UMass Memorial withdrawing from Medicaid ACO initiative
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UMass Memorial, which was one of the six health provider organizations that participated in Massachusetts Medicaid's ACO pilot, said it's lost money on the program and therefore will not participate in the larger initiative that begins next March.
That ACO model will cover more than 850,000 MassHealth members out of 1.9 million statewide. The pilot covers 160,000 members.
UMass Memorial acknowledged Thursday that it projects deficits stemming from its current pilot ACO program and the Primary Care Payment Reform Initiative. Independent actuaries told the organization that it was likely those losses would be greater in the next generation model.
"The new ACO program has much more risk, and taking on additional risk will challenge our ability to provide care to the underserved in Central Massachusetts and support the state's only public medical school," spokesman Anthony Berry said to Modern Healthcare on Friday.
UMass Memorial did not disclose how large the projected losses are.
For the next round of the ACO, UMass Memorial was working with Tuft Health Plans, Harrington Hospital on behalf of its physician hospital organization, Community Health Connections of Fitchburg, Edward M. Kennedy Community Health Center, Family Health Center of Worcester and the Heywood physician hospital organization. The current ACO is at UMass Memorial and its physician partners.
The hospital and its physician groups will continue to see Medicaid patients, who make up 27% of the system's patient volume.
Seventeen other organizations will participate in the expanded ACO initiative, from an alliance of federally qualified health centers to giants like Partners HealthCare ACO.
Medicaid patients do not have to go to the ACOs where they are assigned. The ACOs are tasked with integrating behavioral health, long-term care and medical care, expanding access to substance abuse, and improving member experience and quality. Those providers' payments will be based on health outcomes and how they manage total cost of care.
"The ACO program represents a significant change in the way we contract and partner with providers," said Dan Tsai, Assistant Secretary and Director of the MassHealth program. "Historically, MassHealth has operated under a fee-for-service model that leads to gaps in care and inefficiencies. "
The state will distribute $100 million to the 17 organizations for coordinating with behavioral health and long-term care organizations, improving data analysis, and implementing initiatives to reduce avoidable hospitalizations and ER visits while improving outcomes.
The state did not respond to a request for comment by deadline.
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