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Massachusetts Health Policy Commission
March 2019
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This month’s newsletter focuses on the topic of quality improvement, approaching this broad and important concept from several different perspectives. The newsletter includes lessons from HPC investment awardees making strides in improving the quality of care for their patients, and a presentation on physician burnout as it relates to quality measurement.
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 caredeliverytransformat ion@m ass.gov
Team HPC
Quality Measure Alignment and Physician Burnout
“In order for us to improve the quality of care, we need to decrease administrative complexity, and physician and clinician burnout more broadly.” – Dr. Steven Defossez
On March 20, representatives of the Massachusetts Medical Society (MMS)/Massachusetts Health and Hospital Association (MHA) Joint Taskforce on Physician Burnout delivered a presentation calling for continued progress in reducing the burden of quality measurement and reporting to the Executive Office of Health and Human Services (EOHHS) Quality Measure Alignment Taskforce.  
Leveraging findings from their report, “A Crisis in Health Care: A Call to Action on Physician Burnout,” the presenters, Dr. Steven Defossez of MHA, Dr. Jatin Dave of the New England Quality Care Alliance, and Dr. Alain Chaoui of MMS, suggested that attempts at quality measurement and related documentation requirements have become a tragedy of the commons. With each payer-provider dyad including a different set of measures in their global budget contracts, providers are burdened with tracking and reporting on a myriad of unaligned quality measures. This, according to the presenters, has led to a decrease in physician well-being, which may compromise the quality of patient care. 
Some of the key points they expressed on the topic were:
  • Continued support of the EOHHS Quality Measure Alignment Taskforce’s efforts to align quality measures across payers and providers in order to reduce administrative burden and improve clinical quality;
  • The potential benefits of sharing risk from global budget contracts with front-line providers to support quality measurement and improvement activities; and
  • The importance of strong, trusting relationships between patients and physicians, which are not easily measured.
EOHHS, the HPC, and the Center for Health Information Analysis (CHIA) convened a Quality Measure Alignment Taskforce in 2017 with the primary goal of building consensus on an aligned measure set for voluntary adoption by private and public payers, and by providers in global budget-based risk contracts. The Taskforce aims to align quality measures for use in global budget-based risk contracts. The Taskforce membership includes representatives from provider organizations, commercial and Medicaid managed care health plans, academic institutions, state agencies, and consumer advocates.
For more information about the Taskforce, visit the newly launched EOHHS Quality Measure Alignment Taskforce website , which includes meeting materials describing the process by which the Taskforce achieved consensus on an aligned measure set, a report about the Taskforce’s work to date, the full list of measures in the Massachusetts Aligned Measure Set, and upcoming measure development efforts. 
Addison Gilbert and Beverly Hospitals Leverage Pharmacists for Quality Improvement
Addison Gilbert and Beverly Hospitals , awardees in the HPC’s Community Hospital Acceleration, Revitalization, and Transformation (CHART) Investment Program, engaged pharmacists as care team members as an innovative approach to reducing 30-day returns to the emergency department for patients with a history of high acute care utilization, social complexity, or one or more 30-day readmissions to the hospital. 
The hospitals brought together nurses, social workers, and pharmacists to form committed multidisciplinary teams. As their work unfolded, the teams discovered the unique value that pharmacists could bring to caring for complex patients transitioning out of the hospital. The teams deployed pharmacists to work with social workers and nurse practitioners to establish patient relationships and to complete face-to-face visits in the patient’s home and community. The pharmacists then worked with providers across the care continuum, collected and reviewed patient medication lists, conducted case reviews, evaluated documentation, verified patient data, and provided medication reconciliation and education to patients. 
These efforts contributed to increased patient safety post-discharge. A sampling of reports from the hospitals’ medical error reporting system, Safe Spot, revealed that 46% of possible errors were reported by pharmacists and pharmacy technicians. Pharmacists serving in non-traditional roles were an important feature of these multidisciplinary care teams, improving the safety, quality and value of care provided to patients. 
Mother and Infant-Focused Neonatal Abstinence Syndrome Interventions   
The HPC’s Health Care Innovation Investment (HCII) Program’s Mother and Infant-Focused Neonatal Abstinence Syndrome (NAS) Interventions are contributing to the statewide response to the opioid epidemic by supporting enhanced care and treatment for mothers and infants impacted by opioid use. Starting in 2017, six hospitals across the Commonwealth deployed interventions designed to improve care for opioid-exposed newborns at-risk of developing NAS and for women in treatment for opioid use disorder (OUD) during and after pregnancy. 
Core to all six of the interventions was a quality improvement (QI) framework addressing the newborn’s stay in the hospital, from delivery to discharge. The QI framework focused on improving health outcomes for opioid-exposed newborns by standardizing clinical care management of NAS symptoms, and expanding non-pharmacologic interventions such as breastfeeding, skin-to-skin contact between the mother and infant, rooming-in, and ultimately discharging the infant under the care of their biological family. 
The QI team for Boston Medical Center’s (BMC) NAS award, led by Dr. Elisha Wachman, met monthly to review data and clinical cases to identify areas for improvement. The team shared updates with nursing staff through daily huddles, as well as regular emails and meetings. The team also used a web-based learning platform to disseminate updated procedures and protocols to providers, such as a new, more effective symptom scoring and management model developed in partnership with Dartmouth, the “Eat, Sleep, Console” method.
In addition to taking steps to improve quality of care for the newborns, the staff also took steps to ensure that the mothers were receiving high-quality wraparound care. When updating HPC staff on program implementation, one nurse educator on BMC’s Mother and Infant Unit discussed her experience identifying opportunities to provide further support, observing that mothers “are often hesitant to put the infants down, even when they are exhausted in the days following delivery,” leading to increased risk to the infant. She recommended “putting more attention on the mother’s needs, and implementing a protocol in which the nurses ensure that the mother has adequate rest and support,” with education beginning prenatally in anticipation of the post-partum period.
The Neonatal Quality Improvement Collaborative (NeoQIC) of Massachusetts supported all six HPC NAS intervention sites with technical assistance ranging from QI training and collaborative learning opportunities (such as conferences and peer site visits) to measurement and analysis of key practices and performance indicators. As detailed in a recent presentation by NeoQIC lead Dr. Munish Gupta at the HPC Care Delivery Transformation Committee Meeting on February 27, BMC’s approach to non-pharmacologic care was associated with shorter length of stay and less need for pharmacologic therapy . BMC has been able to sustain its successful initiative beyond the HPC’s grant funding period, and continues to be a national leader in improving care for substance exposed newborns, using QI to push new frontiers in managing and treating substance exposure generally, and NAS symptoms specifically.
“Unlocking Accountable Care” Podcast Highlights Boston Health Care for the Homeless Program
Mary Takach, Senior Health Policy Advisor at Boston Health Care for the Homeless Program (BHCHP) and Investment Director for BHCHP’s Targeted Cost Challenge Investment (TCCI) award, was recently interviewed on the new podcast series “Unlocking Accountable Care.” Ms. Takach was invited to talk about the role that community-based organizations play in serving patients, especially those with complex medical, behavioral health, and social needs.
Ms. Takach cited BHCHP’s TCCI initiative as the “training wheels to get ready for the ACO world,” in which BHCHP now participates as a MassHealth ACO Behavioral Health Community Partner (CP). Ms. Takach highlighted the critical need for CPs and MassHealth ACOs to work together to provide care coordination and care management for patients with severe mental illness. She also described the ways in which BHCHP’s Coordinated Care Hub, a coalition of homeless service providers in Boston with formalized legal and data sharing partnerships, has been using social determinants of health data in caring for patients to address their needs holistically. 
Listen to the full interview here .
Coming Soon – “Transforming Care ACO Policy Brief #3: Risk Contracts and Performance Management Approaches of Massachusetts ACOs”
A forthcoming HPC policy brief 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 covers:

  • Characteristics of the certified ACOs’ public and private risk contracts
  • Strategies for setting quality improvement priorities and goals
  • 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 is issuing to provide stakeholders and the interested public with new information and insights regarding HPC-certified ACOs. This brief, as well as other materials pertaining to HPC-certified ACOs, will be available on our website here: Transforming Care: ACO Briefs and Other Resources
HPC Hosts Webinar on Leveraging Digital Health Solutions for Behavioral Health
On March 7, the HPC hosted a webinar, “ Leveraging Digital Health Solutions: An Introduction to Technologies to Promote Behavioral Health Treatment Engagement,” featuring Marigold Health and DynamiCare Health , two digital health startups focused on supporting patients in behavioral health treatment and substance use disorder recovery. DynamiCare CEO Eric Gastfriend discussed the DynamiCare app, designed to help people monitor and change their use of drugs, alcohol, and tobacco through app-supported breath and saliva tests verified by self-recorded videos and linked to incentives. Shrenik Jain, CEO of Marigold Health, provided an overview of the company’s text-based support group platform, which enables peer chatting moderated by behavioral health providers. The app leverages artificial intelligence tools to help alert providers when a patient’s texts include clinically relevant sentiments that may indicate a need for a higher level of care.
To view a recording of the webinar, register here
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