With the official March 1 launch of Partners HealthCare’s Medicaid Accountable Care Organization (ACO), a host of tools designed to better serve the medical needs of Medicaid patients will now benefit more of our highest risk patients in this population. 

Partners HealthCare Choice builds on the tools tested as part of the MassHealth ACO pilot program launched by Partners and five other Massachusetts provider organizations in December 2016. The pilot examined the impact of population health and behavioral health interventions on Medicaid beneficiaries at Massachusetts General Hospital (Mass General), Brigham and Women’s Hospital (BWH), North Shore Medical Center (NSMC), and Newton-Wellesley Hospital (NWH). These interventions, along with new tools, will now serve Medicaid patients across the Partners system. 

While high-risk Medicaid patients represent a small percentage of Partners’ total patient population, their complex needs consume a full fifth of total healthcare spending. The ACO strategy targets quality improvements for these traditionally underserved patients, enabling Partners to be a “more responsible steward of health care costs with a patient population that is expensive for the state,” notes Eric Weil, MD, Chief Medical Officer for Primary Care, Partners Center for Population Health, and lead of the Partners’ MassHealth ACO pilot.

The ACO will map services to Medicaid patients’ physical location and medical needs, while addressing psychosocial barriers that often limit access to high-quality care. These initiatives include expansion of the Integrated Care Management Program (iCMP) with additional social workers and community health workers to serve patients’ psychosocial needs. A new iCMP Plus program, a collaboration with an organization known as Commonwealth Care Alliance, will add home-based care, primary care, emergent care, and psychiatric care for the highest-risk patients. Other ACO initiatives include the Emergency Department navigator program, recovery coaches for substance abuse, home-based outpatient care, and the Community Health Worker Collaborative. Newly added is a screening program for social determinants of health across clinical settings, to identify those patients whose social, financial, and geographic circumstances warrant referral to the ACO’s resources. 

As innovations from across the Partners system have intersected in these initiatives, collaborative teams from several divisions—from population health and community health to member relations and information technology—have worked together to bring their expertise to scale. Neighborhood Health Plan has also provided its considerable member relations, contracting, and technical infrastructure expertise as a health plan well-versed in the needs of MassHealth patients.

Though the effort to evolve how care is provided to 100,000 MassHealth patients is significant, the program’s architects say early signs are encouraging.

“The interventions have already begun to demonstrate financial savings by helping us better care for this vulnerable population,” says Dr. Weil. 

Read more here.

Topics: Access to Care, Community Health Centers, Medicare/Medicaid

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