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Massachusetts Health Policy Commission
May 2019
This month’s newsletter focuses on the behavioral health workforce and features the work of recovery coaches at UMass Memorial Medical Center and community health workers at Lynn Community Health Center. We are also excited to announce the publication of several reports and resources, including a new HPC research report on the statewide availability of behavioral health providers to treat patients with co-occurring mental illness and substance use disorder.
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
Co-Occurring Disorders Care in Massachusetts
On May 1, the HPC published Co-Occurring Disorders Care in Massachusetts: A Report on the Statewide Availability of Health Care Providers Serving Patients with Co-Occurring Substance Use Disorder and Mental Illness. The report offers the first inventory of Massachusetts behavioral health providers licensed to treat patients with both mental illness and substance use disorder (SUD), or “co-occurring disorders.” Nationally, co-occurring disorders affect 18 percent of adults with mental illness and 43 percent of adults with SUD. In Massachusetts, the HPC estimates that there are at least 236,000 adults with co-occurring disorders. Despite the need for appropriate treatment options for this population, however, rates of patient engagement in treatment are low, reflecting a variety of barriers to care.
“While the Commonwealth has made notable progress in strengthening access to mental health and substance use disorder treatment, the report…highlights the importance of maintaining this commitment moving forward, and for further advancing the integration of treatment for all patients with co-occurring mental illness and substance use disorder,” said Marty Cohen, HPC Commissioner and President and CEO of the MetroWest Health Foundation. “As with our response to the opioid epidemic, Massachusetts can be a national leader in ensuring that these vulnerable patients have access to high-quality, coordinated care in the most appropriate setting.”
Among the report’s key findings are that gaps in treatment access are especially significant for specific populations with co-occurring disorders, including people between the ages of 18 and 21 and people who do not speak English. In addition, among providers that do offer treatment for people with co-occurring disorders, few prescribe medications, a critical evidence-based component of integrated treatment.

The report includes six policy recommendations, including a call for the Commonwealth to deepen investments in developing a diverse, well-trained, and supported behavioral health workforce to improve access to care. The report also recommends that students pursuing primary care or behavioral health clinical roles with prescribing privileges be required to pursue training and waivers to prescribe buprenorphine to promote access to treatment.
Acknowledging behavioral health providers’ challenges recruiting and retaining staff, the report also endorses investment in additional supports for those working with patients with co-occurring disorders, such as:
  • training on occupational hazards and factors that contribute to burnout;
  • access to mental health support services for staff; and
  • sustained loan forgiveness programs for clinicians working with this population.
UMass Memorial Medical Center Recovery Coaches
UMass Memorial Medical Center’s Health Care Innovation Investment (HCII) Telemedicine Pilot helped patients in the emergency department (ED) and inpatient setting access treatment for SUD, and connected enrolled patients to ongoing services to provide post-discharge recovery support.
Recovery coaches played an instrumental role in the program, working with clinical teams to identify patients, and initiate and maintain engagement in treatment. Recovery coaches first connected with patients while they were still in the hospital to begin building a supportive relationship. They also assisted patients using telemedicine for behavioral health by introducing them to the technology utilized by the program, and ensuring their comfort with the tablets. UMass reported that over 90 percent of patients enrolled in the telemedicine pilot agreed to meet with a recovery coach while in the hospital.
Many patients continued to work with their recovery coach for more extensive support after discharge from the hospital. Given their familiarity with common barriers and setbacks that patients in recovery often experience, recovery coaches were able to help patients integrate back into the community, including helping them find community-based addiction recovery services.
UMass described the quality of its care teams, including the inclusion of recovery coaches, as a major “determinant of [our] success” when sharing lessons learned from the pilot at an HPC Tele-Behavioral Health Roundtable last spring. UMass and other attendees spoke to the crucial role that a dedicated and trained workforce played in their initiatives.  Many of these insights are captured in the Tele-Behavioral Health Implementation Guide recently published by the HPC.
Now, as an awardee of the HPC’s newest investment program, the SHIFT-Care Challenge , UMass is continuing to work with recovery coaches, this time deploying them in their ED to connect patients with opioid use disorder (OUD) to medication assisted treatment (MAT). Engaging with recovery coaches in the ED may not only increase the likelihood that patients are successfully initiated in treatment, but also help them to begin a relationship that can support them in longer term recovery.
Community Health Workers at Lynn Community Health Center
Through another HCII award, Lynn Community Health Center (LCHC) utilized community health workers (CHWs) to coordinate care for patients with serious mental illness. When patients were referred to the program by their LCHC primary care provider, CHWs provided an initial assessment and continued to meet with patients in their homes and in the community in the following weeks. CHWs accompanied patients to medical and behavioral health appointments, and worked with patients to set goals and monitor progress toward those goals.
One patient enrolled in the LCHC initiative had been diagnosed with multiple physical and behavioral health conditions, including major depressive disorder, post-traumatic stress disorder, and attention deficit hyperactivity disorder. She would often miss her scheduled medical appointments and struggled to remain active and engaged in her own care. At the initial visit, the CHW completed a comprehensive assessment, during which the patient disclosed that she did not like to use the telephone, and would therefore miss reminder calls or calls to reschedule appointments. The patient also confided in the CHW that she avoided being in crowded places and meeting new people. In collaboration with the patient, the CHW developed a person-centered care plan to address the challenges the patient faced in improving her health. The patient’s care plan included interventions such as developing increased comfort with using the phone, practicing relaxation techniques to use in crowded spaces, and role-playing meeting new people.
Since working with her assigned CHW, the patient has been able to respond to calls from her providers and initiate communication by phone. She enrolled in the Mobile Market at LCHC, and was referred to the Project Bread Food Source hotline for support with maximizing her food stamp benefits. The patient continued to actively engage with the CHW for the duration of the program. The patient reports that her overall goal is “to be healthy,” increase her social activity, and increase her overall confidence – goals that might never have been recognized, let alone achieved, without the support of a CHW.
Tele-Behavioral Health Implementation Guide
The HPC has released a Tele-Behavioral Health Implementation Guide based on the HPC’s knowledge sharing session and roundtable discussion on telemedicine for behavioral health (teleBH) in 2018. HCII awardees and HPC-certified patient centered medical homes convened to discuss important considerations for providers when planning for, building, and expanding teleBH programs. This guide includes key insights and quotes from providers, covering four key areas of teleBH program development: workflow, data and measurement, workforce, and technology. 
Updated Profiles of the HPC-Certified ACOs 
The HPC has 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. The new profiles can be found on our website .
Care Dimensions presents at the Fourth Annual Summit of the MA Coalition for Serious Illness Care
“When will we commit to ensure all nurses care for a dying patient just as fervently as we do to [ensure they see] a baby being born?” – Susan Lysaght Hurley, PhD RN
Susan Lysaght Hurley, Director of Research at Care Dimensions, Inc., an awardee of the HPC’s HCII program, presented at the Fourth Annual Summit of the Massachusetts Coalition for Serious Illness Care on May 16. Dr. Hurley grounded her presentation in her own experience as a first year nurse learning to support patients and families through serious illness. “ As a young nurse, I became aware that I was unprepared to care for the dying. There was no specific course to teach us how to care for the patient, his or her family, or ourselves. We need to change that, ” she said. She went on to overview the significant progress that has been made in serious illness care, including the work nursing schools in the Commonwealth are doing to develop and deliver curricula in caring for patients with serious illness, including symptom management, grief communication, and effective techniques for bereavement.
For more information about advance care planning, the HPC previously co-hosted a webinar with the Massachusetts Coalition for Serious Illness Care regarding ACOs and Advance Care Planning, which you can watch here
Coming Soon—HCII Program Profiles
In the coming weeks, the HPC will publish profiles of the 20 HCII awardee initiatives, targeting 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 their care models, program aims and target populations, and partnerships with other organizations. 
Coming Soon—ACO Policy Brief #3
The HPC will soon publish a policy brief, Transforming Care: Risk Contracts and Performance Management Approaches of Massachusetts ACOs , which provides new insights about the risk contracts and performance management strategies of the 18 HPC-certified accountable care organizations. 
Health Policy Commission
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