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Massachusetts Health Policy Commission
March 2018
We hope this finds you well and ready for spring weather!

In this newsletter edition, we are pleased to inform you of two upcoming HPC events, announce our latest work regarding our accountable care organization (ACO) certification program, convey insights from Manet Community Health Center on its behavioral health integration efforts, and share information on the HPC's public hearing on the potential modification of the state's health care cost growth benchmark for calendar year 2019.
Let us know if there are any other care delivery transformation topics or work in the Commonwealth that you’d like to see the HPC showcase in this newsletter. We love to hear from you! Please email us at HPC-Caredeliverytransformation@massmail.state.ma.us .
Team HPC
Upcoming events
Tele-health for Behavioral Health Integration in Primary Care - Thursday, April 12, 2018, 8:30-10:00 AM
Massachusetts Health & Hospital Association, Burlington
This peer-to-peer knowledge sharing session will explore different models and operational considerations for starting tele-health programs for behavioral health integration in primary care settings. The event will feature a panel presentation including representatives from Pediatric Physicians’ Organization at Children’s Hospital , Codman Square Health Center, Yogman Pediatric Associates, and Health Management Associates. Health care professionals interested in discussing practical strategies for implementing tele-health programs to support behavioral health integration are encouraged to attend. Please register here.

Partnering to Address the Social Determinants of Health - Thursday, May 17, 2018, 8:00-11:00 AM
UMass Club, Boston
This special event will examine how partnerships between health care providers and community stakeholders work to address health-related social needs. This session will feature expert speakers and two panels of Massachusetts health care leaders. Please note that registration is currently closed, as we have reached seating capacity. If you are registered but can no longer attend the event, please email hpc-caredeliverytransformation@state.ma.us so that we can open up registration to others.
Launch of the MassHealth Accountable Care Organization (ACO) Program
March 1, 2018, marked an important milestone in the Commonwealth’s ongoing efforts to improve our health care system. For the first time, approximately 850,000 of MassHealth’s 1.9 million members began accessing care through accountable care organizations (ACOs) – entities responsible for providing services, coordinating care, and facilitating new linkages with community-based organizations and resources to further support their members’ wellbeing. 
What is an ACO?
The term “ACO” is generally used to mean a group of health care providers that contracts with a payer to assume responsibility for the delivery of care to its attributed patients, and for those patients’ health outcomes. ACOs contract with payers under payment models other than fee-for-service (so-called “alternative payment methods,” or APMs), in which the ACO is typically accountable for spending against a budget and may earn financial incentives for meeting agreed-upon quality performance targets. ACOs are not new to the Massachusetts health care landscape; Medicare and commercial insurers have tested and adapted the model for the past decade. 
In 2017, the Health Policy Commission (HPC) launched a set of state-wide standards for ACOs that encourage the provision of value-based, high-quality, and cost-effective care regardless of payer. The HPC certified 17 ACOs in Massachusetts that met those standards through an application process. All of the new MassHealth ACOs were certified by the HPC prior to their launch. 
Upcoming resources: Overview of certified Massachusetts ACOs
The HPC is developing a series of written reports and other resources regarding the landscape of certified Massachusetts ACOs based on the information submitted by applicants for ACO Certification, and other publicly available information. The purpose of this new series of data briefs is to provide policymakers, health care providers, payers and purchasers, researchers and other members of the interested public with new information and insights regarding the characteristics of certified ACOs, including how they are organized and governed, how they set and implement quality improvement strategies, their experience managing patients under risk contracts, and other key features. 

The first brief in the series, scheduled to be published in April, will provide background information on the HPC ACO Certification program  as well as several key facts about the certified ACOs, such as:
  • Approximately 1.9 million commercial or Medicare patients in Massachusetts are served by HPC-certified ACOs.
  • The 17 HPC-certified ACOs represent the majority of the health care providers in Massachusetts that hold risk contracts. In addition to their contracts with MassHealth, the 17 certified ACOs hold a total of 66 commercial risk contracts and 11 Medicare risk contracts.    
  • Over 80% of ACOs have at least one hospital as an ACO participant.
Subsequent briefs will explore these and other details in more depth. In addition, this spring the HPC plans to issue HPC-certified ACO profiles that describe elements of the 17 ACOs and the larger care delivery systems within which they operate.
We look forward to increasing public transparency about ACOs through these briefs, and continuing to engage with a broad range of stakeholders to help shape improvements in our health care system through ACOs.
Behavioral health integration at Manet Community Health Center
Like many community-based providers in Massachusetts, Manet Community Health Center prioritizes access to comprehensive care for its patients in a manner that is sustainable, person-centered, and responsive to community needs. While the health center has robust medication-assisted treatment programs embedded in their primary care practices, finding the right model of integrating behavioral health and primary care services across its four sites was challenging. Key questions Manet considered included:
  • Should the center co-locate behavioral health services in the primary care setting?
  • Should the center emphasize robust referral processes to community-based behavioral health providers?
  • Should the center partner with a local community-based health organization to support provision of these services? 
  • Does the center have the right infrastructure, staffing, and workflows in place to integrate behavioral health screening, monitoring, and treatment processes into the primary care departments to meet patient needs?
Manet enrolled in the PCMH PRIME technical assistance program and collaborated with consultant resources provided by the HPC. Through the technical assistance program, the health center engaged in thoughtful discussions about the role of all care team members in integrating behavioral health conditions, processes, and content within the larger workflows of the clinic. Examples of discussion topics included:
  • Assessing current and available routine screening processes
  • Maximizing the opportunity posed by routine screening through a measurement-based care registry template
  • Defining the roles of all members of the care team with respect to behavioral health screening, decision-making and follow-up to integrate behavioral health-related care management into existing infrastructure

As a result of the technical assistance, the health center designed a model of integrated care that included:
  • Hiring co-located behavioral health staff
  • Improved tracking of their patients with chronic behavioral health conditions
  • Refined workflows to spread the work more evenly among the appropriate team members
Manet has achieved PCMH PRIME Certification in all four of its locations, demonstrating its capabilities in providing medication-assisted treatment, behavioral health screenings, and care management.

Interested in learning more about PCMH PRIME technical assistance and applying for free practice coaching? Visit the HPC website for details!
Health Care Cost Growth Benchmark Hearing
On March 28, 2018, the HPC held a public hearing on the potential modification of the state's health care cost growth benchmark for calendar year 2019, considering data, information, and testimony on whether modification is appropriate. Chapter 224 of the Acts of 2012 established the health care cost growth benchmark, a statewide target for the rate of growth of total health care expenditures across all payers (public and private), which is set annually by the HPC. The HPC has limited authority to modify the statutory benchmark and can decide to either maintain the current default growth rate of 3.1% or vote to change it to an amount between 3.1% and 3.6%.

The Board discussed trends in spending performance among specific categories and opportunities for reducing spending and improving care. 2018 spending reduction scenarios included a number of care delivery transformation indicators, specifically reducing hospital readmissions, reducing institutional post-acute care, reducing avoidable energy department use, and increasing adoption of alternative payment models. The HPC presented a savings opportunity of close to $5 billion over five years if the scenarios occurred.

You can watch a video of the full hearing on the HPC’s YouTube Channel . The slide presentation can be viewed here .
Massachusetts Health & Hospital Association
Burlington, MA
April 6, 2018
9:00am – 12:15pm ET

Health Policy Commission
Hosted at Massachusetts Health & Hospital
April 12, 2018
8:30-10:00 am ET

SDOH Academy
April 12, 2018 
3:00 - 4:30pm ET (webinar)

Institute for Healthcare Improvement
Boston, MA
April 24-25, 2018

American College of Healthcare Executives
Westborough, MA
May 4, 2018
7:30am – 12:00pm ET

Health Policy Commission
Boston, MA (UMass Club, One Beacon St)
May 17, 2018
8-11am ET

Massachusetts Health & Hospital Association
Burlington, MA
June 22, 2018
9:00am – 2:30pm
HPC SHIFT-Care grant opportunity:  This $10 million grant opportunity is designed to foster innovative care delivery models in Massachusetts that shift the unnecessary delivery of care for complex patients from expensive, acute care hospitals, to more patient-centered, community-based settings.
Please see the SHIFT-Care webpage for the RFP and related documents. The deadline for eligible proposals is April 6, 2018 at 3pm ET.

NEW!  Community Resource Directories (CRD): Environmental Scan of Existing CRDs in MA, February 2018. Chaired by BCBSMAF and in partnership with Brookline Community Mental Health Center, a CRD action team recently released a report on existing CRDs in the state. Appendix Tables 2 and 3 of the report provide a list of CRDs reviewed and the services included in each directory. The full appendices with additional information can be found here. Please send any feedback to HPC-Caredeliverytransformation@massmail.state.ma.us .  
Blue Cross Blue Shield of MA Foundation
Blue Cross Blue Shield of MA Foundation
Blue Cross Blue Shield of MA Foundation
Institute for Healthcare Improvement

The Commonwealth Fund
Resource for pregnant and parenting women with substance use disorders
Massachusetts Department of Public Health
Bureau of Substance Abuse Services
Massachusetts Department of Public Health
Massachusetts Association of Community Health Workers
Awardees must use the Commonwealth’s secure Interchange system to submit all reporting. If you need technical support with accessing the Interchange system, please contact the Common Help Service Desk at 1-866-888-2808, 7:00am-6:00pm Monday through Friday, or at CommonHelpServiceDesk@state.ma.us.
HCII Awardees: Please refer to the deliverables schedule for any upcoming due dates for payment requests, Key Performance Indicators (KPI) submissions, or other deliverable requirements. Please contact your HCII Point of Contact with any questions.
CHART Awardees: If you have questions regarding monthly reporting requirements during program closeout and no cost extension periods, please contact your Program Officer.
Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109