August 18, 2017

Reliant, Fallon in, UMass out of ACOs

Courtesy
Worcester-based Fallon Health has joined with fellow city provider Reliant Medical Group to form a care organization under MassHealth.

Worcester-based health care organizations Reliant Medical Group and Fallon Health are joining together in a planned new feature of MassHealth to begin next March, they announced Thursday.

UMass Memorial Medical Center will not be one of the 17 such groups statewide.

Reliant and Fallon announced their plan to form a providers group known as an accountable care organization or ACO to be called Fallon 365 Care. Each ACO will be part of MassHealth, the state Medicaid program that is being reformed with the new organizations.

Anyone eligible for MassHealth in the coverage area that includes much of Worcester and Middlesex counties who has a primary care provider with Reliant Medical Group or Southboro Medical Group, which is part of Reliant, will be enrolled in Fallon 365 Care. Reliant and Fallon said physicians, hospitals, insurers and other providers will work together to improve health and contain costs.

Richard Burke, the president and CEO of Fallon Health, said Fallon is "perfectly positioned to provide care under the ACO model" because of its experience of providing care through other government programs. Reliant President and CEO Dr. Tarek Elsawy said Reliant was anxious to collaborate with Fallon Health and help meet the needs of MassHealth patients.

UMass said it and its partners decided after careful consideration not to participate in the MassHealth program. It stressed that Medicaid patients in the region will continue to be able to see their current providers.

"Each provider remains committed to serving all of the patients in Central Massachusetts," UMass said in a statement. "Over the past year, all participants collaborated closely, at the highest levels of our leadership, to develop a quality and sustainable partnership that would allow each entity to bring strengths and expertise to an ACO plan. Despite best and continuous efforts it was determined that the financial risks were too great."

In addition to UMass Memorial Medical Center, the group includes Harrington Hospital, Community Health Connections of Fitchburg, the Edward M. Kennedy Community Health Center, Family Health Center of Worcester and Heywood Physician Hospital Organization.

In all, there are 17 ACOs that will begin care next March 1 to 850,000 MassHealth patients:

  • Atrius Health with Tufts Health Public Plans
  • Baystate Health Care Alliance with Health New England
  • Beth Israel Deaconess Care Organization with Tufts Health Public Plans
  • Boston Accountable Care Organization with Boston Medical Center HealthNet Plan
  • Cambridge Health Alliance with Tufts Health Public Plans
  • Children's Hospital Integrated Care Organization with Tufts Health Public Plans
  • Community Care Cooperative, an organization of 13 federally qualified health centers.
  • Health Collaborative of the Berkshires with Fallon Community Health Plan
  • Lahey Health
  • Mercy Health Accountable Care Organization with Boston Medical Center HealthNet Plan
  • Merrimack Valley ACO with Neighborhood Health Plan
  • Partners HealthCare ACO
  • Signature Healthcare Corporation with Boston Medical Center HealthNet Plan
  • Southcoast Health Network with Boston Medical Center HealthNet Plan
  • Steward Medicaid Care Network
  • Wellforce with Fallon Community Health Plan
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