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Massachusetts Health Policy Commission
February 2019
Welcome!
This month’s newsletter focuses on efforts to address serious illness care, including insights from the HPC’s recent ACOs and Serious Illness Care webinar, Baycare Health Partners’ care management program, and Care Dimensions’ Palliative Care+ program.
 
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Let us know if there are particular care delivery transformation topics or work in the Commonwealth that you’d like to see the HPC showcase in this newsletter. We'd love to hear from you! Email us at caredeliverytransformation@mass.gov .  
 
Regards
Team HPC
SPOTLIGHT:
ACOs and Serious Illness Care Webinar
“We started talking for an hour. We laughed, we cried, we told stories. And then [my mother’s doctor] asked ‘what would your mother want if she was here right now?’”
Maureen Bisognano, Co-chair of the Massachusetts Coalition for Serious Illness Care, reflecting on a conversation between her family and her mother’s doctor about serious illness care.
The HPC held an event in collaboration with the Massachusetts Coalition for Serious Illness Care , Serious and Advancing Illness Care in Value-Based Payment Models: What ACOs in Massachusetts are doing to document and honor patients' wishes,” to highlight the activities of three ACOs adopting innovative and effective approaches to serious illness care. Over 120 healthcare professionals participated in the event and engaged with panelists as they shared best practices from their respective ACOs.
 
The panel included representatives from three HPC-Certified ACOs: Baycare Health Partners, Lahey Health System, and Partner s HealthC are
Dr. Adrianne Seiler , Medical Director of Baycare Health Partners, discussed Baycare’s Integrated Health Care Program, a care management program embedded in primary care. “Without accountability, everyone is passing the ball, ” she said. 
Dr. Leslie Sebba , President and Chief Medical Officer of Lahey Clinical Performance Network, reflected on Lahey’s experience implementing the Serious Illness Conversation Project, developed by Ariadne Labs. “[Serious illness care] humanizes interactions with patients and makes you remember why you are in the health care profession, ” he said.
Dr. Charles Pu , Medical Director of Partners Center for Population Health, overviewed the Partners Hospice Collaborative, a network of high-quality hospices supporting Partners patients. “A challenge for all health systems is how to integrate [serious illness care programs],” he said.
Maureen Bisognano, Co-chair of the Massachusetts Coalition for Serious Illness Care & President Emerita and Senior Fellow at the Institute for Healthcare Improvement, moderated the event and provided an overview of the work of the Massachusetts Coalition for Serious Illness Care. Courtney Anderson, Senior Policy Associate for Care Delivery Programs at the HPC, shared insights on serious illness care across the 18 HPC-certified ACOs.
 
If you would like to watch a recording of the webinar, please access the video here .  
LESSONS FROM THE FIELD
Baycare Health Partners:
Educating Care Managers in Serious Illness Care
Baycare Health Partners, a physician-hospital organization based in Springfield, MA, is an HPC-certified ACO that seeks to promote access to serious illness care for its Medicare population in the primary care setting. They do so by training nurse care managers and certified medical assistant care coordinators how to communicate with patients about goals of care, and how to initiate conversations with patients on their preferences and values. 
The training takes place over the course of multiple in-person sessions, using a combination of didactic methods and case-based simulations. The program trains providers in identifying appropriate patients for serious illness care, facilitating goals of care discussions, and engaging with care managers in care coordination. To ensure that these conversations and goals of care are documented, the training also familiarizes care managers with health care proxies and Medical Order for Life-Sustaining Treatment (MOLST) forms, which document patients’ advance directives and can be used statewide by health care practitioners and facilities. Simulations are facilitated by palliative care physicians and the ACO medical director, and include role playing scenarios for various diseases often associated with end-of-life care. The sessions allow for group input and feedback, and care managers have access to reference materials at the conclusion of the trainings to assist in their practice. Materials include the Institute for Healthcare Improvement (IHI) Conversation Project and the PREPARE website .
Baycare surveyed the care managers to evaluate the effectiveness of the sessions. Results from this survey show that the care managers universally found the training to be helpful in better identifying when to have the conversation and with whom, experimenting with various styles of communication when having the conversations, improving confidence in initiating the conversations, and designing strategies for how to better partner with their physician and advanced practice colleagues (e.g., nurse practitioners) on shared patients.
 
Through this training, Baycare seeks to improve the delivery of patient-centered end-of-life care by improving patient experience, managing pain and symptoms, emphasizing goal-setting for end-of-life care, and avoiding unwanted, low-utility, and high-cost care at end-of-life.
PATIENT STORY
Care Dimensions' Palliative Care+ (PC+) Program 
The Care Dimensions PC+ Targeted Cost Challenge Investment (TCCI) initiative bridges service gaps among curative care, palliative care, and hospice services for patients with serious illness by integrating palliative care staff into North Shore Physician Group’s (NSPG) primary care sites. The PC+ program aims to support patients by helping them access appropriate care for serious, life-limiting illnesses through conversations around what patients value and the ways in which the PC+ team can assist them in achieving their goals. 
A senior woman with an advanced pulmonary disease, anxiety, and osteoporosis lives with her caregiver husband at home. The patient was hospitalized several months prior to her enrollment in PC+, and was referred to PC+ by her primary care provider at North Shore Physicians Group so she could benefit from palliative care support at home. The PC+ team met with the patient to have a comprehensive discussion about her care preferences. The patient explained to the PC+ team that, in the case of an infection, she would want to go to the hospital and have antibiotics. However, she had been intubated three times previously, and no longer wanted to be intubated or resuscitated, but she did not want to complete the necessary DNR/DNI forms with the PC+ team; instead, she wanted to complete the forms with her primary care physician. The PC+ team factored the patient’s wishes into her patient-centered care plan.
The Care Dimensions PC+ team supported the patient for a year with visits from a nurse practitioner every six to eight weeks and weekly calls with the nurse coach. The patient declined to utilize the PC+ program’s telemonitoring technology, citing that she didn’t want “extra machines” in her home. The PC+ team counseled her on her healthcare needs, and assisted her and her husband in decision-making more broadly as her health declined, always treating her wishes and preferences as paramount. As she gradually grew weaker, the patient needed antibiotics, which the PC+ team ensured were administered in her home. 
A year and a half later, the patient was no longer leaving the house except for physician appointments and was having difficulty performing activities of daily living without taking breaks to catch her breath. She enrolled in hospice a few months later with the support of her primary care and PC+ teams, having never returned to the hospital since her enrollment in the PC+ program. Currently, she and her husband are receiving the full support of hospice care, including home health services, facilitated by a nurse case manager, social worker, and chaplain to help them through this next chapter.
PUBLICATIONS, PRESENTATIONS, & RECOGNITIONS
The HPC Releases the 2018 Cost Trends Report
The HPC recently released its sixth Annual Health Care Cost Trends Report , which presents an overview of trends in health care spending and delivery in Massachusetts, and makes policy recommendations for strategies to increase the quality and efficiency of care in the Commonwealth. This year’s report highlights variation in hospital admissions from the emergency department as well as the spending and prevalence of low value care in the Commonwealth.

The Report’s accompanying Chartpack presents some areas for improvement in care delivery performance, such as decreasing avoidable hospital inpatient and emergency department utilization and expanding the use of alternative payment methods. 
This year’s policy recommendations focus on strengthening market function and transparency, and promoting an efficient, high-quality healthcare delivery system. Recommendations include:
  • Identifying and reducing areas of administrative complexity
  • Reducing drug spending through new mechanisms to review high-cost drugs
  • Reducing unnecessary utilization and increasing the provision of coordinated care in high-value, low-cost settings
  • Addressing the social determinants of heath
  • Reviewing and amending scope of practice laws that are restrictive and not evidence-based
  • Scaling innovations in integrated care
  • Promoting the increased adoption of alternative payment methods (APMs) and improvements in APM effectiveness
UMass Memorial Medical Center Featured in the Worcester Telegram and Gazette
The HPC would like to congratulate UMass Memorial Medical Center’s (UMMMC) Neonatal Abstinence Syndrome (NAS) intervention team, funded with an investment from the HPC, for being featured in the Worcester Telegram and Gazette’s January 24 th article on peer recovery coaches ’ effectiveness in combatting the Commonwealth’s opioid crisis.

Dr. Lawrence Rhein, the Investment Director for UMMMC’s NAS initiative, noted that based on the “terrific outcomes” associated with the peer recovery coaches, the team hopes to continue supporting this work through philanthropic contributions.

See more about UMMMC’s HPC NAS program here , and check out the RIZE Foundation’s new resources on Peer Recovery Coach utilization and impact here .
HPC to Host a Webinar or Leveraging Digital Health Solutions for Behavioral Health
The HPC invites you to join us on March 7, 2019 from 12:00-1:00pm for a webinar , Leveraging Digital Health Solutions: An Introduction to Technologies to Promote Behavioral Health Treatment Engagement, featuring two digital health startups’ tools to support clinicians engaging patients in behavioral health treatment and substance use disorder recovery. The HPC is working with a digital health accelerator, MassChallenge HealthTech (MCHT), to promote community-based provider access to digital health solutions and to identify digital health startups that address high-priority policy areas such as timely access to behavioral health care. This event highlights the work of two digital health startups, Marigold Health and DynamiCare Health.
 
To attend this event, please register here
UPCOMING EVENTS & RESOURCES
National Academy for State Health Policy
March 4, 2019

Massachusetts Health and Hospital Association
Webinar
March 5, 2019

Massachusetts Health Data Consortium
Webinar
March 5, 2019

Massachusetts Health and Hospital Association
Burlington, MA
March 8, 2019

Health Policy Commission
Boston, MA
March 13, 2019

Massachusetts Health Data Consortium
Webinar
March 26, 2019

Ounce of Prevention
Massachusetts Department of Public Health
Worcester, MA
April 2, 2019

Institute for Healthcare Improvement
San Francisco, CA
April 11-13, 2019
Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109