Mass Moving on Comprehensive Payment Reform

The Massachusetts Committee on the Status of Payment Reform Legislation has begun meeting regularly with an aggressive schedule to  draft an outline of legislation to implement comprehensive payment reform.  Secretary Judy Ann Bigby, who chairs the Committee,  has committed to a process that is open to input from all interested stakeholders and experts.

The Committee will next convene on October 6th;  on the agenda:  the structure and regulatory construct for creating and monitoring Accountable Care Organizations.   Among the questions to be considered: what will be legislated in terms of operating structure and what will be left  to a proposed “Oversight Board” to monitor?   How tightly integrated should operating ACOs be – and can many different models for “integration” exist?   How will members be assigned to or chose an ACO?   And, the very central questions involving  provider relations with ACOs: can primary care MDs be in only one or multiple, and what of specialists and other providers?

The later – the role and relationships of providers who are neither hospitals or doctors – has been and will be the focus of the Alliance’s participation on the Task Force.   Based of positions drafted by our Legislative and Policy Committee, the Alliance has submitted initial comments that:

– express strong support for ACOs  with different configurations that vary  from tightly to virtually integrated and models that allow a variety of provider payment configurations .  

– support making explicit in the ACO enabling  legislation that each ACO model must  receive global payment to reflect – and be able to manage  – the full continuum of care settings and services for its assigned patients.

– require that attention and financial resources must be made available to allow providers in an ACO’s post acute care network to connect to integrated IT infrastructure for clinical care management.

Future discussion will focus on modeling global payments and the role and composition of the Oversight Board.

The Alliance welcomes and encourages member feedback – to us or to the Committee directly – on these critical discussions.  Comment or send to

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Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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