO program.  MCOs will serve many members whose Primary Care Physicians (PCPs) are not in ACOs, estimated to be approximately 300,000 MassHealth members.  It is important to note that some of the former MassHealth MCOs such as Fallon, Health New England, and Neighborhood Health Plan will serve as MCO partners in the ACO Accountable Care Partnership Plans along with BMC HealthNet and Tufts.

The Primary Care Clinician (PCC) program will also continue for PCPs that choose not to participate in an ACO or MCO.

MassHealth Member Communications

Enrollees will face a number of choices given the ACO and MCO changes.  A good understanding will be needed to help inform patients how their coverage and provider options could change.   One of the most significant changes compared to the past is that PCPs participating in ACOs will be exclusive to that single ACO.   Members who take no action and whose PCP is in an ACO will be “special assigned” to that ACO.  Many members that are in MCOs that no longer will be participating will also have to make a change or will be auto assigned.

Even after a member is assigned to an ACO, members will have the opportunity to change ACOs/MCOs during a Plan Selection Period which will run between March 1, 2018 and May 30, 2018, after which members will not be able to change except for special circumstances.   New applicants applying after March 1 will also have a 90-day Plan Selection Period.

MassHealth has begun its outreach campaign to members to inform them of their choice.  Members will receive in the mail a letter and this enrollment guide.  In the MassHealth letter, members will be notified of their choices and what will happen if they do not to make their own choice, which in most cases will be assigning the member to the ACO/MCO that includes their PCP if known.

Member notices began in mid-November and were targeted to about 300,000 members whose PCP was not associated with one of the new ACOs.  About 200,000 of these members do not have to change MCOs as their current MCO was either BMC Health Net or Tufts Together.  About 100,000 members are in an MCO that will sunset and therefore they will have to make a new choice or will be auto assigned to an ACO/MCO (auto-assignment rules have not yet been determined).

The next wave of letters will target the 815,000 lives that will be special assigned to an ACO because their PCP joined an ACO.  This group will also be notified in batches through December.

New MassHealth Website

MassHealth has created a new website for enrollees to learn about their ACO and MCO options:www.masshealthchoices.com.  The website includes a PCP search tool showing the ACOs and MCOs that the PCPs participate in.  From there, members can also research which specialists, hospitals, and other providers are available in the ACO or MCO. A list of hospitals by ACO/MCO is available here through the search function on the masshealthchoices website.   The hospitals are also identified in the enrollment guide mailed to members.

Members and those assisting members can view the ACOs and MCOs available in a MassHealth member’s service area (within 25 miles of zip code).  PCPs sites can also be viewed by plan.  When searching for PCPs, please note only those in the ACOs are displayed.  PCPs in the two MassHealth MCOs and the PCC plan must be searched on a separate site.  (Links are noted on the same page as the ACO PCP search.)

Hospitals and providers are encouraged to explore this website.  If you identify any issues, please report them to MassHealth.  The contact person for provider issues related specifically to the masshealthchoices website is Whitney Rudin who can be reached at whitney.rudin@state.ma.us.

Provider Education

EOHHS recently published this provider bulletin that provides a general overview of the ACO program including how it will affect members, access to care, enrollment rules, and ACO contact information.  For updated information, please continue to check the MassHealth provider website, including the provider payment delivery innovation website.

Providers are also encouraged to log into the Learning and Productivity Center for MassHealth Providers located at www.masshealthtraining.com.   Information on MassHealth Payment and Care Delivery Innovations (PCDI) can be found here including webinars and documents.   Providers can register for future webinars that will take place every week in December as well as in-person training that will be offered in January.

For Certified Application Counselors (CACs), there is also further detail available on the MassHealth Learning System located at http://mahealthconnector.absorbtraining.com.  This is where assistors must complete coursework to be recertified as a CAC and take training on the new ACO program.   CACs must recertify by December 31, 2017.  Please see this notice for further information on CAC training.