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Massachusetts Health Policy Commission
November 2018
This month’s newsletter focuses on innovations in digital health, featuring highlights from the HPC’s partnership with digital health accelerator MassChallenge HealthTech (MCHT), as well as insights from HPC awardees, including Holyoke Medical Center’s integration of an electronic health record (EHR) search engine and Care Dimensions’ telehealth monitoring program.

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
Bringing Digital Health Innovations into Accountable Care Organizations (ACOs) 
On November 14, the HPC, MCHT, the Massachusetts e-Health Institute (MeHI), and the Brigham Digital Innovation Hub at Brigham & Women’s Hospital hosted the latest monthly HealthCheck event, November HealthCheck: ACOs ,” featuring speakers from government, digital health startups, and ACOs, to discuss challenges facing ACOs and how digital health startups might approach ACOs with solutions.
Dr. Adam Landman, Chief Information Officer for Brigham Health, provided opening remarks. Catherine Harrison, Deputy Policy Director for Care Delivery Transformation and Strategy at the HPC, provided some context on the ACO landscape. Catherine offered an overview of ACOs, including general information about how risk contracts hold ACOs accountable for costs and quality, how ACOs can adapt their care delivery models to succeed in these contracts, and opportunities for innovation within ACOs.
The presentation was followed by a panel of speakers representing two HPC-certified ACOs, Partners HealthCare and Community Care Cooperative (C3), as well as a representative from 3Derm, a startup that has worked with ACOs. Laurance Stuntz, Director of MeHI, moderated the panel.

  • Dr. Sree Chaguturu, Chief Population Health Officer at Partners HealthCare, emphasized that “the best discussions with startups are collaborative.” He discussed Partners’ four population health priority areas: coordination of care, site of care, improving outcomes for certain conditions, and appropriate coding to ensure return on investment. He recommended that startups tailor pitches to an ACO’s specific needs and demonstrate a potential for return on investment within one year.
  • Matt Mullaney, Chief Financial Officer of C3, shared C3’s priorities: reducing cost, improving quality, and improving member and provider experience. He noted that “greater provider engagement leads to better health outcomes,” and suggested that startups might benefit from first engaging with a provider champion willing to pilot the solution within the ACO. He also spoke about community health centers’ limited resources for digital health investments. He recommended that startups clearly demonstrate the problem they are addressing, the potential for savings in their solution, the solution’s interoperability with the ACO’s electronic health record (EHR) and data warehouse, and what that particular startup can do for the ACO now.
  • Liz Asai, Chief Executive Officer of 3Derm, discussed new opportunities in value-based payment that do not work in a fee-for-service (FFS) environment: “[I]f you told someone you were going to cut their dermatology referrals in half [in a FFS environment], they’d turn you away.” She shared how 3Derm initially approached ACOs with a pitch that did not emphasize the value-add that ACOs were interested in. After working with various ACOs, she realized “we need to deliver a completely different pitch to each ACO.”
Nick Dougherty, Managing Director of MCHT, concluded the event by reiterating that ACOs present a wide range of new opportunities for digital health innovation.

The HPC has partnered with MCHT to promote community-based provider access to the digital health “ecosystem” by identifying digital health startups that address challenge areas of high priority, including timely access to behavioral health (BH), addressing the social determinants of health, and reducing avoidable emergency department (ED) use. Watch this video to learn more.
Real-time Medical Record Searches at Holyoke Medical Center
A common theme in the Community Hospital Acceleration, Revitalization & Transformation (CHART) Program was that providers benefitted from being able to quickly identify target population-eligible patients upon presentation to the hospital. Real-time patient identification enabled efficient and timely engagement by CHART care teams. Some hospitals have chosen to invest in technologies to support this real-time notification of at-risk patients in the ED or inpatient settings. This technology allows care teams to engage with patients in the acute-care setting and post-discharge to assist with any needs that patients may have upon their return to the community.
One example of an investment in technology is Holyoke Medical Center’s (HMC) collaboration with Queriable Patient Inference Dossier (QPID) Health, a health information software company, during HMC’s CHART award period. HMC identified BH services as an area for investment since BH conditions were common among patients who visited the ED. Many of these patients present in the ED for non-medical and non-urgent needs that could be better addressed in the community. Staff at HMC, including psychiatrists, BH nurses, and ED physicians, worked with QPID to develop a search engine for their EHR. This search engine uses natural language processing to allow clinicians to more efficiently locate patient information in the EHR, as compared to manually searching patient records. HMC specifically aimed to ensure that this technology would support the identification of patients diagnosed with BH conditions to address their patients’ needs for BH support.
HMC saw a dramatic increase in identification of BH patients eligible for CHART services and a decrease in ED revisit rates among BH patients following the implementation of this technology. By improving identification of BH needs in the medical record, clinicians were better able to support the medical, behavioral, and social needs of their patients.
Care Dimensions TeleHealth Monitoring Technology
Care Dimensions’ “Palliative Care Plus” (PC+) initiative works to increase care coordination and referrals to palliative and hospice care for North Shore Physicians Group (NSPG) patients with serious advancing illness. Care Dimensions staff support patients in the care setting of their choice using telehealth and remote monitoring units. Video-enabled telehealth hardware allows patients to video chat with their care team, while Bluetooth-enabled remote monitoring units allow palliative care staff to monitor patient vital signs, including weight, oxygen levels, and blood pressure. This information is automatically transmitted to a nurse monitoring the patient who reaches out at any signs of concern.

An 85-year-old NSPG patient living with their daughter was referred to the PC+ program after a respiratory infection and hospitalization in the same year. The patient was dependent on oxygen for chronic obstructive pulmonary disease (COPD) and had heart failure as well as a lung mass. During an initial home visit, the patient’s PC+ nurse practitioner helped to complete and file a medical order for life sustaining treatment (MOLST) form with Do Not Resuscitate and Do Not Hospitalize orders.
The PC+ program used telehealth and bio-monitoring equipment to remotely observe and coordinate with the patient and their daughter, allowing the patient to remain at home. To honor the patient’s preferences, program staff communicated with the patient via telephone, rather than during home visits, and the Care Dimensions nurse coach also communicated with the patient remotely via telehealth. Members of the care team regularly followed up with the patient when oxygen levels were low on the telemonitoring reading. The patient has not had any ED visits or hospitalizations since enrolling in the PC+ program.

The Care Dimensions PC+ program has been deployed in many patients’ homes and has been in high demand among eligible patients. Patient satisfaction with and engagement in the program has been high, and the program has also received support from providers. Remote monitoring will be continued in the PC+ program expansion, expected after the completion of the grant period in 2019.
Heywood Health Resources and Service Administration (HRSA) Grant
Building on their demonstrations in the CHART and Health Care Innovation Investment (HCII) Programs, Athol Hospital, part of Heywood Healthcare, was awarded a $1,050,000 Evidence Based Tele-Behavioral Health Network Program grant by the HRSA of the U.S. Department of Health and Human Services (HHS). The award will bring tele-behavioral health (teleBH) counseling services to students at two local high schools over the next three years.

Through partnerships with Heywood Healthcare’s Quabbin Retreat and the Northeast Telehealth Resource Center, Athol Hospital will deliver and evaluate school-based teleBH services at local high schools. Program results will be compared to traditional BH treatment provided to students at another regional high school.

This initiative shifts the traditional model of BH treatment from the medical setting into the community, reaching children in a familiar setting with social supports. TeleBH accessible services within the school offer timely access, reduce costs, and fill access gaps in rural areas.
Lahey Health Behavioral Services Awarded an Argosy Foundation Grant
Lahey Health Behavioral Services (LHBS) was awarded a grant through the Argosy Foundation to evaluate their CHART program, which aimed to reduce ED utilization for patients with BH diagnoses.

LHBS selected Brandeis University to conduct the evaluation of their CHART program. Brandeis found that the LHBS CHART program leveraged a holistic and patient-centered approach to care management, addressed health-related social needs, and contributed to a decrease in acute care utilization among CHART patients. As part of the Argosy Foundation grant, LHBS convened a diverse group of stakeholders to discuss the results and the effective and innovative treatment of patients with BH diagnoses. Stakeholders engaged in breakout sessions centered on topics including social determinants of health, technology, big data, patient-centered care, systems, and outcomes.

LHBS plans to carefully review stakeholder feedback and idea generation from the symposium to develop a “Blueprint for Action.” Through this Blueprint, LHBS will propose an approach to integrating novel and innovative clinical and technological approaches to improve care for their patient population.
Boston University’s Questrom School of Business Sixth Annual Health & Life Sciences Conference
On Friday, November 2, Questrom hosted its Health and Life Sciences Conference “Healthcare Integration: A Work in Progress.”   Catherine Harrison, Deputy Policy Director of Care Delivery Transformation and Strategy at the HPC, participated in a panel on “Defining the Value in Value-Based Care.” Panelists discussed how ACOs have engaged front-line providers to succeed in value-based payment models, what effect this shift has had on patient care and outcomes, and whether this has improved the integration of medical, BH, and social services. Catherine highlighted some of the cultural and data sharing challenges that health care and social service organizations have faced in trying to integrate these services. She also discussed the Commonwealth’s efforts to align quality measures across global budget-based risk contracts and noted how adoption of the aligned measure set may enable the Commonwealth to better assess what effect ACOs have on patient outcomes across the system.
HPC Fellow Receives Award Following Presentation at Harvard T.H. Chan School of Public Health
The HPC is pleased to congratulate Nayely Chavez, an HPC Fellow and Harvard T.H. Chan School of Public Health student, on winning the Audience Favorite award at the Field Practice Poster Night at the Harvard T.H. Chan School of Public Health. At this showcase of student work, Nayely presented on the evaluation of BH integration programs funded through the HCII Program, specifically programs at the Brookline Community Mental Health Center and Berkshire Medical Center. She shared her findings related to team collaboration, challenges in implementation, patient willingness to engage in BH services, and provider experience.     
Massachusetts Health and Hospital Association
Burlington, MA
December 4, 2018

Massachusetts Health and Hospital Association
Burlington, MA
December 7, 2018

National Academy for State Health Policy
December 7, 2019

Institute for Healthcare Improvement
Orlando, FL
December 9-12, 2018

Health Policy Commission
Boston, MA
December 11, 2018

Blue Cross Blue Shield of MA Foundation
Boston, MA
December 11, 2018

Health Policy Commission
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December 13, 2018

Massachusetts League of Community Health Centers
Boston, MA
January 8, 2019

Centers for Medicare & Medicaid Services
Baltimore, MD
January 29-31, 2019
Health Policy Commission
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