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Massachusetts Health Policy Commission September 2020

This September marks the five-year anniversary of the launch of Phase 2 in the Community Hospital Acceleration, Revitalization and Transformation (CHART) Investment Program. The CHART Investment Program represents a $70 million investment in two phases aimed at community hospitals in the Commonwealth to support integration of medical, behavioral health, and social services; provide care in the community; prepare for value-based care; and support better data and analytics. In honor of this milestone, this issue of the Transforming Care newsletter will celebrate “CHARTember” with reflections on the CHART Investment Program from HPC Executive Director David Seltz, Dr. Alejandro Mendoza of Beth Israel Deaconess-Plymouth Hospital, and Caroline Kinuthia, formerly a community health worker with the Addison Gilbert Hospital and Beverly Hospital CHART initiative and now an HPC program associate. Additionally, the HPC is pleased to release The CHART Evaluation Report and The CHART Playbook this month, which highlight findings and lessons learned from the CHART Investment Program. Let us know if there are care delivery transformation topics or work in the Commonwealth that you would like to see the HPC showcase in this newsletter. We would love to hear from you! Email us at caredeliverytransformation@mass.gov. SPOTLIGHT HPC Executive Director David Seltz Reflects on the CHART Investment Program David Seltz, Executive Director of the HPC, reflects on the five-year anniversary of CHART Phase 2 and discusses the impact and legacy of the CHART Investment Program. Can you reflect on what it was like five years ago to launch CHART Phase 2? The CHART Phase 2 launch was an incredible moment of excitement for the HPC and for the community hospitals. Together, we had worked for years planning the second phase of the investment which was, at the time, one of the most significant investments in community hospitals that the Commonwealth had ever made. We were doing something new by applying investment dollars to prepare hospitals for success in a value-based environment while improving patient care. We were eager for CHART to also help support connections between community hospitals and other community-based organizations that we know are essential not only for meeting the needs of individual patients, but for improving the health of communities overall. These concepts were not necessarily new, but CHART allowed us to apply them at a much larger scale. Is there moment with a CHART Investment Program awardee or a site visit that was particularly memorable for you? It was important for me to be able to visit as many of the hospitals as I could throughout the course of CHART Phase 2. What always struck me about those visits was how the teams at these hospitals had embraced CHART as an ethos and a source of pride. I remember attending a CHART launch event with 50 to 100 people in attendance, and while it was encouraging to see so much excitement from all levels of the organization, what really inspired me was hearing the CHART teams share stories of the patients they cared for who had benefitted from the program. Some of the patient stories were success stories, but others reflected the real and continuing challenges of individuals with mistrust of the health care system, who felt abandoned and isolated. There was such dedication of these staff members to the communities they served. Many of them were community health workers who came from the very communities they were supporting, who just didn’t give up. They believed in their patients. They said, “I am here to support you in your journey, whatever that may be. I support your health, your wellbeing, and your happiness, whatever happens,” and they would stick with those patients through all of their setbacks. Having the opportunity to see the real-life impacts of these programs and of these investments through the eyes of those team members is something that I’ll always remember and value.  How would you describe the CHART Investment Program’s legacy in the Commonwealth? Community hospitals are so connected to the needs of their communities and the needs of their patient populations. They are jewels in our health care system, which should be protected and supported, and they are sources of remarkable innovation. Everyone thinks that innovation is a robot or a laser or a new app, but the innovation of CHART was compassion. The CHART programs oriented care to be delivered where people actually were — whether that was a Dunkin Donuts, a homeless shelter, a church basement, or a patient’s home. Wherever these patients were, CHART went with them. The people on the ground doing this work were nurses, community health workers, social workers. CHART, at its core, was an investment in compassionate people. It was an investment in staff who knew and were committed to the communities they were serving. This investment helped to build and support a workforce with experience in this model of care that became the foundation for the MassHealth ACO program and for many other initiatives both within the HPC and across the Commonwealth.

LESSONS FROM THE FIELD

Beth Israel Deaconess-Plymouth Hospital Builds on Lessons Learned from the CHART Investment Program to Implement their SHIFT-Care Challenge Initiative

Several of the HPC’s current SHIFT-Care Challenge awardees previously participated in the CHART Investment Program. Dr. Alejandro Mendoza, the SHIFT-Care Challenge Investment Director at Beth Israel Deaconess-Plymouth Hospital (BID-Plymouth) reflects on BID-Plymouth’s CHART initiative and how it paved the way for the their SHIFT-Care initiative and informed other programs in sister hospitals.

CHART Phase 2 allowed us to expand integrated care to a true collaborative care program across four distinct medical groups and gave us a lot of vital data to fine-tune the delivery of behavioral health services. Due to the severe shortage of psychiatry consultation in the greater Plymouth area, we developed a model in which a dedicated psychiatrist supervised a cohort of nurse practitioners. We used this model to expand into both evaluating and treating patients in the emergency department (ED). Having a behavioral health team in the ED allowed us to not only break down the silos between us and ED clinicians, but also to develop true teamwork and shared ownership.

CHART Phase 2 also allowed us to take a detailed look at a very costly, high-utilization patient population (i.e., the dually insured Medicare and MassHealth population). We learned that face-to-face initial contact is much more effective for this population than phone calls. We also learned that patients were relying on the ED for what otherwise could be accomplished at an outpatient visit because of all of the psychosocial challenges they faced in being able to keep appointments during regular business hours.

We learned how to utilize and maximize existing partnerships in the community — i.e., the school system, the drug courts, the police departments — to both expand the continuum of care and to co-develop programs, such as the Plymouth County Outreach program which now serves 28 towns.

The CHART Phase 2 efforts led to a decrease in ED revisits, and therefore we began exploring scaling our processes to our sister hospitals, Beth Israel Deaconess-Milton Hospital and Beth Israel Deaconess-Needham Hospital. This new partnership with the ED staff allowed us a chance to start medication for addiction treatment (MAT) in the ED through the HPC SHIFT-Care Investment Program. We continue to utilize other facets of CHART Phase 2 as we embark on collaborative efforts with Tufts Health Plan through the MassHealth Accountable Care Organization (ACO) program, and they are particularly interested in our organic and constantly evolving multidisciplinary care plans for patients with high utilization, which we developed under the CHART program.

I am hoping that the above highlights many, if not all, of our achievements with the help of the HPC and its funding. We are profoundly grateful for that reason and we continue to think outside the box as we care for our populations.

PROVIDER REFLECTION

HPC Staff Reflection: A Journey from CHART Community Health Worker to SHIFT-Care Challenge and MassUP Program Contact

Caroline Kinuthia, an HPC program associate, previously served as a community health worker (CHW) for the Addison Gilbert Hospital and Beverly Hospital CHART initiative and currently serves as an HPC program contact for the SHIFT-Care Challenge and the Moving Massachusetts Upstream (MassUP) Investment Programs. Caroline shares her story of participating in HPC investment programs as both an awardee and an HPC program contact.

As a CHW working on the CHART initiative under a licensed social worker, I was able to work directly with patients, families, and caregivers in various settings to address psychosocial barriers that were impacting their health and well-being. I had firsthand visibility into health inequities patients from marginalized populations faced and was able to form trusting relationships with patients and their families and coordinate existing and new services to support patients’ stability in the community. This experience further validated my personal and professional goal of working toward greater equity in the health care delivery system.

When there was an opportunity to work at the HPC as a program contact for SHIFT-Care, I saw it as an opportunity to build on what I had learned in CHART at a larger scale. Through my past experiences as a CHW, I am able to relate to awardees regarding some of the challenges they face because I’ve been in their shoes. I know how challenging it can be when a patient is getting help for their substance use disorder and they experience relapse. I have also been fortunate enough to experience how grateful patients are when they receive support and compassion, by simply being present and listening to their story.

PUBLICATIONS, PRESENTATIONS, AND RECOGNITIONS

HPC Publishes the CHART Investment Program Phase 2 Evaluation Report

The HPC is pleased to share findings from CHART Phase 2 in the newly published CHART Investment Program: Phase 2 Evaluation Report. In 2014, the HPC, through CHART Phase 2, made up to $60 million available to eligible community hospitals to establish the foundation for sustainable care delivery transformation. The CHART Phase 2 Evaluation Report provides an overview of how the 29 CHART initiatives were implemented, their progress towards the goals of Phase 2, and the extent to which the initiatives were sustained after the performance period.

Key highlights include that of the 29 programs funded: 28 programs made notable progress in operational use of data. 27 programs made notable progress towards integrating whole-person care. 24 programs reported reductions in hospital utilization, with 16 programs reporting a 15% or greater reduction in utilization for their eligible target population. 23 programs were sustained in total or in part after the CHART funding ended.

Overall, there is evidence that the CHART Investment Program supported sustainable care delivery transformation that prepared community hospitals to participate in a health care marketplace increasingly oriented towards risk-based payment arrangements and value-based care models. CHART hospitals made significant strides in re-aligning people, programs, and processes and, in so doing, delivered meaningful value to thousands of patients – many of them facing complex illnesses and challenging social conditions.

HPC Releases the CHART Playbook

The HPC is pleased to release The CHART Playbook: A guide to building capacity, engaging patients, and transforming care in community hospital settings. The CHART Playbook is a practical resource for providers working to address the needs of medically and socially complex patients. The Playbook is based on the experiences of CHART community hospitals and features key lessons learned and resources that CHART awardees developed over the course of the implementation period.

Topics include: Defining and identifying target population patients Engaging and collaborating with patients Staffing and managing a team Measuring for improvement

HPC Releases the Telemedicine Pilot Investment Program Impact Brief

The HPC is pleased to release the Telemedicine Pilot Investment Program Impact Brief. The HPC invested $1.7 million across four awardees to use telemedicine to increase access to behavioral health care services for populations with unmet behavioral health needs, including individuals with substance use disorder, children and adolescents, and older adults aging in place. This impact brief provides an overview of the program and highlights awardees’ achievements. To learn more about this program and other initiatives funded through the Health Care Innovation Investment Program, please visit our website.

Register Today for the 2020 Annual Health Care Cost Trends Hearing

The HPC's 2020 Annual Health Care Cost Trends Hearing will be held Tuesday, October 20, 2020, from 9:00 AM - 12:30 PM. The hearing will be fully virtual via the HPC's YouTube Channel, with a focus this year on the COVID-19 pandemic: the impact on the Commonwealth's health care system and residents, with consideration for the future. The hearing will feature two panels comprised of health care stakeholders and policymakers engaged in discussion with the HPC's 11-member Board of Commissioners and representatives from the Attorney General's Office and the Center for Health Information and Analysis.

This year, we are pleased to welcome Dr. David R. Williams of the Harvard T.H. Chan School of Public Health as the keynote speaker. Dr. Williams is an internationally recognized social scientist focused on social influences on health. He is the Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Chair of the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, and a Professor of African and African American Studies and Sociology at Harvard University. His research has enhanced understandings of the complex ways in which socioeconomic status, race, stress, racism, health behavior, and religious involvement can affect health. His TEDMED talk "How Racism Makes Us Sick" was released in April 2017. Registration is now open. More information about the 2020 hearing is available on the HPC's website.

UPCOMING EVENTS & RESOURCES

HPC Board and Committee meetings, and some upcoming meetings and training opportunities offered by non-profit and governmental organizations focusing on health care quality improvement and cost containment. Disrupting the Poverty Cycle Conference 2020 Economic Mobility Pathways October 6-9, 2020 Webinar State Approaches to Incarceration-Based Treatment for Opioid Use Disorder National Academy for State Health Policy October 7, 2020 Webinar Excellence in the Emergency Department Massachusetts Health & Hospital Association October 14, 2020 Webinar Virtual Salute to Excellence Association for Behavioral Healthcare October 16, 2020 Webinar 2020 Health Care Cost Trends Hearing: COVID-19 and the MA Health Care system: Assessing Impact, Advancing Equity Health Policy Commission October 20, 2020 Webinar Primary Care Summit Institute for Healthcare Improvement October 21-23, 2020 Webinar A sampling of resource materials and publications about the CHART Investment Program and community hospitals, produced by the HPC, other Commonwealth agencies, and non-profit organizations.   The CHART Phase 2 Evaluation Report Health Policy Commission, 2020 The CHART Playbook: A guide to building capacity, engaging patients, and transforming care in the community Health Policy Commission, 2020 CHART Program Impact Brief Health Policy Commission, 2019 CHART Awardee Profiles Health Policy Commission, 2019 CHART Phase 1 Report Health Policy Commission, 2015 Community Hospitals at a Crossroads: Findings from an Examination of the Massachusetts Health Care System Health Policy Commission, 2016 Massachusetts Hospital Profiles Center for Health Information and Analysis Telemedicine Pilots Investment Program Impact Brief Health Policy Commission, 2020

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