Mercy Health ACO Announces State Certification for New Program

SPRINGFIELD — Mercy Health ACO announced that the Massachusetts Health Policy Commission (HPC) certified it as an accountable-care organization (ACO) in the HPC’s new, first-in-the-nation program. The HPC’s first round of ACO certification includes 17 HPC-certified ACOs and is a significant milestone for Massachusetts, making it the first state to implement statewide, all-payer standards for care delivery.

“We are pleased to take the next step in this important effort to improve care for MassHealth patients and reduce costs for the Commonwealth,” said Mark Fulco, president of Mercy Medical Center.

Mercy has formed an ACO partnership with Boston Medical Center (BMC) Health System, including its affiliate, BMC HealthNet Plan. The Mercy ACO will provide coverage, care, and services to MassHealth enrollees in Western Mass.

The HPC’s ACO certification program is closely aligned with efforts by the Executive Office of Health and Human Services (HHS) and the MassHealth to improve health and reduce healthcare cost growth in the Commonwealth through ACOs. The goal is a healthcare delivery system that delivers coordinated, patient-centered health care that accounts for patients’ behavioral, social, and medical needs.

“The ACO program represents a significant change in the way MassHealth contracts with healthcare organizations throughout the state,” said Massachusetts Secretary for Health and Human Services Marylou Sudders. “The goal of the ACO program is to improve the care coordination and health outcomes for 850,000 MassHealth members, and we are pleased they all met the thorough certification standards.”

For the first year of the program, the HPC defined a set of criteria on which to assess ACOs for certification against that goal. However, unlike other state or federal programs, the HPC’s certification program evaluates ACOs on an all-payer basis, including for their Medicaid, Medicare, and commercially insured patient populations.

The HPC-certified ACOs include a diverse cross section of 17 healthcare organizations from across the Commonwealth. Importantly, the HPC will certify all organizations participating in the MassHealth ACO program.

“The ACO certification program will bring new transparency and information to the public regarding how ACOs are structured and operating today,” said David Seltz, HPC executive director. “The HPC expects to analyze the information received and identify best practices and areas of improvement for payers, policy makers, researchers, providers, and consumers.”

In order to be evaluated for certification, organizations were required to provide information for 15 standards, including patient-centered governance, performance-improvement strategy, experience in quality-based risk contracts, population-health management programs, and ability to coordinate cross-continuum care. Full certification is effective for two years, and organizations with provisional certification must apply for full certification within one year.

“Mercy Medical Center’s new ACO is big step forward for increasing access and affordability in Western Massachusetts,” said state Sen. James Welch. “I am excited to see this new and innovative program come into action and proud that Mercy is helping the Commonwealth carry the torch of healthcare delivery transformation to the benefit of our citizens and as an example to the nation.”