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Central Mass. agencies partnering under MassHealth

December 2018


Allison Bernier, the vice president of the Central Community Health Partnership of Worcester, which is leading care agencies in treating MassHealth patients.


This spring, the state ventured into a new system of medical care for MassHealth, the state's Medicaid insurance program, by giving patients options in one of 17 new groups that provide both care and insurance.

Each of those so-called accountable care organizations are aimed at making health care more accessible to MassHealth patients and keep costs down, with incentives tied to quality measurements and cost thresholds.

In Central Massachusetts, that has meant new care systems for Reliant Medical Group and Fallon Health. The two Worcester-based companies have partnered on one ACO, and Fallon works in two others, with Health Collaborative of the Berkshires to cover the westernmost edge of the state and with Wellforce, the company that oversees Lowell General Hospital and Tufts Medical Center, which covers much of the eastern half of the state.

"We're really encouraged so far," said Jonathan Chines, Reliant's vice president of payer contracting and network strategy.

Reliant, which has a network of nearly 300 physicians, had a bit of a head-start on other ACOs, which include many of the state's biggest names in health care, including Partners HealthCare and Tufts Health Plan. Reliant and Fallon had already been working together under a managed care contract to help treat Medicaid patients. Their new ACO, which has around 30,000 patients, goes by the name Fallon 365 Care.

"For Reliant, the program is less of a brand-new initiative as much as it is in some ways an evolution in what had been a productive relationship with Fallon in the last decade in a half," Chines said.

Statewide, the accountable care organization program is still in its infancy, but the state is encouraged by its progress, said Elissa Snook, a spokeswoman for the Executive Office of Health and Human Services.

The organizations have an enrollment of more than 860,000, and enrollment has been stable, Snook said, suggesting that members have embraced the new system.

The state doesn't yet have data on the new system's financial performance, Snook said.

There are signs that costs may be coming down in Central Massachusetts, at least. Reliant staff has combed through data and found, for example, that visits to emergency rooms by its patients are down.

"We think measures like that really indicate the level of engagement of our patients," Chines said.

Patients in Fallon 365 Care likely wouldn't notice too much of a difference with the new system. They may carry a new insurance card, Chines said, but still receive their care with the same staff and at the same facilities. Most of the 30,000 participants in Fallon 365 Care were already receiving their care at Reliant.

For Reliant Medical Group, the new accountable care partnership with Fallon has improved patient care by integrating primary care more closely with behavioral health and substance abuse treatment, Chines said. Barriers that have often made it more difficult for patients to receive care in those specialty areas have largely gone away, he said.

For Fallon, the accountable care organization system has brought the company to two very different areas of the state, said Michael Nickey, the insurer's vice president of state programs.

Fallon is now in rural areas of the Berkshires, where many doctors' practices may have just one or two doctors and a nurse, and to denser communities in the eastern part of the state where there are diverse populations and far more competitors. Fallon recently purchased a mobile health clinic for the Berkshires that it'll run next year to help those farther from the region's only full-service hospital.

"They're all very different models in how they operate," Nickey said of the various regions.

Fallon was already familiar with Reliant, but it also coordinates closely with its other accountable care organization partners, Nickey said.

"It's just a learning curve, but I do weekly calls with our ACO's checking in," he said.

MassHealth has also created a community partners program in which accountable care organizations work with local agencies to handle more significant cases, such as behavioral health. The community partners began operating in the new MassHealth system in July.

The Central Community Health Partnership is paired with nine of the state's 17 accountable care organizations, or ACOs, to coordinate care for cases that need extra attention.

In Central Massachusetts, a network called the Central Community Health Partnership has been assembled for behavioral health needs that consists of Open Sky Community Services, AdCare, LUK Inc., and Venture Community Services.

There's also a long-term services and supports team to help those with physical or intellectual disabilities. That team also includes Open Sky, LUK Inc., and Venture Community Services, along with two others, Elder Services of Worcester Area and the Center for Living & Working.

Between those groups — behavioral health and long-term care, which helps with independent living — the Central Community Health Partnership has 2,500 patients.

"We know them," said Ken Bates, the president and CEO of Open Sky. "We know who their families are."

The objective at community partners programs is to get providers together to organize care, which can include figuring out public transportation or even joining patients in doctor's visits to make sure the right questions are being asked or that the patient understands a doctor's advice.

"We're still learning," said Allison Bernier, the vice president of the Central Community Health Partnership. "The ACOs are still learning. We're all still learning together."

Bates credited the state for getting local partners involved who often already work to help the same population with the new MassHealth system.

"The state really did it right," he said.