Medicare and MassHealth ACOs

Accountable Care Organization (ACO) logo

As an Accountable Care Organization (ACO), our affiliated doctors, hospitals, and other health care providers, come together to provide coordinated, high-quality care to our patients.

About ACOs

Improving your care

By participating in an ACO, your primary care physician can enhance the care you receive by coordinating with your other health care providers. Together, they share your health information to better meet your individual needs and care preferences.

The goal of an ACO is for doctors, hospitals, and other health care providers to work closely together to deliver coordinated, high-quality care.

What does “accountable” mean?

ACOs have agreements with insurance companies to provide special services and care coordination for patients. These agreements set performance standards in quality and spending for the ACO. If the ACO is able to meet or exceed these standards for patient care, they may be eligible for shared savings with the insurance company. If they do not meet the standards, they may have to pay money back to the insurance company.

Our commitment to high-quality care

Since 2012, our health system entered into contracts with all the major insurers, including the Centers for Medicare and Medicaid Services (CMS), commercial payers, and MassHealth (state Medicaid program).

After five years in the Medicare Pioneer ACO model, we saved $36.7 million. As a Medicare Next Generation ACO, with an overall quality score of 100% in 2017, we were among the top ACOs in the nation for delivering high-quality care to patients. Today, we participate in the Mass General Brigham Medicare ACO (Medicare Shared Savings Program), as well as the Mass General Brigham MassHealth ACO.

Mass General Brigham Medicare ACO (Medicare Shared Savings Program)

We are committed to improving the health of individual patients and patient populations, while lowering costs.

Many of our affiliated providers are participating in a care coordination program called the Medicare Shared Savings Program (MSSP), designed specifically for Medicare patients and sponsored by Medicare. 

As part of the Mass General Brigham Medicare ACO, your provider may be participating in this program, including providers affiliated with Brigham and Women's Hospital, Massachusetts General Hospital (including Nantucket Cottage Hospital and Martha’s Vineyard Hospital), Newton-Wellesley Hospital, Salem Hospital, Cooley Dickinson Hospital, Emerson Hospital, Pentucket Medical Associates, Milford Regional Physicians Group, Wentworth-Douglass Hospital, and Charles River Medical Associates.

Download MSSP ACO Provider List (PDF) 

Your Medicare benefits

If your provider is a part of the Mass General Brigham Medicare ACO, your benefits are not changing with this program. This is not a Medicare Advantage plan or an HMO. Your health coverage, premiums, and insurance arrangements are unaffected. You do not need to do anything or change your doctor. You can continue to see the same providers you normally do. And you are always free to choose any doctor or hospital who accepts Medicare at any time. Your primary care physician may continue to recommend that you see particular doctors for your specific health needs, but it’s always your choice of what doctors you use or hospitals you visit.

You may be eligible for a waiver that allows Mass General Brigham Medicare ACO providers to send patients directly to nursing facilities from an emergency room, a primary care physician’s office, or other setting, therefore avoiding unnecessary and preventable hospitalizations. This program is only for Medicare patients in the Mass General Brigham Medicare ACO who meet certain clinical guidelines. 

Download MSSP ACO Public Report (PDF)

Have questions?

Mass General Brigham MassHealth ACO

Important information for Mass General Brigham MassHealth ACO members in response to COVID-19 

Mass General Brigham MassHealth ACO is a health plan for MassHealth members offered by Mass General Brigham. It is an Accountable Care Organization or “ACO.” An ACO is a team of doctors, nurses, and other providers who work together to provide coordinated, high-quality care for members. The Mass General Brigham MassHealth ACO offers the same benefits as MassHealth (the Massachusetts Medicaid program).

Our goal is to make sure that you have access to the doctors and caregivers that you need to improve your overall health. A Mass General Brigham PCP will coordinate your care, and you will have access to additional benefits, support programs, and services.

Where to go for care

Primary care

Mass General Brigham MassHealth ACO members must have a primary care doctor at a primary care practice or health center within Mass General Brigham. See the list of primary care practices

To find the location of your primary care doctor’s office, please visit the our Find-A-Doctor online search tool.

Hospitals and specialty care

With Mass General Brigham MassHealth ACO, you will have access to the world-class medical experts at our hospitals and organizations. View the list of the Mass General Brigham MassHealth ACO Members and Provider Organizations.

You can also go to the many doctors and hospitals that accept MassHealth. To find a hospital or a specialist (e.g., cardiologist, endocrinologist), visit the MassHealth Find a Doctor tool. You do not need a referral for most providers in the Mass General Brigham system.

Behavioral health

You can see any behavioral health provider on the Massachusetts Behavioral Health Partnership (MBHP). For questions or concerns about your mental health care, contact Massachusetts Behavioral Health Partnership (MBHP) at 1-800-495-0086. You can search for a mental health provider using the MBHP provider directory.

Resources for Mass General Brigham MassHealth ACO members

Health survey for members

The Mass General Brigham MassHealth ACO health survey is available for current members.

For more information