Massachusetts has tentatively selected six organizations to participate in a three-year, capitated payment model demonstration for dual eligible patients.
Enrollment in the program is set to begin in February. From the 10 organizations that applied, the six selected include Blue Cross and Blue Shield of Massachusetts, Boston Medical Center HealthNet Plan, the Commonwealth Care Alliance, Fallon Total Care, Neighborhood Health Plan and Network Health.
Massachusetts was the first of 26 states to sign an MOU with the Centers for Medicare & Medicaid Services for a dual eligible care demonstration. The state will test the capitated financial alignment model with its roughly 111,000 Medicare-Medicaid eligible beneficiaries between the ages 21 and 64.
CMS's aim is to streamline and improve what are largely fragmented and costly healthcare delivery systems for often-disabled Americans enrolled in both Medicaid and Medicare. Many of the applications for demonstrations emphasize a form of coordinated care broadly modelled after patient-centered medical homes; 18 states want to test the capitated model, five want to test the managed fee-for-service model and three want to test both.
Massachusetts’ demonstration emphasizes patient relationships with independent-living counselors and community organizations, as one way to prevent costly and unnecessary hospitalizations. What the state calls integrated care organizations, or ICOs, provide and help coordinate MassHealth and Medicare benefits, behavioral health services and independent living services.
The ICOs will contract with the Massachusetts Department of Health and Human Services and with CMS, receiving a global payment from MassHealth and Medicare, and independent living counseling will be overseen by certain coordinators at community organizations.
Massachusetts has less experience with managed care than other states, and annual spending per dual eligible patient in Massachusetts was around $23,000 in 2009, compared to the national average of $16,000, according to the Kaiser Family Foundation.
The demonstration will run statewide, and it has spurred collaboration between some health plans and health management and services firms.
The Blue Care Partnership, set to operate in 11 of the state’s 14 counties, is a joint venture between Blue Cross Blue Shield of Massachusetts and the Massachusetts Behavioral Partnership, a provider of mental health services to about 430,000 people enrolled in the MassHealth Primary Care Clinician Plan.
The Worcester-based non-for-profit Fallon Community Health Plan formed a joint venture called Fallon Total Care with the Connecticut-based Magellan Health Services, a diversified healthcare management company working in areas of behavioral health, radiology, public sector pharmacy benefits and Medicaid administration.
“This is a transformational event for Magellan as we move aggressively from developing a Medicaid strategy for the future to implementing Fallon Total Care's unique model of care to specific states,” Scott Markovich, the company’s senior VP for Medicaid strategy, said in a press release.
The Commonwealth Care Alliance, like Fallon Community Health Plans, has its roots in the late 1970s. Since 2003, the not-for-profit Commonwealth Care Alliance has operated managed care programs for seniors and disabled individuals.