Dana-Farber Becomes In-Network Provider for BMC HealthNet Plan

A long-sought contractual agreement with the Boston Medical Center HealthNet Plan (BMCHP) is providing thousands of Medicaid (MassHealth) patients in Massachusetts with easier access to Dana-Farber’s specialty cancer care, while also expanding its mission to serve historically neglected, excluded, and disinvested communities and populations.

Under the agreement, which was finalized in December 2020, Dana-Farber and all its Massachusetts hospital-based satellite sites are now in-network providers for the approximately 325,000 members of the BMCHP, which is the second largest MassHealth managed-care plan in the Commonwealth.

The BMC HealthNet Plan was established in 1997 by Boston Medical Center, the largest safety net hospital in New England. The plan provides health insurance coverage to Massachusetts residents, including MassHealth members from systemically and structurally excluded neighborhoods, those facing economic marginalization, people living with disabilities, and senior populations.

An exterior view of Dana-Farber's Yawkey Center for Cancer Care.

‘The stars aligned’

Prior to the new agreement, “the Institute was considered non-participating in BMCHP with two exceptions: Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center and Dana-Farber Cancer Institute – Merrimack Valley,” says Diane Lanahan, RN, MBA, executive director of Payor Contracting and Performance, who spearheaded the negotiations leading to the contract.  “For many years, Dana-Farber and BMCHP tried to finalize a comprehensive provider contract.”

The conversation evolved over the last several years, especially with increasing emphasis on the goals of inclusion, diversity, and equity within Dana-Farber and beyond.

“Now, leadership and staff across Dana-Farber are excited to expand our relationship with the BMCHP, as it provides its members easier access to Dana-Farber and the specialty care we provide,” Lanahan says. She adds that “not every single cancer patient” will need to come to Dana-Farber for care. Additionally, doctors in the plan may refer patients to Dana-Farber for second opinions, and they may go back [to BMCHP providers] or stay with the Institute.

The agreement covers all four of the Medicaid accountable care organizations under the BMCHP umbrella, as well as members of Qualified Health insurance plans available through the Massachusetts Health Connector.

Before the BMCHP relationship was formalized, 67% of Medicaid members in Massachusetts were enrolled in a health plan that offered access to Dana-Farber. After the contract agreement that number grew to 88% because of the large number of Medicaid enrollees in BMCHP, says Louro. And from FY20-21, BMCHP Medicaid member outpatient visits increased by 47%, he adds.

“It is incumbent upon all of us at Dana-Farber to do our part to create equitable, accessible cancer care to all who need it, and to provide that care in spaces where every patient feels a sense of inclusivity and belonging,” says Kate Audette, MSW, MBA, director of Government Affairs at Dana-Farber.

“We have made clear that our goals include ensuring our patient populations reflect our community — we have historically fallen short on this,” says Michael Reney, executive vice president and chief Finance and Business Strategy officer at Dana-Farber. “The BMCHP insurance products are one of the largest of the Medicaid and Connector plans, and they insure many individuals in our communities.”

“This arrangement is quite significant for us,” says Magnolia Contreras, MSW, MBA, vice president for Community Health. “We know that it will require that we do business differently. We will need to develop new access pathways, new support services, new policies and procedures to provide this new patient population with the world class quality of care that we are experts at.”