| Boston Medical Center Health Plan and Tufts Health Public Plans have signed state contracts with a combined value of $1 billion per year to manage care for between 150,000 and 200,000 MassHealth members, the state announced Tuesday.
Four other organizations had bid on the high-dollar contracts.
The members are in MassHealth’s managed care organization program and the two MCO organizations will manage primary, behavioral, pharmacy and specialty care for the enrollees, under contracts signed with MassHealth that are effective for a five-year period beginning in March 2018.
Under restructuring plans, 900,000 MassHealth members by March 2018 will be covered through 17 accountable care organizations, or ACOs. Other members will have the choice of selecting coverage from one of the two newly selected MCOs or MassHealth’s primary care clinician plan. The Executive Office of Health and Human Services estimates the three programs will cover 1.2 million residents.
Rising MassHealth spending is the subject of ongoing policy talks on Beacon Hill where Gov. Charlie Baker and legislative leaders this fall are eyeing cost controls, including measures that will affect the private sector.
Boston Medical and Tufts were selected after a December 2016 competitive procurement that the Baker administration said resulted in “fewer MCOs that offer greater scale, administrative cost savings and high quality of care for members.”
The current MCOs not selected for new contracts are Neighborhood Health Plan, Health New England, Fallon Community Health Plan, and CeltiCare Health, but a Baker administration official said most MCOs will continue to provide care for MassHealth members as part of accountable care organizations.
There are currently more than 800,000 members in MassHealth MCOs and 400,000 in the primary care clinician plan. In March, members will be enrolled in ACOs if their primary care provider participates in the ACO, with an opportunity to opt out and join an MCO or PCCP, a state official said.
“The selected health plans will complement our ACO program and our commitment to improve the quality and experience of care for MassHealth members while providing administrative savings to the Commonwealth,” Secretary of Health and Human Services Marylou Sudders said.
