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Massachusetts Health Policy Commission
June 2019
This month’s newsletter focuses on the HPC’s research and initiatives addressing opioid use disorder. We are excited to announce the launch of the HPC’s SHIFT-Care Challenge investment program and highlight a recent presentation from a SHIFT-Care awardee, Holyoke Medical Center. This newsletter also highlights key findings from the HPC’s newly published data chartpack on opioid-related acute hospital utilization. Finally, we showcase some successes achieved by Lowell General Hospital in caring for mothers and infants through their Health Care Innovation Investment (HCII) award.
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
Team HPC
Holyoke Medical Center Cites Broad Staff and Partner Engagement as Keys to Successful Launch of Bridging to Recovery Program
“[Opioid addiction] is a real tragedy for our community on a daily basis… Staff members deal with it, our families deal with it…so this is something that is important to us.”

-John Kovalchik, Director of ACO Operations, Holyoke Medical Center
On June 5, representatives from Holyoke Medical Center (HMC) shared early experiences and lessons learned from the launch of their new program for patients with opioid use disorder (OUD), Bridging to Recovery, at the meeting of the HPC’s Care Delivery Transformation Committee. The program seeks to reduce emergency department (ED) visits by 20 percent by improving access to medication for addiction treatment (MAT) in the ED. HMC’s model connects patients with peer recovery coaches and social workers who assist patients in accessing follow-up treatment services from the hospital bridge clinic, as well as other recovery resources.
John Kovalchik, HMC’s Director of ACO Operations and SHIFT-Care Investment Director, introduced the hospital’s history, provided context on its local health needs, and highlighted its extensive efforts to engage and invest in addressing OUD in the community. He highlighted how Bridging to Recovery will build on work initiated during the hospital’s previous participation in the HPC-funded Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program. 

Psychiatric Nurse Practitioner and SHIFT-Care Program Manager Maria Quinn described the program’s care model, the intensive planning required to launch the program, and the importance of involving a broad range of interdisciplinary stakeholders in the planning process.

Other early lessons learned and key strategies from HMC’s launch of Bridging to Recovery include :
  • It takes a team: Quinn stressed the importance of engaging all ED staff in program implementation. “Not just nursing and providers, but techs and security… they’ve referred clients to us as well,” she said. 
  • Raise the profile: It has been vital to saturate the ED with messaging about the program. A branded graphic detailing the care model is now a hospital screen-saver, and updates on the program are shared in the staff newsletter. These things help “keep the fire going,” according to Quinn, both to raise the program’s visibility for potential referrals, as well as bolster the number of staff interested in MAT waiver training. Quinn noted that, in the brief time since the start of their program, the number of HMC providers with waivers to prescribe buprenorphine has increased from one to eleven.
  • Build bridges: The program has found early success in efforts to break down traditional care siloes to create a continuum of care. By bringing together ED staff, nurse navigators, social workers, and community partners, program staff hopes to link more patients with needed community services and continue to support them even after they leave the ED.
  • Meet patients wherever they are in their recovery process: Some patients may not be ready to begin MAT. HMC strives to provide a range of treatment options for patients in recovery. They are “looking at every individual as an individual and assessing where they are, and assessing what would work for them,” Quinn said.

HMC’s initiative is one of nine SHIFT-Care awards taking an innovative approach to enhancing access to timely behavioral health care, including those that improve access to MAT through the ED. Awardees focusing on enhancing timely access to behavioral health care include Addison Gilbert and Beverly Hospitals; Beth Israel Deaconess-Plymouth; Harrington Memorial Hospital; Holyoke Health Center; Holyoke Medical Center; Lowell General Hospital; Massachusetts General Hospital; Mercy Medical Center; North Shore Medical Center, and UMass Memorial Medical Center.

To read more about these initiatives, and the six SHIFT-Care awards targeting health-related social needs, please visit our website .
HPC Released New Analysis Highlighting Health Disparities within Opioid-related Hospital Use

The HPC has published a new data chartpack including analyses on opioid-related acute hospital utilization and mortality in the Commonwealth. This chartpack shows that opioid-related morbidity and mortality have affected people of every race, income quartile, sex, and age in the Commonwealth, and that opioid-related discharges increased in every region of Massachusetts from 2012 to 2017. The most recent data show that the impact of opioid-related conditions is moderating in some populations (such as younger adults), but continuing to increase among those identified in the data as Black/African American, and older age groups.
Some of the key findings include:

  • Opioid-related ED use remains highly variable by region, with Fall River and Metro South having the highest rates.
  • Residents with opioid-related discharges are disproportionately lower-income, on public insurance, and between the ages of 25 and 44.
  • For all individuals with race identifiers available in the data, the rate of opioid-related discharges increased by more than 50% between 2012 and 2017; the rate among those identified as Black/African American increased by 98%.
  • From 2016 to 2017, while the rate of opioid-related discharges fell among those identified as White and Hispanic, it rose by more than 5% among those identified as Black/African American.

Between 2012 and 2017, opioid-related discharges for patients living in areas of the state with the lowest income quartile increased twice as fast as they did in areas with the highest-income quartile. By 2017, 40% of discharges were for patients living in the lowest income areas.

This chartpack builds on previous HPC research, including a 2016 report on OUD and an updated chartpack issued in 2017 . Its findings affirm previous recommendations for policies that facilitate and incentivize coordinated, evidence-based care for OUD, and for continued investments in expanding behavioral health treatment capacity, including through programs like the HPC’s SHIFT-Care Challenge.
Lowell General Hospital
Lowell General Hospital’s (LGH) Neonatal Abstinence Syndrome (NAS) initiative aims to serve mothers and infants throughout the care continuum by integrating care between acute care settings, outpatient providers of medication for addiction treatment (MAT), and other behavioral health services. The LGH NAS team supports families impacted by OUD through pregnancy, delivery, and six months postpartum. 
One of the clients of the LGH NAS team had been enrolled in LGH’s outpatient OUD support program very early in her pregnancy, but had disengaged from the program by the end of her second trimester. The team learned that she relapsed later in her pregnancy, and had been actively using opioids until the day of her delivery. During the birth admission, LGH’s NAS outpatient support team and inpatient social workers and nursing staff came together with the client to assess her readiness for change and to discuss options for inpatient detoxification. After considering her options, the client elected to pursue admission at a local withdrawal management program. In planning for the admission, the LGH NAS team took care to engage with the client as well as representatives from the Department of Children and Families (DCF) to establish common expectations for what treatment outcomes would be necessary in order for the client to be reunited with her child.

“I wouldn’t be here without you guys,” the client said about the support she received through intensive coordination and communication with LGH, the NAS team, and DCF over the course of the eight months she was enrolled in the program. Today, the client has completed a detoxification program, moved to a clinical stabilization program (CSS) and remains in contact with DCF. She plans to go to a family residential program once the CSS is completed. Grateful for the LGH NAS team’s support for her recovery, the client stated “I haven’t felt this good in a long time and it’s because I have a plan.”
HPC Presents at Academy Health Annual Research Meeting
The HPC’s Research and Cost Trends team presented at Academy Health’s Annual Research Meeting in early June . The research presented by HPC staff covered the growth of urgent care clinics, variation in inpatient admission rates from the ED, follow-on costs of low value care, and variation in health spending for patients living with diabetes. 
Heath Care Innovation Investment (HCII) Program Profiles
The HPC has published profiles of all 20 HCII awardee initiatives , which targeted some of the Commonwealth’s most persistent health care cost challenges with innovative partnerships, technology, and protocols. The profiles highlight key features of these initiatives, including care models, program aims, target populations, and partnerships with other organizations.

The HCII program represents over $11 million of investment in innovative projects that further the Commonwealth’s goal of better health and better care at a lower cost. The program includes three investment pathways focusing on:

  • Innovative delivery and payment models to reduce health care costs (Targeted Cost Challenge Investments)
  • Care for mothers and babies impacted by OUD (Mother and Infant-Focused Neonatal Abstinence Syndrome Investments)
  • Implementation of telemedicine programs for increased behavioral health care access (Telemedicine Pilot Initiatives)

The HPC looks forward to sharing results and learnings from each of the three pathways of the HCII Program over the coming year.
Perinatal Neonatal Quality Improvement Network of Massachusetts Spring Summit
The Perinatal Neonatal Quality Improvement Network of Massachusetts (PNQIN), the technical assistance partner for the HPC’s NAS investments, hosted over 300 clinicians, peer coaches, social workers, public health researchers, and mothers at its semi-annual summit this month. Highlights of the summit included a moving story from a ‘Peer Mom’-- a peer recovery coach in recovery from OUD during pregnancy -- from the HPC’s Beverly Hospital NAS team. Additionally, speakers highlighted throughout the summit how Massachusetts learning collaborative-based leadership in the NAS field has inspired others working in the field nationwide to spread promising practices. Dr. Munish Gupta also presented on Massachusetts statewide trends from the voluntary database supported by the HPC. Several posters from HPC NAS teams were represented, all of which focused on sharing insights to promote continued improvements in the quality of services for pregnant and post-partum women with OUD and their babies.
Transforming Care ACO Policy Brief #3 
The HPC has published a policy brief , Transforming Care: Risk Contracts and Performance Management Approaches of Massachusetts ACOs , which provides new insights about risk contracts and performance management strategies of the 18 HPC-certified accountable care organizations (ACOs). Leveraging information submitted through the ACO Certification process, the brief describes:

  • Characteristics of the certified ACOs’ public and private risk contracts
  • ACOs’ strategies for setting quality improvement priorities and goals
  • ACOs’ approaches to analyzing performance and sharing reports with providers
  • Methods by which the certified ACOs share risk-based incentives with participants

ACO Policy Brief #3 is part of a series of briefs and other resources that the HPC has issued to provide stakeholders and the interested public with new information and insights regarding HPC-certified ACOs. These resources include a recently published set of updated profiles of the 18 HPC-certified ACOs . Each profile provides key facts about the certified ACO and its corporate parents, including the payers with whom the ACO has risk contracts, the geographic area in which the ACO provides care, and the approximate patient count of the ACO. All of these materials can be found on our website .
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