Value-Based Care and Provider Partnerships in Massachusetts

Member-Focused

Members are our focus and services are provided in a variety of settings at differing levels of intensity. Our care management activities emphasize the provision of the right services, at the right time, in the right place, for the right reason and at the right cost.

This holistic approach allows our members to receive an Individualized Care Plan that addresses all diagnoses and needs identified during the assessment process. Each member is also assigned a care manager who assists the member with their unique needs. All members with Long-Term Services and Supports (LTSS) needs are provided face-to-face visits. Every member who resides in a long-term care facility is provided an advanced practice clinician who provides face-to-face care to the member within the facility. There is also an on-call system available to help members address their needs and concerns 24/7.

Provider Support

Provider Advocates are available to support Home and Community-Based Services (HCBS) and LTSS providers, including contracting and claims processing. They have virtual engagements to share information on new policies and protocols and to discuss any issues. Our Clinical Practice Consultants also help providers address open gaps in care for better patient care and improved quality.

Through these various supports and processes, we’re able to help reduce administrative burdens for high-performing providers. We’ve partnered with ASAPs to deliver efficient care for our members and support the State’s goals on LTSS oversight and have allowed for prior authorization to be completed through our online portal, Link. In addition to these ongoing efficiencies, we incorporated additional administrative ease throughout the pandemic.

As we continue to strengthen our provider relationships and move toward paying providers based on the quality rather than the quantity of care, we can continue to help improve the health of Massachusettsans.

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