Bill > H982

This bill proposes that the Office of Medicaid, also known as MassHealth, create a new program focused on improving the quality and coordination of healthcare for Medicaid beneficiaries by using managed care in a more effective way. The program will be "goal-driven" and "performance-based," meaning it will set specific objectives and measure success based on how well those objectives are met. A key aspect of this new approach is the increased use of "value-based payment arrangements," which are ways of paying healthcare providers that reward them for the quality of care they provide, rather than just the quantity of services. Examples of these arrangements include "shared savings" (where providers and the state share in cost savings), "bundled or episodic payments" (paying a single price for all services related to a specific condition or episode of care), and "global payments" (a fixed payment for all services for a patient over a period). The bill also specifies that MassHealth should work closely with its managed care organizations, which are private companies contracted to provide services to Medicaid recipients, and encourage innovation in payment methods. Providers who take on financial risk for patient care will need to obtain a "risk certificate" from the division of insurance, and the program will establish clear benchmarks for measuring quality improvement, patient access to care, and overall medical expenses.