Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care.

ABSTRACT:

Importance

In 2023, the Massachusetts Medicaid and Children's Health Insurance Program (MassHealth) required accountable care organizations (ACOs) to increase payments to primary care practices and shift to monthly payments, currently calibrated to historical revenues and enhanced practice capabilities, such as being staffed to address behavioral health needs. To prevent rewarding practices for avoiding difficult patients, future payments to primary care practices should reflect their patients' apparent need.

Objective

To describe MassHealth's initiative and a complexity-adjusted payment model.

Design, setting, and participants

This cross-sectional study of payment model development and performance was conducted between February 2022 and November 2024. Participants in

SUBMITTER: Ash AS 

PROVIDER: S-EPMC11791707 | biostudies-literature | 2025 Feb

REPOSITORIES: biostudies-literature