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The Massachusetts Alliance for Communication and Resolution following Medical Injury is a healthcare alliance formed in 2012 which comprises some of the most notable health and medical groups in the Commonwealth of Massachusetts. These include major teaching hospitals and their insurers, statewide provider organizations, and patient advocacy groups listed hereEight hospitals participated as pilot sites, and several additional sites are committed to rolling out the Communication, Apology, and Resolution (CARe) model. Members share their experiences and lessons learned to aid in the dissemination of this model throughout Massachusetts, and eventually in other states.


MACRMI is committed to the implementation of Communication, Apology, and Resolution (CARe) following medical injury. Prompt recognition of, and response to, medical injury, along with appropriate compensation to the patient or family, has demonstrated potential to improve patient safety, reduce medical costs, and enhance fairness and transparency in health care. It is, simply, the right thing to do.


Through its activities and this web site, MACRMI seeks to:

  • Assist the Massachusetts pilot hospitals in implementing the Communication, Apology, and Resolution (CARe) approach and continuously improving upon the model. 
  • Share lessons learned from the pilot sites with other sites to enable a broad implementation of CARe in Massachusetts and, eventually, in other states.
  • Inform other interested stakeholders (patients, attorneys, hospital leadership, health insurers) of this approach, its benefits, and the status of its implementation, and involve these stakeholders in the ongoing CARe initiative.

A Summer 2012 Vital Signs article provides a further overview of the initiative and the CARe model.


MACRMI was formed as the result of a research initiative led by Beth Israel Deaconess Medical Center and the Massachusetts Medical Society, and funded by the Federal Agency for Health Care Research and Quality in 2010. Its purpose was to uncover the barriers to implementation of a CARe program (often also referred to as Disclosure, Apology, and Offer or DA&O) in Massachusetts, and to propose a roadmap for overcoming these barriers. This roadmap was developed in 2010, vetted in 2011, and made public in 2012. It has garnered significant attention at the state and national levels.

Enabling Legislation

MACRMI has already helped pass enabling legislation in Massachusetts. The 2012 Payment Reform legislation included a comprehensive adoption of the so-called Michigan model of “disclosure, apology and offer” to resolve patients’ claims of medical malpractice. This includes the establishment of a 182-day waiting period to permit the disclosure, apology and offer process. It it provides strong apology protections, sharing of pertinent medical records, and expectations of full disclosure.

More Information:

MACRMI is part of a larger effort - funded in part by the Federal Agency for Health Care Research and Quality - which includes four specific aims

  • To prepare the environment in Massachusetts for broad implementation of the Roadmap for Transforming Medical Liability and Improving Patient Safety in Massachusetts by creating a multi-stakeholder collaborative (i.e. MACRMI) representing all major constituencies with ability to advance CARe. Click here for the full Roadmap document, and here for the Executive Summary.
  • To leverage the stakeholder collaborative to develop a recommended approach for responding to adverse events, including education, training, dissemination of best practices, and pursuit of legislative initiatives focused on removing barriers to CARe in Massachusetts. 
  • To support healthcare institutions across Massachusetts, including those that are smaller and in more rural settings, in the implementation of the CARe model by creating a centralized statewide resource (i.e. this site) of educational materials and support systems using the approach developed above. 
  • To test the feasibility of the CARe model in disparate clinical practice environments and liability insurance arrangements by implementing it in two Massachusetts health systems and evaluating effects on costs and other metrics related to medical liability, and effects on patient safety.

For background on AHRQ-funded planning and demonstration projects around the nation regarding medical liability reform, click here.

Details of legislation

Full text of Massachusetts legislation.

Key liability provisions found in the 2012 Massachusetts Payment Reform Legislation are available for download here.