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Provider Connection

A newsletter of the                                                          Spring/Summer 2017
MassHealth Primary Care Clinician (PCC) Plan                                                
ACO
Full ACO Implementation Anticipated in December 2017
 
After launching an Accountable Care Organization (ACO) Pilot program in December 2016, MassHealth is working toward rollout of a full ACO program for December 2017.  MassHealth is currently in the process of procuring ACOs.  Details are available on the MassHealth Innovations website .  Full payment reform implementation will provide MassHealth managed care-eligible Members with new enrollment options to choose from.
 
ACOs are groups of doctors and other health care providers who work together to help Members stay healthy and meet their health care needs. ACOs will coordinate care and be accountable for the care of MassHealth Members assigned to them.  The goal of the ACO is to help MassHealth Members receive more coordinated and integrated care.
 
Starting this summer, MassHealth will be participating in community events to assist Members with understanding these new managed care options.  A Member booklet outlining Member choices will also be released in the fall of 2017.  Improvements are being made to the Provider Directory, as well as a development of a new Health Plan Choice Tool to make it easier for Members to pick a managed care product.
 
MassHealth will post a Provider Bulletin with additional information once the ACOs are selected and contracted.  In the meantime, please visit MassHealth Innovations for details.
Metabolic
Let's Improve the Rate of Metabolic Screening in Pediatric Members Being Prescribed Antipsychotics

Weight gain and metabolic alterations are frequent adverse effects of the second-generation/atypical antipsychotics. The American Diabetes Association (ADA) and the American Psychiatric Association (APA) recommend baseline screenings as well as periodic monitoring of weight, body mass index, serum lipids, and fasting glucose levels for all patients started on or maintained on antipsychotics.  These guidelines are also endorsed by the American Academy of Child and Adolescent Psychiatry.

Despite these recommendations, MBHP's data indicate a very low average rate of 28 percent for either glucose or lipid screening of pediatric Members taking antipsychotics.  In an effort to improve this rate, a mailing will be sent to prescribers of antipsychotics as well as PCCs informing them of Members being prescribed antipsychotics who do not have a claim for glucose or lipid screens in their history (last 18 months).
 
Please help us improve the rate of this important metabolic screening and monitoring toward 100 percent!

References: 
 
 
 
HPV
HPV Vaccine Concerns and the Need for Improved Rates
 
Dr. Jennifer Allen, ScD, MPH, MSN
Professor, Department of Community Health, Tufts University 
and Quinn A. Bottom-Johnson

HPV (human papilloma virus) affects an estimated 30,000 individuals annually. High-risk HPV strains have been causally related to genital warts and cancers of the mouth and reproductive organs. The HPV vaccine has been shown to prevent more than 90 percent of HPV infections.
 
The American Advisory Committee on Vaccinations and the Centers for Disease Control and Prevention recommend that 11-12-year-old girls and boys receive the two-dose HPV vaccine series. Despite the efficacy of the vaccine in protecting against high-risk types of HPV infection, vaccine uptake is suboptimal; only about a half of adolescents receive the first dose. Reasons for low vaccination rates include parental concerns about vaccine safety and side effects or beliefs that the vaccine will increase sexual activity. To reach the Healthy People 2020 goal - that 80 percent of the eligible population be vaccinated - concerted efforts are needed to increase uptake.
 
The most potent predictor of vaccination is provider recommendation. Research has shown that provider recommendations that are presumptive or directive (stating that the vaccine is due) and those that emphasize the cancer prevention benefits of vaccination are more effective than other types of communication. Providers should also communicate to parents that the vaccine is safe, efficacious, and may only have mild side effects associated with other types of vaccination (e.g., swelling or redness at injection site, etc.). The Centers for Disease Control and Prevention has recently launched a campaign, "You Are the Key," which emphasizes the importance of strong provider recommendation and provides resources for providers to facilitate conversations about HPV with patients and their parents (see below for websites).

Resources: