My Care Family: Lawrence General’s New Accountable Care Organization

If you follow health care news you are probably aware that the Commonwealth of Massachusetts is deep into its effort to overhaul its Medicaid program, MassHealth. The goal of Governor Baker and his Executive Office of Health and Human Services is in line with the themes of other health care reform efforts: increase access to care, improve the quality and continuity of care, and decrease the cost. Lawrence General Hospital, in partnership with Greater Lawrence Family Health Center and Neighborhood Health Plan, has now been approved and contracted as one of 17 Medicaid Accountable Care Organizations (ACO) in the state. In the coming weeks and months, this partnership, doing business under the name My Care Family, will work through a rigorous series of deadlines identified by the state to be ready to go live with our new offering for MassHealth patients on March 1, 2018.

An ACO is a model for health care that uses a provider-led organization to better integrate and manage members’ care to achieve the goals of reform. They are called “accountable” because the state will hold us responsible for providing patients with needed care in the most efficient way we can and on a fixed budget. If we save the state money, we share in those savings. If we overspend our budget, we are at risk to absorb those extra costs. Along with the hospital, health center, and BIDCO primary care physicians, the PHO’s specialty physician and post-acute participants have been designated as the local ACO network of specialists and facilities, to which care will be directed, with NHP’s full network available to fill any specialty gaps. Patients will be assigned to our ACO if they are a patient of a participating PCP now, with an estimate of 35,000 patients expected to be in our ACO.

The communication process will be intense over the next six months, as we work to educate our PHO clinicians, our post-acute partners (nursing and rehab facilities), and hospital employees to this new world of Medicaid. The state will also be providing extra resources to help patients understand these changes, although patients will retain their primary care physicians for minimal disruption. Other preparations include establishing the clinical connections (both human and electronic) that will help us to build and operate a highly efficient, accessible, culturally sensitive health care system for this population of patients.

Multiple working teams are meeting and planning portions of the larger picture. In late-September, the group announced a new chief executive officer for this partnership. Dean Cleghorn, the former vice president for quality and performance at the health center, has recently transitioned into this role. More to come with this very exciting and innovative work!