Health care payers, providers, and policymakers are increasingly pursuing value-based payment (VBP) to improve the quality of care and population health while controlling rising health care costs. When implemented in Medicaid, VBP programs often include children and adults in the same model, though these models may not fully account for children’s distinct health needs.

This report seeks to inform the work of Massachusetts policymakers and stakeholders to better incorporate children’s health needs and experiences within the payment models in the MassHealth Accountable Care Organization (ACO) Program by examining lessons from states and providers throughout the country.  Based on the results of an environmental scan, including a review of peer-reviewed and gray literature and interviews with 18 subject matter experts, this report identifies and describes four main VBP approaches for delivering care to pediatric populations. The authors then synthesize key themes and lessons learned for successfully implementing VBP models for children. These findings suggest there is great opportunity for Massachusetts to serve as a leader in this field, and the report lays out a set of policy and program considerations to help Massachusetts design an approach to better serving children within and alongside the framework of the existing ACO Program. Ultimately, adapting VBP for pediatric populations requires recognition that pediatric VBP models should not be focused on short-term savings but rather on improving quality of care to support child health and long-term population health outcomes.

Addressing timely access to behavioral health care through the adoption of open access methods supports the well-being of people with behavioral health conditions, improves staff productivity, and increases financial stability for provider organizations. However, no study has previously documented the experience of provider organizations using this model in Massachusetts.

The report identifies organizations that operate open access today and highlights the approaches that have been most successful. The report also pinpoints keys to success for organizations to consider in adopting an open access model and offers policy recommendations to promote the broader adoption of open access in the Massachusetts behavioral health care system.  The case studies provide detailed descriptions of each model, describe the successes and challenges of implementation, and indicate how COVID-19 has impacted operations.

Independent, nonpartisan research and analysis about the impact of state and national health reform on Massachusetts.

Lack of access to quality, affordable health care is created and compounded by structural racism and prevents people from achieving positive health outcomes. Our emerging grant program and policy analysis agenda aim to understand and disrupt structural racism to eliminate inequities in health care access, quality, and outcomes.

This is a new focus area for the Foundation and this section will be updated as the work evolves. Publications found in this section include those related our previous focus area on Social Equity and Health.

Coverage does not always equal care. Our focus is on expanding health insurance coverage and access to care, and developing strategies to increase coverage to reach those most in need.

Access to behavioral health is uneven and consumers often have difficulty getting the right combination of care when they need it. Our focus is on exploring methods that expand access and eliminate barriers to integrating behavioral and physical health care.

The Blue Cross Blue Shield of Massachusetts Foundation today announced that Dr. Thomas H. Lee, a cardiologist, clinical researcher and health policy expert, has been appointed to its Board of Directors.

The Blue Cross Blue Shield of Massachusetts Foundation today announced that Dr. Thomas H. Lee, a cardiologist, clinical researcher and health policy expert, has been appointed to its Board of Directors.

Dr. Lee practices medicine at Brigham and Women’s Hospital in Boston and serves as chief medical officer of Press Ganey, an international health care performance improvement consulting firm.  He became a professor of medicine at Harvard Medical School and professor of health policy and management at the Harvard T.H. Chan School of Public Health in 2004.

''Given his clinical knowledge, strategic perspectives, expertise in health policy, and enduring focus on improving health care quality and outcomes, Dr. Lee will be a tremendous asset for the Foundation's board,'' said Andrew Dreyfus, Chair of the Blue Cross Blue Shield of Massachusetts Foundation. ''Most importantly, he has a deep commitment to patients and their experience.''

Dr. Lee also recently became a board director at the Blue Cross Blue Shield of Massachusetts, where he helps guide the health insurance company’s strategy and direction.

“I started working with leaders of the Foundation during the push for health care reform in Massachusetts,” Dr. Lee said.  “I was proud to work with them then, and I’m thrilled to begin again.  There is still important work to do.”

Prior to joining Press Ganey in 2013, Dr. Lee was the network president for Partners HealthCare (now Mass General Brigham), the integrated delivery system founded by Brigham and Women’s and Massachusetts General Hospitals in 1994.  He has performed clinical epidemiological research leading to more than 300 articles in peer-reviewed journals and five books.

Dr. Lee is a member of the Editorial Board of The New England Journal of Medicine, the Board of Directors of Geisinger Health System, the Board of Directors of Health Leads, the Special Medical Advisory Group of the Veterans Administration, and the Panel of Health Advisers of the Congressional Budget Office.

Dr. Lee received a bachelor’s degree from Harvard College and his doctor of medicine degree from Cornell University Medical College.  He trained in internal medicine and cardiology at Brigham and Women’s Hospital, where he is a practicing primary care physician.  He also received a master of science in epidemiology from Harvard T.H. Chan School of Public Health.

About the Blue Cross Blue Shield of Massachusetts Foundation

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally or socially marginalized.  The Foundation was established in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts.  It operates separately from the company and is governed by its own Board of Directors.  For more information, visit www.bluecrossmafoundation.org.

This budget brief highlights the state fiscal year (SFY) 2021 budget – which ran from July 1, 2020 through June 30, 2021 – for MassHealth and other health reform programs. The SFY21 budget was delayed by six months due to the COVID-19 pandemic and the resulting economic challenges and fiscal uncertainty. Included within the budget was $18.9 billion designated for health care coverage programs and related operational expenses. This brief provides an analysis of spending in the SFY2021 budget associated with MassHealth and other health care coverage and health reform activities, as well as a summary of new initiatives included in the SFY2021 budget that are expected to impact MassHealth program spending.