BOSTON >> Marylou Sudders was expecting to hear more worrying Wednesday morning. After all, the secretary of health and human services was presiding over a listening session on the first major reform of the MassHealth program in about two decades.

But after about 40 minutes of mostly positive feedback from about 15 organizations or individuals, Sudders closed the session satisfied that everyone had their chance to weigh in as the state works to redesign MassHealth, the insurance program that serves 1.84 million citizens.

"I'm a worrier by nature, so I was surprised there actually wasn't more worrying put on the table," she said after the session ended. "The comments that I received would suggest that we're on the right path, but we obviously need to provide greater detail."

In search of greater efficiency and to control costs, Sudders and Gov. Charlie Baker's administration are in the process of restructuring the MassHealth payment method to get away from the current fee-for-service model and instead offer Medicaid coverage through accountable care organizations (ACOs) -- networks of doctors that work collaboratively to manage a patient's care. Sudders said ACOs would be paid "for the total care of an individual," including managing acute care, behavioral health care and other needs.

At more than $15 billion, MassHealth is easily the largest area of spending in the state budget and accounts for roughly 40 percent of state spending. The program has been growing at an unsustainable double-digit rate, Sudders said.


"If we do not do something different, this time next year you all will be in this room yelling at me or being vociferous in your concerns that I'm looking at benefit reductions. I have no interest in minimizing and cutting benefits in order to provide a sustainable MassHealth program, but the current structure is not sustainable," she said Wednesday morning. "It is the same structure we've had in place in Massachusetts since the mid-1990s and rumor has it health care has changed since the mid-1990s."

Representatives from community-based health organizations and other agencies responded Wednesday to overviews of the MassHealth reforms that were developed with a series of stakeholder working groups and after more than a year of meetings, briefings and listening sessions.

Among the concerns expressed Thursday by health groups across the state was how ACOs will engage patients who are homeless, have physical disabilities or are part of minority groups.

"I think it's absolutely critical as to the how, particularly as you move into a public comment period and you're getting ready to issue a proposal, I'm strongly going to recommend that we could do some reach-out to the homeless community ... to talk about how this might be adapted, how this might look under this particular reform," Joe Finn of the Massachusetts Housing and Shelter Alliance said.

Others told state health officials that they would need to be convinced that ACOs will be able to work on chronic disease prevention to the same extent that some community-based groups do.

"We do not see the incentivizing of ACOs to work on chronic disease modeling for prevention and for retention and services of evidence-based programs. There are multiple examples of these across the state that are often community-based that have proven results to both improve health and lower costs," Peter Doliber, executive director of the Alliance of Massachusetts YMCAs, said. "We believe what is missing is this piece of addressing chronic illness both by prevention and treatment, and reduction of the impact of the disease."

An issue that was not raised at Wednesday's meeting but that has been a point of contention for Massachusetts hospitals is what they describe as a $250 million tax on hospitals that Baker has proposed in his fiscal 2017 budget.

The administration, which refers to the $250 million as an increase in an existing hospital assessment, has said the additional $250 million will support the state's share of the costs associated with the transition to new care delivery models. The reforms would also mean an additional $250 million in annual MassHealth payments to hospitals, "resulting in no net impact to hospitals as a class," according to MassHealth.

Sudders said she was pleased with the feedback received Wednesday because it exemplified how homogeneous the MassHealth population and their needs are. That feedback, plus the written feedback which will be accepted online until at least the end of the month, will be integral as the administration continues to craft the new MassHealth.

"We will have a complicated system after this because a one-size MassHealth program will not meet either the complexity and sophistication of providers that exist in Massachusetts nor the complexity and needs of the folks who have MassHealth," Sudders said. "MassHealth is not being designed on the 11th floor of One Ashburton, it is being designed with all of the input of the people in this room. It will be all of your voices working with us that will ensure a sustainable MassHealth program."

The state plans to pilot ACO launches by the end of 2016 with a full rollout of ACOs by October 2017. The full MassHealth reform is expected to be completed by late 2018, Sudders said.