Medicare patients are those on federal health insurance, typically people aged 65 or older and certain younger people with specific conditions or disabilities. Many people on Medicare live with health problems, including multiple chronic conditions, cognitive impairments, and limitations in their activities of daily living, and many beneficiaries live on modest incomes.
Patients in this population are covered under our Accountable Care Organization (ACO) model. As of July 1, 2019, Mass General Brigham is now participating in the Medicare Shared Savings Program Model (MSSP) through the Centers for Medicare and Medicaid Services (CMS). Our transition to the MSSP model has allowed Mass General Brigham to extend care to additional patients and add more providers. For 2020, Mass General Brigham Medicare ACO serves a total of approximately 130,000 Medicare patients and includes approximately 11,000 providers supporting the Medicare population.
Mass General Brigham was one of the first Medicare Pioneer ACOs in the country, achieving a total savings of more than $36.7 million and maintaining an overall quality score of 94.5 percent between 2012 and 2016. When CMS phased out the Pioneer ACO Model, Mass General Brigham converted to the Next Generation (NextGen) ACO model, which Mass General Brigham participated in from 2017-March 30, 2019, until the recent transition to MSSP.
While Population Health programs today are offered to approximately 130,000 Medicare patients across the Mass General Brigham system, initial Medicare pilots programs started over 12 years ago at Massachusetts General Hospital (MGH). The MGH Care Management Demonstration would evolve into Population Health suite of High-Risk Care Management programs. Since then, the suite has expanded to include innovative programs designed for the Medicare population in areas of home health, post-acute care, and remote monitoring technologies that can be used right in a patient’s home. We also support a spectrum of end-of-life programs to better help patients with serious illnesses as they navigate this difficult time in life. These programs are designed to meet the unique needs of our Medicare population; however, all our programs are available to Medicare patients if deemed appropriate by their care provider.