Transforming Health Care in MA - Request for Information
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Introduction
In Massachusetts, significant health care affordability challenges persist. The Massachusetts Life Sciences Center (“MLSC”), in collaboration with the Division of Insurance (“DOI”) and the Executive Office of Economic Development (“EOED”), is issuing this Request for Information (the “RFI”) from stakeholders regarding innovative approaches to managing high-risk claimants within the Commonwealth’s unique merged health insurance market. The objective is to explore models that facilitate early intervention and high-quality care for high-risk individuals while achieving premium reductions for the broader merged market risk pool.
Background
The MLSC is committed to enhancing health equity across Massachusetts and increasing visibility of the ecosystem, including providers, payers, patients, innovators, and other industry and actuarial stakeholders who may support and advance our mission to close the health care divide. There is a unique opportunity to leverage the state’s health care and life sciences ecosystems with the Life Sciences 3.0 initiative that was passed with the Mass Leads Act.
As part of its efforts, MLSC is issuing this RFI to receive feedback and insight from market participants and any other interested parties focused on promoting important health care equity and inclusion principles. Specifically, MLSC is soliciting ideas that principally drive at furthering equitable, accessible, and affordable health care and health care coverage.
Interested Respondents may currently operate in Massachusetts but are not required to operate exclusively in Massachusetts. Interested Respondents are encouraged to collaborate in preparing a response to the RFI, and the MLSC welcomes combined submissions from multiple stakeholders.
The objective is to improve healthcare outcomes and cost efficiencies by exploring the creation of a high-risk claimant management mechanism that supports sustainable models of care within the Commonwealth’s merged market. Key principles underlying a potential mechanism include ensuring early intervention and access to emerging technologies and therapies for high-risk enrollees, as well as promoting high-quality care investments over time.
This RFI is not a mechanism to pre-qualify any individual or organization for future funding from MLSC. RFI feedback may help shape possible future program initiatives at the MLSC or policy ideas within the Commonwealth.
Objectives
Driven by the foundational principles of health care affordability and equity, the primary goals of this RFI are to:
Evaluate high-risk claimant management mechanisms (e.g., reinsurance, risk-pooling) suitable for the Massachusetts merged market, including, e.g., exploring potential long-term funding mechanisms that ensure high-quality patient care and meaningful premium relief for the remainder of the merged market.
Identify innovative models for the reimbursement and funding of early intervention and care management for high-risk claimants.
Assess potential cost savings for the remaining patients within the merged market risk pool upon separating out and reinsuring high-risk claimants.
Understand barriers to implementation and necessary changes to address them.
Q&A - below are responses to the inquiries received prior to August 29, 2025.
1. Is this RFI primarily about chronically ill adults/elders?
Response: No, the RFI does not include a focus on that population, but respondents are not precluded from doing so in their responses as desired.
2. Is the RFI explicitly focused on small group?
Response: Yes, the RFI is focused on the Massachusetts “merged market”, which is a unique market structure that combines the state’s individual (nongroup) and small group markets.
3. Is the RFI mostly trying to get at different economic/insurance models as opposed to also thinking about care delivery?
Response: The RFI is intended to solicit comprehensive responses that include (but are not limited to) information about both economic models of high-risk claimant management as well as patient protection and care management. Care delivery considerations and clinical care management are fundamental to the state goals of improving healthcare outcomes and cost efficiencies, as well as promoting affordability and equity.