We develop products and programs to provide consumers with what they want when they want it. This consumer-first model provides health care that is tailored to each individual. By leveraging innovative technologies and methods, our value-based care models support the needs of the whole patient, no matter how complex.
Accountable Care Organizations (ACOs) are a core component of the Affordable Care Act and a framework Mass General Brigham uses to deliver value-based care. ACOs have agreements with insurance companies to provide special services and care coordination for certain patients. These agreements set performance standards for quality and spending. There are financial incentives to meet the standards. If Mass General Brigham does not meet the standards it faces financial penalties. Since 2012, Mass General Brigham has undertaken new contracts with all the major insurers including the Centers for Medicare and Medicaid Services (CMS), commercial payers, and MassHealth.
Consumers have a choice in the health care they receive. Their choice is influenced by many factors, with insurance coverage playing a major role.
Most of our patient population is covered by “commercial payers”—insurance fees people pay for independent coverage or receive through their employers.
The Medicare population represents individuals with federal health insurance who are typically aged 65 or older or certain younger people with specific conditions or disabilities.
Medicaid patients (MassHealth) are enrolled in a joint state and federal insurance program for individuals and families with limited resources. To create a more sustainable health care ecosystem, Massachusetts has distributed and shared the responsibility, accountability, and financial risk for many of its patients by adapting the ACO model.
Redesigning care strategies and focusing on the whole patient is the mission of Population Health. Population Health designs, develops, implements, and evaluates innovative care programs that put consumers at the center of their care. Our programs are available through our academic medical centers, community hospitals and smaller affiliated practices. Regardless of where we deliver care, our value-based care models support the needs of the whole patient, no matter how complex.
Chronically ill patients with multiple medical conditions often need the most help coordinating their care. The Integrated Care Management Program (iCMP) is focused on caring for patients with the most complex care needs. The objective of the iCMP program is to help patients stay healthier longer by providing the specialized care and services they need to prevent complications and avoid hospitalizations. The iCMP program matches high-risk patients with a nurse, social worker, or other care providers who work closely with patients and their families to develop and implement a customized care plan. Studies have shown that iCMP is a population health strategy that helps control health care costs.
Through our Transitional Care program, we develop and implement innovative programs to provide patient care outside of the hospital and in more comfortable care settings, such as a patient’s own home. We call this the “Care Continuum.” Our evidenced-based innovations include Post-Acute Care and End-of-Life Care.
We are working to make the journey of providing palliative care as peaceful and stress-free as possible through acute care, skilled nursing, and rehabilitation facilities.
Risk Capture is the coding and documentation of chronic and complex diagnoses in a face-to-face patient/provider encounter each calendar year. The result of this encounter generates a risk score that reflects the predicted overall resource use (claim dollars) for each person relative to the claim dollars for an average risk person.
Accurate risk capture ensures patients are connected to care and resources that address their medical conditions. It promotes data integrity to reflect the true illness cost of patients and drives favorable performance in value-based care arrangements.
Risk coding relies on a risk-adjustment model designed to estimate future health care costs for patients. The Center for Medicare and Medicaid Services established this model, and it has become increasingly prevalent as health care systems move to value-based payment models.
Population Health manages Mass General Brigham’s care transformation by evaluating and analyzing the impact of our programs on patient and provider experiences, clinical outcomes, and health care costs. The Product Development and Data and Analytics teams conduct and support evaluations and analyses of the care delivery transformation projects we sponsor.
Population Health’s leaders, together with clinical and administrative teams, oversee population health management initiatives. They work toward improving the quality of care for Mass General Brigham patients while reducing overall costs.
Lindsay E. Jubelt, MD, MS
Chief Population Health Officer
Vice President, Clinical Product Development
Senior Director, Clinical Program Operations
Stanley M. Hochberg, MD
Senior Medical Director, Planning and Performance
Adam Licurse, MD
Senior Medical Director, Planning and Performance
Senior Director, Administration
Population health management is a recognized solution to improve quality of care and reduce health care costs.
Currently, there are limited pathways for training clinical and administrative leaders in population health management. In response, Mass General Brigham created the Population Health Fellowship and Resident Elective Rotation.
These comprehensive educational programs provide direct experience and leadership development to spark innovation for the next generation of population health leaders: