MassHealth is changing.

What you should know about MassHealth Accountable Care Organizations

Beginning March 1, 2018, MassHealth members will have more options for getting care, including MassHealth Accountable Care Organization (ACO) Partnership Plans.

Why is MassHealth restructuring?

MassHealth has grown unsustainably and constitutes almost 40% of the Commonwealth’s budget (over $15 billion); the current fee-for-service payment model for providers has resulted in fragmented, siloed care; and the fundamental structure of the MassHealth program has not changed in over twenty years.

Why is MassHealth restructuring now?

Financing for the current MassHealth waiver expired June 30, 2017, providing an opportunity to obtain federal investment to support the delivery system reforms. Massachusetts state law (Chapter 224) requires MassHealth to adopt alternative payment methodologies for promotion of more coordinated and efficient care. The waiver to support the MassHealth ACO models has already been granted by the federal government, extending through June 30, 2022.

What does the MassHealth restructuring entail?

The current delivery system will transform from fee-for-service, siloed care into integrated, Accountable Care Organization (ACO) models.

What is an ACO?

An ACO is a provider-led entity (e.g., a group of providers or a health system) that coordinates care, has an enhanced role for primary care, and is rewarded for value—improving total cost of care and outcomes—not volume. An ACO is expected to deliver a more integrated and improved member experience and have flexibility to engage members differently (e.g., enhanced services, care coordination).

What is the role of a health plan in an ACO?

The health plan (i.e., Fallon Health) pays claims and partners with the provider group to improve care delivery and to support integration of care. The partnership between the health plan and the provider group allows additional support, increased capacity, and improved analytics for population health management.

Which ACO Partnership Plans does Fallon participate in?

Fallon has partnered with hospitals, health care providers and community health centers across the state to create three new ACO Partnership Plans to better serve MassHealth patients:

  • Berkshire Fallon Health Collaborative—a partnership with Berkshire Health Systems, Community Health Programs and several Berkshire County community physician practices. Learn more at
  • Fallon 365 Care—a partnership with Reliant Medical Group and Southboro Medical Group. Learn more at
  • Wellforce Care Plan—a partnership with Wellforce, which is made up of physicians and other health care providers from, or affiliated with: Circle Health; Floating Hospital for Children at Tufts Medical Center; Hallmark Health; Lawrence Memorial Hospital of Medford; Lowell Community Health Center; Lowell General Hospital; Lowell General Physician Hospital Organization; Melrose-Wakefield Hospital; New England Quality Care Alliance (NEQCA); and Tufts Medical Center
    Learn more at

What is the timing for the MassHealth restructure?

  • Spring 2017: ACO selections announced
  • Summer 2017: MCO selections announced; MCO and ACO readiness reviews
  • Fall/Winter 2017/2018: Member assignment to new ACOs/MCOs
  • March 1, 2018: New MCO and ACO enrollments begin

How will my MassHealth patients know if they’re being enrolled into an ACO?

Your patients will receive letters from MassHealth in November or December letting them know which plan they will be enrolled in for March 1, 2018. The letter will come in an envelope with a big green stripe and will also include an enrollment guide, enrollment form and community enrollment event information. If your patients feel confused, they should call MassHealth at 1-800-841-2900 (TTY: 1-800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m., or visit

Does anything change for my patients before March 1, 2018?

Nothing changes with their current MassHealth health plan through February 28, 2018. Their new MCO or ACO enrollments will begin on March 1, 2018.

Who should my patients call with questions?

If your patient is being enrolled into one of Fallon Health's ACO plans (Berkshire Fallon Health Collaborative, Fallon 365 Care or Wellforce Care Plan), they can call Fallon Health at 1-800-341-4848, 8 a.m. to 6 p.m., Monday – Friday. Or, they can call MassHealth at 1-800-841-2900 (TTY: 1-800-497-4648), Monday through Friday, from 8 a.m. to 5 p.m., or visit