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Massachusetts Health Policy Commission September 2019

This September “Back to School” edition of the Transforming Care newsletter highlights HPC investment awardee efforts to support children and families, such as care for mothers and infants affected by neonatal abstinence syndrome, services to prevent asthma-related hospital use, and support for families experiencing housing instability. 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 [email protected] .  SPOTLIGHT HPC Releases DataPoints on Outcomes from the Mother and Infant Focused Neonatal Abstinence Syndrome Interventions Early findings from HPC investments focused on supporting mothers with opioid use disorder (OUD) and infants born opioid-exposed suggest the opportunity to reduce inpatient length of stay and the need for pharmacotherapy for these infants at the six hospitals implementing evidence-based models for addressing neonatal abstinence syndrome (NAS). NAS is a condition that can affect infants exposed to opioids in utero as a result of the mother’s use of opioids and/or prescribed medication for addiction treatment. Reflecting the impact of the opioid crisis, Massachusetts has higher than average rates of NAS and the number of infants diagnosed with NAS has increased since 2010. The latest edition of the HPC’s DataPoints presents an overview of the prevalence of NAS in Massachusetts and highlights outcomes in the HPC’s Mother and Infant-Focused NAS Intervention s track of the Health Care Innovation Investment ( HCII ) Program.  Through their participation in the HCII Program, hospitals implemented evidence-based practices to increase the use of non-pharmacologic interventions, optimize the use of pharmacologic treatments, and increase access to services for mothers prenatally and after discharge. Non-pharmacologic interventions include promoting breastfeeding, engaging families in infant care, connecting mothers to peer support, involving volunteer cuddlers, and rooming-in of mother and infant. Early findings from these interventions demonstrate:  A 53% reduction in median length of stay for infants, from 17 days to eight days A 36% reduction in the need for pharmacotherapy, from 66% to 42% of infants Improved infant outcomes associated with the use of non-pharmacologic interventions, such as breastfeeding and rooming-in of infants with their mothers Dr. Munish Gupta, a neonatologist and the Chair of the Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC), which provided technical assistance to the six hospitals funded through the HPC’s NAS Interventions, highlighted the importance of these non-pharmacologic interventions at a meeting of the HPC’s Care Delivery Transformation Committee: “These elements of non-pharmacologic care – breast milk use, rooming-in, avoiding the intensive care setting – they are working and they improve outcomes,” he said. With the support of the Massachusetts Department of Public Health and in partnership with NeoQIC, the HPC continues to support the adoption of these interventions across the Commonwealth.

LESSONS FROM THE FIELD

Baystate Health Care Alliance Provides Holistic Care for Patients with Asthma

Baystate Health Care Alliance’s SHIFT-Care Challenge initiative, the Springfield Healthy Homes Asthma Program , supports residents of the Springfield area with a history of asthma-related hospital use by providing services to reduce asthma triggers and improve asthma control with the goal of lowering acute care utilization. Services range from education about asthma to in-home services to address environmental triggers such as carpeting and mold.

After identifying an eligible patient from hospital records, a community health worker (CHW) reaches out by phone to voluntarily enroll them in the program. The CHW conducts a home visit and collaborates with the enrollee’s primary care provider or pulmonologist to assess and support the patient and their family’s needs in their home environment. CHWs and other program staff then coordinate the provision of services, involving local program partners as needed.

The Springfield Healthy Homes team works to build trust with their patients and to address each patient’s unique needs. CHWs have received significant training in patient engagement, health equity, and public health. Since many patients enrolled in the program do not own their homes, the team coordinates with landlords and other housing stakeholders on behalf of the patient and their family to further support them and advocate on their behalf to address environmental triggers in the home.

PATIENT STORY

Family Experiencing Housing Instability with Behavioral Health Needs Finds Support through Behavioral Health Network

Through the HCII Targeted Cost Challenge Investment (TCCI) Program, Behavioral Health Network’s (BHN) Families in Transitions (“Project FIT”) initiative supported families affected by substance use disorder and/or mental illness who were experiencing homelessness or were at risk for homelessness. Project FIT provided families with high-touch care coordination for behavioral health, primary care, housing support, and vocational services.

One family enrolled in Project FIT included a mother with behavioral health needs and her two young children living in a shelter. While at a pediatrician visit for her children, the mother began experiencing acute pain and was transported, then admitted to the hospital. The mother was admitted for several days with her children.

Since her children were not in the shelter during her hospital stay, the mother lost custody of her children and lost her space at the shelter. The mother was referred to Project FIT, and the team connected the mother to medical and behavioral health treatment, and worked with her to stabilize her medical and behavioral health needs. The team also helped her to be an advocate for her family in discussions with DCF and the shelter system so that she could be reunited with her children in a shelter placement.

PUBLICATIONS, PRESENTATIONS, & RECOGNITIONS

Massachusetts General Hospital Hosts Event Series for National Recovery Month

A national leader in substance use disorder and addiction treatment, Massachusetts General Hospital has invested in improved quality of care and enhanced outcomes for patients in addiction treatment through its Substance Use Disorders Initiative . As a mechanism for spreading awareness and shifting the culture of stigma that surrounds addiction, MGH celebrated National Recovery Month with events throughout September. These events brought attention to the racial inequities that exist in the drug overdose crisis, provided parents with effective strategies for supporting children with substance use disorder, and covered many other topics. MGH also offered naloxone training to the public, and hosted buprenorphine waiver trainings for prescribers. Through these efforts, MGH engaged the community and promoted greater understanding of substance use disorders and recovery. For more information on MGH’s Recovery Month events, visit [ https://www.massgeneral.org/recovery-month.aspx ].

Heywood Hospital Featured in Massachusetts Health and Hospital Association Video

Heywood Hospital , an awardee of the HCII Telemedicine Pilot Initiative , was recently featured in a Massachusetts Health and Hospital Association (MHA) video on telemedicine programs. The video was created by MHA to fulfill their organizational goals, and highlighted Heywood Hospital’s innovative telemedicine model that embeds a telemedicine for behavioral health program in local high schools. The telemedicine program aims to increase access to behavioral health care for adolescents in a rural region of the Commonwealth. To learn more about strategies for implementing telemedicine for behavioral health programs from Heywood Hospital and other HCII awardees, check out our Tele-Behavioral Health Implementation Guide .

HPC Issues Challenge Areas for Digital Health Startups The HPC has partnered with MassChallenge HealthTech (MCHT), the Commonwealth’s digital health innovation hub, to promote community-based providers’ access to digital health solutions and to identify digital health startups that address high-priority policy areas identified by the HPC. Working with MCHT, the HPC will leverage digital health startups participating in the MCHT 2020 cohort to develop solutions in the following areas: Enabling health care providers and patients to address health-related social needs Enabling health care providers to increase their behavioral health care capacity to increase access and better serve patients Enabling health care providers to better care for patients in their homes and communities Promoting prescription medication affordability, access and safety Reducing administrative complexity (e.g., provider credentialing, prior authorizations) Listen to this interview featuring HPC’s Executive Director, David Seltz, to learn more.

UPCOMING EVENTS & RESOURCES

HPC Board and Committee meetings, and meetings and training opportunities offered by non-profit and governmental organizations focusing on health care quality improvement and cost containment. HPC Market Oversight and Transparency Committee Meeting Health Policy Commission Boston, MA October 2, 2019 HPC Care Delivery Transformation Committee Meeting Health Policy Commission Boston, MA October 2, 2019 Excellence in the Emergency Department Massachusetts Health and Hospital Association Burlington, MA October 18, 2019 2019 Salute to Excellence Association for Behavioral Healthcare Auburndale, MA October 18, 2019 2019 Health Care Cost Trends Hearing Commonwealth of Massachusetts Boston, MA October 22-23, 2019 Social Work and the Health of Populations Boston University School of Public Health Boston, MA October 22, 2019 A sampling of resource materials and publications addressing children and families, produced by the HPC, other Commonwealth agencies, and non-profit organizations.   HRSA’s Home Visiting Program: Supporting Families Impacted by Opioid Use and Neonatal Abstinence Syndrome Health Resources and Services Administration National Survey of Children’s Health Questionnaires, Datasets, and Supporting Documents Health Resources and Services Administration The Children’s Health Insurance Plan (CHIP) Annual Reports MassHealth Nation’s Progress on Children’s Health Coverage Reverses Course Georgetown University Health Policy Institute Center for Children and Families Boston Child Health Study Boston Public Health Commission   Pathways to Stable Homes: Promoting caregiver and child health through housing stability Children’s Health Watch Children's Behavioral Health Initiative MassHealth

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