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Massachusetts Health Policy Commission
June 2018
This month’s newsletter features some of the Health Policy Commission’s work to address the statewide opioid epidemic. The HPC is committed to supporting innovative models in opioid use disorder (OUD) treatment through our investment programs, and to advancing policy to promote access to OUD treatment through our research and publications. We are excited to highlight the HPC’s presentations on substance use at AcademyHealth ’s 2018 Annual Research Meeting, share Lowell General Hospital’s work in caring for opioid-exposed newborns and their mothers through the HPC Neonatal Abstinence Syndrome (NAS) award program, and report on the successful Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) Spring Summit.
Let us know if there are other 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 HPC-Caredeliverytransformation@massmail.state.ma.us .
Team HPC
HPC Presents at AcademyHealth's 2018 Annual Research Meeting
HPC staff presented some of the agency’s work addressing the opioid crisis in Massachusetts at AcademyHealth’s 2018 Annual Research Meeting (ARM) in Seattle, Washington, June 24 th -26 th . ARM is an opportunity for those doing critical research work in transforming healthcare delivery systems to gather and exchange ideas and best practices. The HPC was pleased to share key lessons learned around OUD from several of the agency’s investment programs.
The HPC’s NAS program awarded $3 million in funding for six hospitals in Massachusetts, two of which have the highest volume of NAS births in the state, to implement an inpatient quality improvement program to enhance care for opioid-exposed infants. A series of interviews on best practices with awardees and subject matter experts, conducted by the HPC, culminated in a 90-minute knowledge sharing session with NAS award teams focused on addressing stigma. The presentation highlighted several approaches implemented by the hospital cohort to address stigma in the hospital setting, including hiring and integrating peer recovery coaches, training hospital staff in trauma-informed care, and supporting and engaging the hospital workforce as well as family members with OUD.
This case study identified promising practices and lessons learned from the Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) program during their CHART Phase 2 award. Although the COACHH program served multiple populations, this study focuses on the component serving pregnant and postpartum women with OUD. The study highlights the value of using a collaborative care team to coordinate outpatient care and provide specialized programming to address the unique complexity of this population. In particular, the deployment of non-medical staff, such as community health workers, was critical to building supportive relationships with patients.
This case study was designed to showcase how a Massachusetts District Drug Court and a community hospital collaborate to promote patient-centered care and evidence-based treatment. In this rural court, cases are jointly reviewed by the judge, probation officer, and treating clinician. Having multiple touch points allows the judge to gather the necessary information to create a plan customized to an individual. Frequent communication and professional respect among the multidisciplinary team members are key to managing the multifaceted needs of drug court participants. Team members from both criminal justice and health care settings value the collaborative approach, which enables them to create an individualized and comprehensive care plan.
Caring for Opioid-Exposed Newborns and their Mothers at Lowell General Hospital

As described above, the HPC’s NAS awards are six hospital-based quality improvement programs currently testing and spreading best practices in care for opioid-exposed newborns and their mothers across the Commonwealth. Lowell General Hospital’s NAS initiative aims to serve patients throughout the care continuum by integrating care between acute care settings, outpatient providers of medication-assisted treatment (MAT), and behavioral health services. Lowell General’s inpatient quality improvement initiative is focused on reducing the length of stay for all infants monitored for NAS symptoms by emphasizing non-pharmacologic treatment for opioid-exposed newborns, such as increasing rates of breastfeeding and encouraging skin-to-skin contact between mothers and infants early and often.
Lowell General’s outpatient Moms Do Care program, funded by the HPC and administered in partnership with the Massachusetts Department of Public Health (DPH), aims to serve mothers with OUD by identifying women with OUD early in their pregnancies and assisting them in accessing pharmacotherapy and behavioral therapy, as well as engaging them in prenatal care. The HPC initiative funded education across the hospital on trauma-informed care, the science of addiction, and self-care strategies for providers who work with patients with a substance-use disorder (SUD). Families are supported through pregnancy, delivery, and six months postpartum with wrap-around services that help mothers navigate the complex Department of Children and Families (DCF) system, find resources including housing and social support, and offer recovery coaching for women in recovery from substance use disorder. 

At the hospital, the Lowell General NAS team hosts supportive programming for parents of infants with NAS, with specific instruction on bathing newborns, safe sleep practices, and infant massage. At their Nurturing Parent Group meeting each Tuesday, nurses teach about the labor and delivery process, pain control, and what to expect immediately after delivery. In addition to providing valuable early education for parents-to-be, the team is also helping families develop relationships and become familiar with the faces they’ll see during their stay at Lowell General, which helps reduce anxiety. The feedback from patients has been overwhelmingly positive. One provider team member explains why in Lowell’s programmatic update to the HPC:

Our patients feel more supported, have better understanding and more control during and after pregnancy. One of the great changes we have seen with the program is arranging for mothers to have consultations with pediatricians and neonatologists prior to delivery. These consultations have allowed the patients to ask questions, understand the importance of their presence with the baby during the hospital admission, and be better prepared to help care for their baby at discharge.
Just halfway through their implementation period, the Lowell General NAS team has seen promising emerging results: length of hospital stay for opioid-exposed newborns and unplanned readmissions post-discharge are both trending downward since the program launch. The program will run through May 2019.
Community Health Workers: Supporting Behavioral Health Needs Across the Care Continuum
The Lahey-Lowell Joint CHART Phase 2 Award was an effort by Addison Gilbert Hospital, Beverly Hospital, Lowell General Hospital, and Winchester Hospital to reduce emergency department (ED) revisits by identifying and serving patients with moderate or high utilization and behavioral health diagnoses. The multidisciplinary care teams developed strong relationships with patients as they conducted comprehensive needs assessments, developed individualized, patient-centered care plans, and coordinated services across the care continuum. The CHART team shared a patient story highlighting the critical role a community health worker (CHW) played in providing care navigation and support services for a patient with behavioral health needs.
A woman with a complex behavioral health history repeatedly presented to the ED with substance use-related symptoms, and regularly declined detoxification or outpatient treatment referrals. She was enrolled in the hospital's CHART program and received support from a CHW who was able to meet the patient’s needs through a broad range of care coordination activities.
The CHW helped to address the patient’s behavioral health needs by referring the patient to a psychiatric nurse practitioner and sending her text reminders about upcoming visits. The CHW also provided grief support resources when the patient’s close family member passed away from an overdose. Additionally, the CHW encouraged the patient to return to substance use counseling meetings after a relapse. The CHW also assisted the patient in cancelling and rescheduling her outpatient appointments during any hospitalizations, and had regular check-ins by phone and in-person.
The CHW also helped to address the patient’s social needs. She assisted the patient in applying for the Supplemental Security Income program (i.e. Social Security), and completed all necessary paperwork with the Massachusetts Rehabilitation Commission to qualify the patient to receive financial aid and attend classes. The CHW also linked the patient to the hospital's financial services to help the patient understand MassHealth’s coverage of services and coordinated the patient’s transportation to a local food pantry.

The CHW role on the care team was integral in addressing the care coordination, navigation, and social support services that this patient needed to support her recovery.
Healthcare Leadership Summit: Leading Teams to Address the Opioid Epidemic
HPC Strategic Investment team director Kathleen Connolly, MSW LICSW, spoke at Lawrence General Hospital’s annual Leadership Summit on May 22, 2018. The summit focused on practical approaches to address the opioid epidemic, and featured presentations from Dr. Marc Myer, an addiction medicine specialist; Paul Moakley, an editor at TIME magazine, which recently featured Lawrence General’s work in treating patients with an OUD; and Dr. Christin Price, the Administrative Program Director of the Bridge Clinic at Brigham and Women’s Hospital.
Ms. Connolly discussed the HPC’s investments in innovative care delivery models as a key component of the agency’s focus on promoting a high-quality delivery system with aligned incentives. She shared recent data on SUD in Massachusetts and discussed the HPC’s investments in SUD treatment. Her presentation highlighted recent data from CHART Program awardee Beth Israel Deaconess -Plymouth, Targeted Cost Challenge Investment (TCCI) Program awardee Berkshire Medical Center, and NAS awardees Baystate Medical Center and Lawrence General Hospital.  
Congratulations to the team at Lawrence General Hospital on the success of the Summit!
PNQIN Spring Summit
The HPC supports and partners with the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) on their Substance-Exposed Newborn (SEN) project, and their semi-annual summit series, which convenes members of the statewide learning collaborative focused on improving the care of mothers, infants and families impacted by perinatal and neonatal opioid use.
The day-long summit on May 23, the largest to date, drew over 250 maternal health and newborn clinical providers, community-based advocates, public health officials, and state leaders to review, discuss, and focus statewide efforts to improve the care of infants and families. With a keynote address by the Grayken Center’s Michael Botticelli, and representation from the Massachusetts DPH, DCF, Attorney General’s Office, and many providers and peer recovery coach organizations, this season’s summit focused on ‘Extending the Improvement Framework Beyond Hospital Walls.’
The HPC’s NAS awardees participated in the summit, with some teams presenting research posters on their work, and some participating as expert faculty during the day. The HPC’s NAS awardees were also featured during the day for their contributions to the state’s efforts in this space through learning collaborative site visits, online quality improvement toolkits to spread best practices, and participation in a statewide quality measurement database.
July 11, 2018
HPC Board Meeting: SHIFT-Care awards announcement 
Boston, MA
July 18, 2018
12:00pm – 3:00pm

Bureau of Substance Addictions Service & AdCare Educational Institute, Inc.
North Andover, MA
July 18, 2018--July 20, 2018

Institute for Healthcare Improvement
Virtual Training, Session 1
July 26, 2018
Boston, MA
August 28 th—August 30 th, 2018

HPC resources on Opioid Use Disorder
Massachusetts Attorney General’s Office
The National Center for Complex Health and Social Needs
Center for Health Care Strategies
Blue Cross Blue Shield of MA Foundation
Center for Health Care Strategies, Inc.
Blue Cross Blue Shield of MA Foundation
The Commonwealth Fund
Bureau of Substance Abuse Services
Massachusetts Department of Public Health
Massachusetts Association of Community Health Workers
Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109