The new ACOs feature a value-based payment structure for providers who had largely been paid fee for service for MassHealth members in the past. For members, this means the opportunity to receive medical, behavioral, dental and long-term support services in an integrated model of care. This will improve quality of care, the member experience, and potentially help stabilize Medicaid costs in Massachusetts.
"We support the Commonwealth's goal of providing integrated health care to MassHealth members that is more efficient and improves their overall health," said Tom Croswell, president and CEO of Tufts Health Plan. "We have partnered with four highly-regarded provider groups, all of whom share our vision of what collaboration and highly coordinated care can look like."
Continued Croswell: "Tufts Health Plan has an excellent reputation for our collaborative approaches with providers. We've been working with value-based contracts for more than 20+ years, starting in our Medicare Advantage plans. We know first-hand that working closely with providers on coordinating care results in healthier members. We're excited to broaden our success and bring this approach to our Medicaid members."
MassHealth ACO transformation is a major component in the state's five-year innovative 1115 Medicaid waiver from the federal government, which allows Massachusetts to restructure the current health care delivery system for 1.9 million MassHealth members.
Tufts Health Plan's ACO partners are:
Atrius Health, which provides high quality, patient-centered and coordinated care to more than 740,000 adult and pediatric patients in eastern and central Massachusetts.
Cambridge Health Alliance, an academic community health system committed to providing high quality care in Cambridge, Somerville and Boston's metro-north communities. CHA has expertise in primary care, specialty care and mental health/substance use services, as well as caring for diverse and complex populations.
About Tufts Health Plan Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage. Staying true to our mission of improving the health and wellness of the diverse communities we serve, we touch the lives of more than 1.1 million members in Massachusetts, Rhode Island and New Hampshire through employer-sponsored plans; Medicare; Medicaid and Marketplace plans, offering health insurance coverage across the life span regardless of age or circumstance.
We continually rank among the top health plans in the country based on quality and member satisfaction:
Our private HMO and PPO plans are rated 5 out of 5 and our Medicaid plan is rated 4.5 out of 5 by the National Committee for Quality Assurance.[i]
Our Tufts Medicare Preferred HMO and Senior Care Options plans received a 5-star rating from the Centers for Medicare & Medicaid Services, the highest rating possible.[ii]
[i]The National Committee for Quality Assurance Private Health Insurance Plan Rankings and Medicaid Health Insurance Rankings 2016-2017.
[ii] Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov. Tufts Medicare Preferred HMO plans received 5 out of 5 stars for contract year 2016 and 2017.