Massachusetts Health Policy Commission
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This winter edition of the
Transforming Care
newsletter focuses on care in the community and highlights initiatives led by CHART awardees who have gone on to participate in the HPC’s SHIFT-Care Challenge investment program. This issue also previews findings from the forthcoming CHART Evaluation Report.
Let us know if there are 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
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Highlights from the CHART Phase 2 Evaluation Report
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The HPC’s evaluation of the Community Hospital Acceleration, Revitalization and Transformation (CHART) Phase 2 investment program found that the 29 CHART programs made meaningful progress towards the four program goals:
- Deliver integrated care across medical, behavioral health, and social needs
- Shift care from the hospital to the community
- Prepare community hospitals to succeed in value-based care models
- Use data and analytics to better serve patients
These results were facilitated by the awardees’ adoption of new operational procedures and team-based care models that reached further into the community to deliver whole-person care.
At the close of the CHART Phase 2 performance period, 23 awardees planned to sustain all or part of their programs, reflecting the long-term value that community hospital leaders saw in their CHART programs. Among hospitals that sustained all or part of their CHART programs, the majority cited their existing or anticipated participation in value-based care as a key factor that influenced their decision to continue CHART activities.
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The Phase 2 evaluation used quantitative and qualitative data to understand how the program was implemented and its cohort-wide impact. Key findings include:
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A sub-analysis of programs focused in the emergency department (ED) found that all 13 ED-focused programs reported reductions in acute care utilization for their eligible target populations. Interviews with CHART patients revealed that they valued the relationship-based approach that extended beyond the walls of the hospital. Patients described changes in how they interacted with the health care system, including feeling more empowered to navigate their care and less reliant on the hospital to access the care they needed. During interviews, frontline staff and leadership expressed support for the CHART program and described how the CHART program contributed to organizational culture change.
In 2014, the HPC made up to $60 million available to eligible community hospitals through the CHART Phase 2 investment program. Launching in 2015, the two-year program was implemented across 27 non-profit, non-teaching community hospitals throughout the Commonwealth. The HPC’s CHART Phase 2 Evaluation report will be released in 2020.
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Addison Gilbert and Beverly Hospitals' SHIFT-Care Team Uses
Lessons Learned from CHART
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Addison Gilbert and Beverly Hospitals (AGB) have developed a joint
SHIFT-Care
initiative that expands access to medication for addiction treatment (MAT) for opioid use disorder (OUD) for eligible patients in the emergency department (ED). This program’s service model aims to reduce ED utilization by initiating MAT-eligible patients in the ED and connecting them to ongoing care through the Lahey Behavioral Health Services (LBHS) Lahey Enhanced Assessment Program (LEAP) to Recovery Clinic.
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AGB’s SHIFT-Care initiative target population is adult patients who present to either of the two hospitals’ EDs with evidence of an opioid overdose or an OUD. Patients are identified in the ED, and a recovery coach or clinician from the SHIFT-Care team meets with them to discuss available treatment options. If patients are interested in and eligible for MAT, they can be initiated either in the ED or during a follow up appointment at the LEAP to Recovery Clinic. LEAP recovery coaches maintain contact with each patient to ensure follow up and to assist with accessing resources such as transportation to treatment appointments and connection to other community-based services.
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AGB’s SHIFT-Care program builds upon collaborations and workstreams established in its CHART initiative, including the strong working relationship between LBHS and the hospitals. In the SHIFT-Care program, the hospitals’ EDs and the LEAP to Recovery Clinic continue to work together to implement, troubleshoot, and improve processes and protocols. Some of the team members and ED clinician champions have experience working with people with OUD through their work in AGB’s CHART program, and the team has been able to build upon relationships with community-based organizations developed through CHART, including the Gloucester police department. The SHIFT team also continues to utilize Loopback Analytics, the software used to identify eligible patients in the ED during AGB’s CHART Phase 2 project. AGB has incorporated lessons learned from previous investment programs, building a bridge from CHART to SHIFT-Care.
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Beth Israel Deaconess-Plymouth Hospital Connects Patients to Medication for Addiction Treatment
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Beth Israel Deaconess-Plymouth Hospital (BID-Plymouth) has built on the successes of its CHART Phase 2 award in launching its SHIFT-Care program, Medication-Assisted Treatment for Transformative and Extended Results (Project MATTER).
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A patient, “David,” arrived in the ED after an overdose. A recovery navigator met with him in the ED and the two discussed David’s treatment options, including MAT induction in the ED. David expressed that he was not interested in any of the ED’s services and left against medical advice. Days later, David called the recovery navigator and expressed an interest in accessing inpatient treatment. The recovery navigator was able to successfully link David to treatment within hours of their phone call. Though David initially declined all treatment, the recovery navigator’s work to build trust with David meant that David knew where and how to reach out when he was ready.
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Project MATTER builds on the collaborative models created through CHART. BID-Plymouth’s CHART Phase 2 program supported patients with behavioral health needs in the ED by ensuring continuity of care in the community through co-located behavioral health and primary care. Project MATTER continues this collaborative approach, allowing the team the flexibility to cater to each individual patient’s needs at the time and place where the patient feels most comfortable.
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PUBLICATIONS, PRESENTATIONS, AND RECOGNITIONS
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HPC Releases CHART Program Profiles
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The HPC has published
profiles of all CHART awardee initiatives
, which enabled community hospitals to assess local needs, modify services, and expand relationships with medical, social, and behavioral health community organizations to better prepare for value-based care. The profiles highlight key features and outcomes of these initiatives, including:
- Initiative care models
- Process and outcome data highlights
- Patient stories
- Patient and provider quotes
The CHART Program represents over $70 million of investment, in two phases, in innovative projects that further the Commonwealth’s goal of better health and better care at a lower cost. The HPC looks forward to sharing more results and learnings from the CHART Program in the coming months. In the meantime, please see our
CHART Program Impact Brief
for high-level information on the goals and preliminary outcomes of the CHART Program.
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HPC Announces Partnerships with Digital Health Startups to
Address Health Care Challenges
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- EatWell Meal Kits – addresses food security and diet-related chronic conditions by making healthy eating easy with affordable, nutritious meal kits
- Health Note – auto documents medical notes and captures patients’ data prior to their visit via a text-based link and populates a structured note
Through these partnerships, the HPC seeks to promote community-based providers’ access to digital health solutions, and to identify digital health startups that address high-priority policy areas, including addressing health-related social needs and administrative complexity.
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HPC Issues RFP for the Moving Massachusetts Upstream Investment Program
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The HPC recently issued a Request for Proposals (RFP) for a new grant opportunity, the Moving Massachusetts Upstream (MassUP) investment program. Through the MassUP investment program, the HPC anticipates funding approximately three to four partnerships that include Massachusetts health care providers and provider organizations and community-based organizations working together to address upstream (i.e., social, environmental, and economic) challenges and enable sustainable improvements in community health and health equity. The investment program will provide awards of up to $650,000 for three years of planning and implementation. Proposals are due to the HPC by 3:00 pm on February 21, 2020. For more information about the MassUP investment program opportunity, click
here
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The MassUP investment program, administered by the HPC, is one component of the MassUP initiative, a partnership across Massachusetts state agencies including the HPC, the Department of Public Health, the Office of the Attorney General, the Executive Office of Elder Affairs, and the Executive Office of Health and Human Services. The vision of the MassUP initiative is better health, lower costs, and reduced health inequities across communities and populations in Massachusetts through effective collaboration among government, health care systems, and local organizations.
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UPCOMING EVENTS & RESOURCES
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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.
Health Policy Commission
Boston, MA
February 5, 2020
Massachusetts Health & Hospital Association
Newton, MA
February 7
Health Policy Commission
Boston, MA
February 26
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A sampling of resource materials and publications about community hospitals, produced by the HPC, other Commonwealth agencies, and non-profit organizations.
Health Policy Commission, 2019
Health Policy Commission, 2015
Health Policy Commission, 2016
Center for Health Information and Analysis
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Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109
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