Massachusetts Health Policy Commission |
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The COVID-19 pandemic has tested our health care systems and has shed new light on longstanding structural inequities. Eliminating inequities is integral to achieving the HPC's mission of better health and better care at a lower cost for all residents of the Commonwealth. This edition of the Transforming Care newsletter highlights the HPC’s approach for advancing health equity through the agency’s work, as well as some examples of how SHIFT-Care Challenge awardees have applied a health equity lens to their work.
Let us know if there are care delivery transformation topics or work in the Commonwealth that you would like to see the HPC showcase in this newsletter. We would love to hear from you! Email us at caredeliverytransformation@mass.gov.
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HPC Announces Health Equity Framework |
"We see a tremendous opportunity for the Health Policy Commission to be a leader among state agencies, not only here but across the country in developing and releasing our own statement on how we apply equity principles to our work.”
– David Seltz, Executive Director Health Policy Commission
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In light of the disproportionate impact of COVID-19 on communities of color and the sense of urgency around addressing systemic racism, the HPC unveiled its health equity framework at July 2020 meetings of its Advisory Council and Board of Commissioners. This framework, which will guide all aspects of the HPC’s work, will apply a health equity lens to all four of the HPC’s core strategies. For example:
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Research and Report: The HPC will continue its focus on affordability (e.g., health insurance premiums, pharmaceutical costs) while contextualizing the ways health care spending disproportionately impacts different communities in the Commonwealth.
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Convene: The HPC will put health equity at the center of the upcoming 2020 Annual Health Care Cost Trends Hearing, specifically focusing on COVID-19’s impact on communities of color.
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Watchdog: The HPC’s Market Oversight and Transparency team will continue to consider access factors that are relevant to health equity when reviewing market transactions.
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Partner: The Moving Massachusetts Upstream (MassUP) Investment Program will support four partnerships between health care providers and community organizations to address upstream social determinants of health that lead to health inequities in Massachusetts communities.
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Recognizing that the pursuit of health equity in the health care system is a long-term goal, the HPC has devised accountability and action plans to ensure that this work continues. These plans include publicizing the agency’s health equity framework and regularly devoting time in public meetings to reporting on the status of health equity efforts. The HPC also highlighted internal action steps to ensure that while health equity remains an agency-wide focus through its different workstreams, diversity, equity, and inclusion are priorities within the workplace. |
“We’ve got to hold ourselves accountable in the months and years to come that we keep the focus where it needs to be. I know I'm committed and all of you are committed to keep that focus [on equity] … going forward so we don't lose faith in the process and the outcomes and the goals of the presentation.”
– Tim Foley, HPC Commissioner and Vice President for 1199SEIU (July 22, 2020 Board Meeting)
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The HPC staff looks forward to partnering with organizations in the Massachusetts health care system to advance this work and address health inequities across the Commonwealth. |
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SHIFT-Care Challenge Awardees Incorporate
Health Equity into Initiatives
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Equity has been top-of-mind for the nine SHIFT-Care Challenge awardees expanding access to opioid use disorder (OUD) treatment. The separation of behavioral health and medical care, as well as a lack of education around addiction treatment, has caused some providers to blame patients’ choices for their OUD rather than treating OUD as a chronic, manageable disease. As a result, many patients experiencing OUD encounter stigma that creates barriers to achieving equitable access to quality treatment. To address these issues of inequity, many awardees have utilized funds from the SHIFT-Care Challenge to provide expert training or consultation for providers and partners. Below are three examples of awardees who have capitalized on this opportunity to advance equity in their patient care:
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National Alliance on Mental Illness (NAMI) anti-stigma trainings: North Shore Medical Center partnered with NAMI to provide anti-stigma trainings to its program staff. Presenters with lived experience provided a personal perspective on what it is like to live with behavioral health conditions in order to help dispel assumptions and improve treatment of people with behavioral health conditions.
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Health equity consultant: Holyoke Medical Center (HMC) included a health equity consultant as part of its SHIFT-Care Challenge grant to provide clinical training, education, and support to HMC staff, community partners, and other interested stakeholders on a monthly basis. The consultant is also available on an “as needed basis” to address specific staff concerns or training needs.
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Trauma-informed care training: Recognizing the high burden of trauma in marginalized populations, Massachusetts General Hospital (MGH) launched a two-part trauma-informed care training for all of its staff at the Bridge Clinic, its transitional outpatient addiction clinic. Both clinical and non-clinical staff undertook this training to better understand how past trauma can affect behavior and the different ways that it can manifest.
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HPC and the Perinatal-Neonatal Quality Improvement Network Explore Disparities in Substance Use Treatment |
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The HPC has partnered with the Perinatal-Neonatal Quality Improvement Network (PNQIN) to support the HPC’s Mother and Infant-Focused Neonatal Abstinence Syndrome (NAS) Investment Program and ongoing statewide quality improvement initiatives focused on perinatal opioid use. The PNQIN leadership team, in collaboration with the HPC and other stakeholders, is leading a new project to understand racial disparities in outcomes for pregnant and parenting people affected by substance use disorder.
Davida Schiff, MD, MSc, Medical Director MGH HOPE Clinic and PNQIN Leadership Team Member, contributed the following perspective:
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Racial and ethnic disparities in substance use treatment receipt and inequities in maternal mortality and morbidity have been well documented, but the intersection of how substance use stigma and maternal health inequities can impact treatment engagement among pregnant people with OUD has not been well described.
Medications to treat OUD in pregnancy, including use of methadone or buprenorphine, result in improved maternal and infant outcomes, yet these medications remain underutilized. Using population-level data from the Massachusetts Department of Public Health’s unique Public Health Data Warehouse, we explored racial and ethnic differences in degree and type of medication use for OUD in pregnancy.
Of more than 5,200 pregnant women with OUD in Massachusetts, 87% were white non-Hispanic, 9% were Hispanic, and 4% were Black non-Hispanic. Yet there was evidence of significant racial and ethnic disparities in any medication receipt, continuation of medication use, and type of medication received:
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Building on this work this summer, a multidisciplinary team from the PNQIN and the HPC are working to further understand and describe disparities across the perinatal continuum for people and families impacted by substance use disorder to come up with clear targets to guide ongoing improvement efforts.
This will involve performing a scoping review assessing the extent to which the existing literature on health care utilization and maternal and infant health outcomes among people with OUD currently describes racial and ethnic differences and inequities and use a public health critical race praxis framework to assess how racism is explored in explaining reported differences. PNQIN hopes to identify key target areas for perinatal quality improvement collaboratives to try to address existing health inequities.
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PUBLICATIONS, PRESENTATIONS, AND RECOGNITIONS |
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PNQIN Publishes Paper on the Adoption of the Eat, Sleep, Console Care Tool to Care for Opioid Exposed Newborns |
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Congratulations to the PNQIN team on their recent publication, “A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts’ PNQIN collaborative.” This publication details findings from 11 hospitals in Massachusetts that adopted a new approach to caring for opioid exposed newborns. Building on the HPC’s Neonatal Abstinence Syndrome Investment Program, the HPC is pleased to continue to support ongoing efforts by PNQIN to promote best care practices for families, mothers, and infants impacted by opioid use.
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Summer Fellows Contribute to HPC’s Health Care
Transformation and Innovation Work
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Each summer, the HPC welcomes a cohort of summer fellows to join the staff for ten weeks. This year, the Health Care Transformation and Innovation (HCTI) team was joined by five fellows who completed projects related to the HPC’s care delivery transformation and investment priorities:
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Tiffany Alunan, MPH candidate at Harvard T.H. Chan School of Public Health, developed recommendations for increased accountable care organization performance transparency.
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Chelsea Kamuene, MSW candidate at Boston College School of Social Work, compiled research on food systems and security and economic stability to inform the MassUP program.
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Brianna Raposo, MPH candidate at Columbia University Mailman School of Public Health, conducted a landscape analysis to determine investment program evaluation best practices and develop recommendations for future HPC consideration.
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Colette Rector, MPH candidate at the Harvard T.H. Chan School of Public Health, developed an impact brief and case study series summarizing key findings from HCTI investment programs.
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Daria Turner, MPH candidate at Emory Rollins School of Public Health, examined best practices and barriers of utilizing demographic information to assess health equity.
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UPCOMING EVENTS & RESOURCES |
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HPC Board and Committee meetings, and some upcoming meetings and training opportunities offered by non-profit and governmental organizations focusing on health care quality improvement and cost containment.
Health Policy Commission
September 2, 2020
Webinar
Massachusetts Health & Hospital Association September 3, 2020
Webinar
Health Policy Commission
September 15, 2020
Webinar
Massachusetts Health & Hospital Association September 24, 2020
Webinar
Health Policy Commission
September 30, 2020
Webinar
Economic Mobility Pathways
October 6-9, 2020
Webinar
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A sampling of books, articles, podcasts, and resources that HPC staff are reading and listening to this summer.
Reveal, 2019
New York Times “The Daily,” 2020
New York Times, 2019
Harvard Public Health Magazine, 2019
Institute for Health care Improvement, 2020
New England Journal of Medicine Catalyst, 2020
Health Affairs, 2020
New England Journal of Medicine Catalyst, 2020
National Academy for State Health Policy, 2020
A non-partisan organization to increase voter turnout among registered voters who are unexpectedly hospitalized in the days and weeks prior to the November election
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Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109
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