INSIDE THE ISSUE

> MP3: New Payer-Provider Group
> CHIA’s Latest Financial Data
> HPC on ED Boarding
> DPH Vaccine Guidance
> MHQP’s 30th Anniversary
> QIN-QIO Contract
> Transition at DMH

MONDAY REPORT

Payer-Provider Group Launched to Improve Care, Affordability

Some Massachusetts health plans and hospitals have joined forces to create the Massachusetts Payer-Provider Partnership (MP3), a first-of-its-kind organization dedicated to improving the patient experience and promoting affordability for patients and employers.

MP3 will be led by Lauren Peters, who most recently served as executive director of the state’s Center for Health Information and Analysis (CHIA). Before joining CHIA, Peters served as undersecretary for the Massachusetts Executive Office of Health and Human Services.

“It is a distinct honor to be working with these best-in-class organizations to build this partnership from the ground up,” Peters said. “Every MP3 success will represent innovation for Massachusetts healthcare – innovation that is patient-centered, action-oriented, and partnership-driven.”

The organization’s inaugural members will begin meeting in early spring 2026 to discuss initial goals and ideas. Those members include: Baystate Health, Boston Medical Center Health System, Fallon Health, Health New England, Mass General Brigham, Mass General Brigham Health Plan, UMass Memorial Health, UMass Memorial Health Mass Advantage, and WellSense Health Plan.

MP3 is designed to unite and implement shared ideas between institutions that deliver care and organizations that pay for care. The partnership will focus on practical, collaborative solutions – which may include modernizing and streamlining administrative processes and fostering new care delivery and payment models – to reduce costs and improve patient access. Members will pilot these solutions within their own organizations and patient populations with the goal of scaling successful initiatives statewide.

MP3 is affiliated with, but autonomous of, MHA. It is designed to be an on-the-ground complement to important policy-focused efforts underway, including the Healey-Driscoll Administration’s Health Care Affordability Workgroup, the work of the Health Policy Commission, and other statewide collaborations.

“This is a bold effort to integrate two of the largest components of our health care system, accelerate meaningful change and ignite innovation – all for the benefit of the members and patients we serve,” said Peter D. Banko, President & CEO of Baystate Health, Board Chair of Health New England, and MP3 Board Member. “There is an inherent tension – too often, not healthy – between health plans and providers. We believe this pioneering new organization will enable us to break down unnecessary barriers and create a new frontier for Massachusetts healthcare.”

“Our healthcare system faces increasingly complex challenges, but we have a proud history in Massachusetts of taking bold action to address these challenges through a model of collective action,” said David Seltz, Executive Director of the Massachusetts Health Policy Commission. “MP3’s focus on providing opportunities for meaningful collaboration between healthcare providers and insurers is a welcome new effort that will help advance our shared goal of a healthcare system that is more affordable, accessible, and equitable for all commonwealth residents.”

Small Operating Margins Come With a Cost

Last week, the Center for Health Information & Analysis (CHIA) released hospital and health system financial data through December 31, 2025, which effectively covers the first quarter of Fiscal Year 2026 for most hospitals.

The figures show that due to the concerted, often painful, efforts of hospitals, the median operating margin for them was 2% – an increase over the anemic negative -0.7% operating margin the previous year. A series of cost-cutting efforts, including reductions in force across the state, contributed to that result. Labor costs account for about two-thirds of hospital costs. Although the median margin across the state was positive, 38% of reporting hospitals had negative operating margins.

For health systems, which include physician practices controlled by the systems, the news was worse. Their median operating margin was negative -1.4%. Fourteen of 21 systems (67%) reported an operating loss.

Upon release of the findings, MHA cautioned that “daunting days” ahead will further disrupt hospitals’ financial footing.

“As CHIA’s reports have illustrated for years now, this is an exceedingly challenging time to operate a hospital and meet patient needs,” said MHA’s Senior Vice President, Healthcare Finance & Policy Dan McHale. “Behind the scenes, it has taken many months of hard work and tough decision-making for hospitals to reach a small statewide operating margin, and two-thirds of hospital health systems were still operating at a loss in the early months of FY2026. But we know there are daunting days ahead as coverage losses continue and the cost of that care becomes more challenging for hospitals due to the state’s fragile and financially strained Health Safety Net program. This is a critical time to be thinking about policies that safeguard hospitals, their caregivers, and their patients.”

View the data on this interactive dashboard.

HPC Releases Report on ED Boarding at Hospitals

Boarding of behavioral health patients in hospital emergency departments (EDs) continues to be a persistent problem in Massachusetts, according to a new report from the Health Policy Commission (HPC) released last Wednesday.

The HPC defines behavioral health (BH) ED boarding as any ED visit with a BH primary diagnosis that lasts for 12 or more hours in the ED. The reasons for boarding are diverse, from the unavailability of an appropriate inpatient bed to which a patient can be admitted, lack of staff, medical complexities or behaviors, delays in transportation, or the need to involve the courts or other state agencies to make decisions for the patient – among many other reasons. MHA has been tracking BH boarding numbers for years, showing that hundreds of patients are still boarding in hospital EDs and other units at any given time (see below).

The HPC found that ED boarding increased in the state between 2020 and 2024. “Overall, the percentage of visits to the ED that resulted in boarding rose from over 7% in 2020 to 11% in 2024, consistent with national rates and trends,” the report notes. “However, the percentage of BH-related visits that boarded increased from 32% in 2020 to a high of 40% in 2022. By 2024 this percentage has come down slightly to 37.5% in 2024. In absolute terms, there were 4,500 fewer patients who experienced BH ED boarding in 2024 compared to 2023.”

The HPC also highlighted the fact that both commercial payers and MassHealth paid more for ED visits in which patients boarded and were ultimately discharged from the ED compared to patients who were discharged without boarding (22% and 33% more, respectively). When put into context, observers like MHA saw that fact as a success. This is explained by the fact that MassHealth, starting in 2023, began paying for stabilization and treatment for BH patients in EDs. And as part of the Mental Health ABC Act of 2022, commercial plans are also required to pay for ED-based BH treatment and stabilization services. As a result, hospitals are able to provide more BH services in the ED and, therefore, many patients are stabilized in the ED to the extent that they no longer need an inpatient level of care and can be discharged to the community. This is both better for the patient in terms of allowing them to have a less restrictive level of care and reduces costs by avoiding more expensive inpatient care. MassHealth is also now paying for EDs to provide BH evaluations, but not all commercial plans are paying for ED-based BH evaluations.

Leigh Simons, MHA’s vice president of policy & regulatory affairs, who has been leading the association’s behavioral health efforts, said the HPC report is important in that it consolidates data and stakeholder insights to help define the ED boarding problem, while offering solutions.

“The key problem now for BH patients in the ED is similar to the problems other segments of the healthcare continuum face – mainly moving patients through the system,” Simons said. “That patient flow logjam – the difficulty moving patients out of inpatient beds and into post-acute facilities, or to home care, or out to community services – means there are not enough inpatient beds to accept patients in the ED.”

Beyond addressing patient flow challenges, MHA said additional solutions to address BH boarding include:

• Ensuring commercial health plans reimburse hospitals for BH crisis evaluations to ensure facilities have the staffing and programmatic resources needed to care for those patients;
• Continued development of the behavioral health workforce pipeline across all positions;
• Learning from the Health Policy Commission’s upcoming Behavioral Health Rate Adequacy study to ensure the financial stability of behavioral health units and facilities, and to allow behavioral health providers to pay their workforce adequate salaries; and
• Addressing administrative barriers such as Determination of Need requirements for providers expanding BH services, and insurance prior authorization/notification processes.

DPH: RSV Prevalence Means Vaccines Should Continue

Ongoing respiratory syncytial virus (RSV) activity in Massachusetts and the region has caused the Department of Public Health (DPH) to issue a clinical advisory advising clinicians to administer RSV vaccines to eligible infants through April 30.

RSV is the leading cause of lower respiratory tract infection and hospitalization among young infants in the United States, according to the advisory, which noted that “Very young infants less than 8 months of age (including healthy infants without underlying conditions), and infants with history of medical conditions such as prematurity, immuno-compromising conditions, cystic fibrosis, and neuromuscular disorders are at highest risk of severe RSV disease.” The advisory contains specific recommendations about who is eligible for the vaccines and when the shots should be administered.

Help MHQP Celebrate Its 30th Anniversary on May 11

Massachusetts Health Quality Partners (MHQP) is celebrating its thirtieth anniversary on Monday, May 11, 6:30 p.m. at the Museum of Science in Boston. The thirtieth anniversary gala will honor Dr. Atul Gawande, who is receiving the group’s leadership award, and will recognize the efforts and 27-year leadership of MHQP President and CEO Barbra Rabson, who late last year announced her retirement. Learn about sponsorship opportunities and register for the gala here.

Mass. Hospitals to Benefit From Quality Improvement Initiative

The Centers for Medicare & Medicaid Services (CMS) has awarded IPRO, in partnership with the non-profit healthcare quality improvement group Healthcentric Advisors, the 13th Scope of Work Quality Innovation Network–Quality Improvement Organization (QIN-QIO) contract for the Northeast Region 1, which includes New York, New Jersey, Massachusetts, Maine, New Hampshire, Vermont, Connecticut, Rhode Island, Puerto Rico, and the U.S. Virgin Islands.

CMS QIN-QIOs provide no-cost, expert quality improvement support to nursing homes, hospitals, and outpatient clinical providers across a region. They focus on priority areas such as reducing readmissions and avoidable emergency department visits, improving behavioral healthcare, promoting preventive care, strengthening emergency preparedness, and much more. The recent grant is for a five-year initiative that will be available to nearly all acute care hospitals in Massachusetts. MHA is helping to coordinate the initiative with its membership.

Transition

Emily Bailey has been appointed commissioner of the Department of Mental Health, effective April 12. Beth Lucas, who has served as acting commissioner since October 2025, is returning to her prior role as the deputy commissioner for mental health services. Bailey most recently served as senior vice president at Commonwealth Care Alliance. She previously served as chief of behavioral health at MassHealth, and has held executive roles at Point32Health and Carelon.

John LoDico, Editor