Reports Summarize Health and Medicine Research from UMass Chan Medical School (Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care): Health and Medicine

2026 JAN 15 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Researchers detail new data in agriculture. According to news reporting from Worcester, Massachusetts, by NewsRx journalists, research stated, “Importance: In 2023, the Massachusetts Medicaid and Children’s Health Insurance Program (MassHealth) required accountable care organizations (ACOs) to increase payments to primary care practices and shift to monthly payments, currently calibrated to historical revenues and enhanced practice capabilities, such as being staffed to address behavioral health needs. To prevent rewarding practices for avoiding difficult patients, future payments to primary care practices should reflect their patients’ apparent need.”

The news editors obtained a quote from the research from UMass Chan Medical School: “To describe MassHealth’s initiative and a complexity-adjusted payment model. Design, Setting, and Participants: This cross-sectional study of payment model development and performance was conducted between February 2022 and November 2024. Participants included all 2019 Massachusetts Medicaid managed-care eligible members who were enrolled for 183 days or longer. Exposures: Medical and social complexity. Main Outcomes and Measures: For each member, the primary care activity level (PCAL) outcome proxies the resources that primary care clinicians need to provide comprehensive, coordinated care. Models were evaluated via R² and through ratios of observed-to-expected (ie, estimated by the model) outcomes for selected subgroups, which will be approximately 1.0 when payments and expected costs are well matched. The implications of paying practices using PCAL (vs a model based only on age and sex) were explored by examining financial and practice-level characteristics in high and low deciles of practice-level estimated mean. Among 1 092 742 MassHealth members enrolled in 3602 primary care practices (1 014 252 person-years; mean [SD] age, 25.9 [18.4] years; 538 065 [53.1%] female), the PCAL model achieved R² = 69.6% and estimates within 10% of observed PCAL spending for high-risk populations (mental health disorders, substance use disorders, complex chronic conditions, and disabilities) and across racial and ethnic groups. Age-adjusted and sex-adjusted payments would overpay practices in the lowest-need decile by 10% and underpay those in the highest-need decile by 34%, while the PCAL model would match payment to estimated need almost exactly in the lowest decile and underpay by just 6% in the highest decile.”

According to the news editors, the research concluded: “Conclusions and Relevance: MassHealth’s 2023 reform invests in primary care. This cross-sectional study developed a risk model that can adjust primary care payments to patient needs. Neither age and sex adjustments nor inflated historical payments would provide adequate resources to primary care practices caring for the most complex patients.”

For more information on this research see: Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care. JAMA Network Open, 2025,8(2). (JAMA Network Open - https://jamanetwork.com/journals/jamanetworkopen). The publisher for JAMA Network Open is American Medical Association (AMA).

A free version of this journal article is available at https://doi.org/10.1001/jamanetworkopen.2024.58170.

Our news journalists report that additional information may be obtained by contacting Arlene S. Ash, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, United States. Additional authors for this research include Matthew J. Alcusky, Randall P. Ellis, Meagan J. Sabatino, Frances E. Eanet, Eric O. Mick.

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