Commonwealth Conversations: Health and Human Services

MassHealth begins paying incentives to providers who adopt and use Electronic Health Records (EHRs)

By MassHealth Health IT Project Manager Deborah Schiel

Recently, I was referred to a specialist by my primary care physician. Prior to the appointment, the new physician requested my medical records so he could review my health history. It seemed easy enough. Since my physician had an electronic health record (EHR) system I thought I could simply sign the paperwork that would allow him to share my medical information with the new provider and it would be transferred electronically in a timely way.

Although Massachusetts has more providers using EHRs than most other states, many providers still use paper medical records or if they do have electronic medical records, these systems are not set up to “talk to each other.” In my particular case, the two electronic medical record systems did not “communicate” with each other, transfer of my medical information meant that my primary care provider had to print out a copy of my medical record; I had to stop by his practice to pick it up and then drop it off at the specialist’s office a couple of days prior to my appointment. Can you imagine having to take these same steps to transfer money from one bank account to another bank account? Shouldn’t the transfer of health care information be handled electronically much like the banking industry?

Last October, Massachusetts reached a health care milestone with the launch of the Medicaid EHR Incentive Payment Program, working toward the Commonwealth’s goal of ensuring that every provider in the state has access to a federally certified EHR system that communicates with other certified EHR systems by 2015. During the first four months of the program, more than $76 million in Medicaid EHR incentives have been disbursed to over 40 short-term acute care hospitals and nearly 1,700 eligible health care professionals.  Both the Medicaid program and the Medicare EHR Provider Incentive Payment Program were established through the Health Information Technology for Economic and Clinical Health Act (HITECH) of the American Recovery and Reinvestment Act (ARRA). 

The Centers for Medicare and Medicaid Services (CMS) provide 100% of the incentives paid to providers and 90% of the state’s costs to operate the program. In August 2011, CMS announced that MassHealth would receive more than $12 Million in federal reimbursement to support operations and provider outreach activities for the first two years of the Medicaid incentive program. MassHealth estimates that more than 6,000 eligible professionals and most of the acute care hospitals in Massachusetts will be eligible for the program, which means potentially more than $500 million in federal EHR incentives being paid to Massachusetts providers during the 10-year program. 

MassHealth is partnering with its colleagues at the Massachusetts eHealth Institute (MeHI), a division of the Massachusetts Technology Collaborative, which will support key operational and provider outreach components of the incentive program.  MeHI is the state agency dedicated to  health care innovation, technology and competitiveness.  Another crucial participant is the Provider Compliance Unit of The University of Massachusetts Medical School’s Center for Health Care Financing. They will be reviewing providers to make sure they meet all necessary requirements for receiving the incentive payments, and they will also audit the providers after the incentive payments are made.

Launching the Medicaid EHR Incentive Payment Program is just one of many exciting health information technology (HIT) initiatives that MassHealth,  Executive Office of Health and Human Services (EOHHS), other state agencies and key stakeholders (including MeHI) are collaborating on to promote the widespread adoption and meaningful use of certified EHRs by providers across the Commonwealth. Widespread use of EHRs by Massachusetts health care providers is essential to transforming health care in the Commonwealth, and the move away from a fee-for-service model towards a system that offers fully integrated, coordinated, and patient-focused health care services. 

For more information on the Program, providers can contact the Massachusetts Medicaid EHR Incentive Payment Program staff at 1-855-massEHR or submit questions to massEHR@masstech.org.  In addition, providers can receive information on the Program at www.mass.gov/masshealth/ehrincentives.

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Increasing the dialogue on sexual assault awareness and prevention

By DPH’s Director of Sexual Assault Prevention and Survivor Services Unit
Marci Diamond

Sexual violence is everyone’s issue: in fact, a new national study found that one in three women and one in five men in Massachusetts have experienced sexual violence, typically starting at a young age.

April is National Sexual Assault Awareness Month (SAAM), and as the DPH Director of Sexual Assault Prevention and Survivor Services Unit, I am honored to serve this year as Advisory Council Chair for the National Sexual Violence Resource Center (NSVRC). NSVRC serves as a coordinating and resource organization for SAAM, and has designated this year’s SAAM theme as "Healthy Sexuality".

This theme connects with conversations we’ve long had at DPH about healthy sexuality, and its connection to preventing sexual violence and other health concerns. Several years ago, staff from DPH programs such as violence prevention, teen pregnancy prevention, and HIV prevention came together with the understanding that that our work would be more effective in all of these areas if we could find common ground and coordinate efforts in what we were all trying to promote as a vision of wellness. DPH now has a cross-Department Healthy Sexuality/Healthy Relationships workgroup to coordinate the promotion of positive sexual development across the lifespan, in order to improve the health, safety, and well-being of MA residents. The MA Sexual Violence Prevention Plan further reinforces these connections, and supports our community partners who work across MA to prevent and respond to sexual violence.

Gov. Patrick said: "Massachusetts has a plan…to keep children from developing problem sexual behaviors, help parents and educators teach children that sexual respect is expected, and assist adults in changing the climates in our diverse communities and institutions so that healthy relationships between all people can be the state norm…not only to improve our response to incidents…but also toward shaping a safer, healthier future".

We invite you to join the dialogue not just this April, but throughout the year. You can find lots of resources at NSVRC  and at your local DPH-supported Rape Crisis Center  or Child Advocacy Center. It may be challenging to start, but we CAN talk about --and practice -- appropriate boundaries, sexual respect, and healthy, nurturing, equitable relationships.  By starting the conversation early and often, we can all help to build safe, healthy relationships and communities.

 

 

DTA assists low-income households affected by the Back Bay blackout: Replacement SNAP benefits can be requested until close of business April 5

By DTA Commissioner Dan Curley

Few of us will forget the sight of the darkened Prudential Tower and surrounding buildings on the evening of March 13, especially those who live in the immediate area and were forced to evacuate their homes. A fire at an NSTAR substation in Boston’s Copley Square resulted in widespread power outages that affected more than 20,000 people – some for as long as six days. 

Many of the residents cast into the dark that night are elderly and disabled individuals who live in senior, public, and privately-managed low-income housing. The City of Boston and the Department of Transitional Assistance (DTA) acted quickly on behalf of these individuals to ensure they would not go hungry. Households enrolled in the Supplemental Nutrition Assistance Program (SNAP) can request replacement benefits if food is lost due to a disaster or household misfortune such as fire, flood, loss of electricity, equipment (refrigerator/freezer) failure or other disaster.

Additionally, DTA asked for, and recently received, a waiver from the U.S. Department of Agriculture (USDA) to give residents an additional ten days to request replacement SNAP benefits. Requests can be made until close of business on Thursday, April 5. Getting this extension is especially critical because many evacuated residents were unable to contact a DTA office until recently, and others were unaware they could request additional help.

Since the blackout, the Department has received and processed hundreds of requests for replacement SNAP benefits, primarily through the DTA office on Massachusetts Avenue in Newmarket Square.   

As always, I am proud of my team for their work assisting people during challenging times. I am also very pleased with our collaboration with the City of Boston, and I appreciate the Mayor’s concern for affected Boston residents and willingness to partner with the Department to administer replacement SNAP benefits. Working together, we can make a significant difference in the lives of people in need. If you know someone who receives SNAP benefits and lost food during the power outage, please encourage him or her to call us at 1-800-445-6604 by close of business on April 5.        

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National Brain Injury Awareness Month: Reaching Out to Veterans

By Nicky Osborne, Director of Massachusetts Rehabilitation Commission (MRC) - Brain Injury & Statewide Specialized Community Services (BI&SSCS)

March is National Brain Injury Awareness Month, when the Massachusetts Rehabilitation Commission (MRC) redoubles its efforts to promote awareness that a brain injury can happen anytime, anywhere, to anyone – a brain injury does not discriminate. In fact, every year 1.7 million Americans sustain a brain injury. The estimated cost of traumatic brain injury (TBI) nationally, including treatment and lost productivity, is $76.3 billion per year, according to the Centers for Disease Control and Prevention. In Massachusetts alone, 51,000 residents —indeed our loved ones, friends, acquaintances, neighbors, and coworkers -- sustain a TBI every year. 

Lately, TBI has been in the news as the public is riveted by the remarkable story of former Congresswoman Gabrielle Giffords and her recovery, as well as by recent research on the effects of repeated concussion among both high school football players and professional athletes such as Marc Savard of the Bruins hockey team. There is another group of Americans for whom TBI has become a distinguishing and invisible wound: returning veterans of the conflicts in Iraq and Afghanistan.

In general, TBI is a disruption of brain function typically due to a blow or jolt to the head, from incidents such as car crashes, falls, physical assaults and gunshots. No two brain injuries are alike: lasting effects can include a combination of memory problems; issues concerning judgment and socially acceptable behavior; high levels of frustration; fatigue; barriers to physical ability (including speech, vision, hearing, sensation) and chronic pain. Soldiers serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are particularly vulnerable to TBI from warfare and the impact of Improvised Explosive Devices (IEDs). 

MRC’s Brain Injury & Statewide Specialized Community Services (BI&SSCS) department is proud to have been awarded a federal grant for $530,000 that focuses on identifying women and minority OEF/OIF veterans in the state who may have sustained TBI and are traditionally underserved.  Perceptions about the military culture may make soldiers feel they have to “tough it out” if they are experiencing any problems after an injury.  Women and minority service members especially seem reluctant to self-identify and seek help.  BI&SSCS is working on reaching out to these service members and to better understand their unique needs as well as the cultural and other barriers that may delay serving them.

Three upcoming MRC events are geared toward promoting brain injury awareness:

• Weekend Retreat for Veterans with TBI in Groton (March 16-18) – this 3-day event offers education about brain injury, workshops, resources, holistic methods for stress management, accommodations and meals for returning veterans with TBI, including but not limited to women and service members from culturally diverse groups, and their families.  Small group sessions will be facilitated by clinicians in a safe, supportive environment.  This event is offered in collaboration with Project New Hope, an organization offering retreats as a way to improve quality of life for combat veterans by helping them heal, cope, reintegrate and reconnect with their families.  More information is available at their website (www.projectnewhopema.org).
   
• Screening Clinics will be held throughout the month of March at the New England Shelter for Homeless Veterans, the Soldiers' Home in Chelsea, the Veterans Center in Hyannis, the Worcester Veterans Center, and the Springfield Veterans Clinic. Confidential diagnostic interviews and screening by neuropsychologists will be offered to OIF/OEF veterans who may have sustained a brain injury in combat or from other causes during military service.  In addition, staff from the BI&SSCS-Statewide Head Injury program (SHIP) will be onsite to assist with filling out applications for services from SHIP.  SHIP coordinators will also provide information and resources at these regional screening clinics.  For exact dates of these clinics, please contact Felisha Bennett at 617-204-3852 or Felisha.Bennett@ state.ma.us.

• Symposium for Women and Minority Veterans – recognizing that the military experience of women veterans and service members of diverse cultures often differs from that of the mainstream armed forces, this conference will explore the unique needs and challenges related to gender and cultural roles, particularly within the family structure.  Participants will have the opportunity to share experiences and receive support from their peers, as well as learn more about TBI and available services and supports.  This symposium will be held on June 16 at UMass-Boston and on June 23 at Springfield College.  Secretary of Veterans’ Services Coleman Nee, is expected to deliver the opening remarks at both events.   

Promoting awareness of brain injury as what is sometimes a lifelong condition is the first step toward MRC’s goal of early and equal access to services, supports and compassion. BI&SSCS hopes that grant opportunities such as this one will help Veterans with TBI overcome stigma and find the strength and courage to seek help and choose healing.                    

For more information about any MRC BI&SSCS or SHIP activities for Veterans, please contact Felisha Bennett at 617-204-3852.

 

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State undertakes a new initiative to improve the quality of health care

By Commissioner of the Division of Health Care Finance and Policy Áron Boros and Commissioner of Public Health John Auerbach

Firmly established as a national leader in guaranteeing health coverage for all its residents, Massachusetts is turning to the next phase of innovation, improving value in the health care system by further increasing quality and reducing cost. While the Commonwealth has long had a reputation for high quality care, a new undertaking offers the promise of sustained, public focus on quality in certain key areas by establishing a minimum set of quality measures to be uniformly reported across the state. This set of measures will ultimately be available for adoption by hospitals, clinics, primary care providers, accountable care organizations (ACOs), and insurance carriers, to help enhance decision making in health care delivery. As was true with Massachusetts Health Care Reform, this effort to transparently focus on quality measurement and improvement may offer a model for the rest of the nation. 

The quality initiative is guided by legislation that directs the Department of Public Health and the Division of Health Care Finance and Policy to form and chair a Statewide Quality Advisory Committee (SQAC) to recommend measures for inclusion in a Standard Quality Measure Set.  The Department of Public Health will later develop regulations advised by these recommendations, requiring uniform public reporting of the Standard Quality Measure Set for a variety of purposes, including driving quality improvement and facilitating informed consumer decision making to ensure that the right care is delivered at the right time, in the right place.

The Committee, which includes representatives from a variety of stakeholders (the full list of members is available at the Committee’s website) met for the second time in mid-February, and is in the process of considering four national measure sets (required by statute) that apply to inpatient hospital and ambulatory settings.

In order to help broaden the recommendations beyond these sets, the Committee is currently soliciting input from the public. The SQAC is currently looking to address three specific priorities identified by the Department of Public Health:

• efficiency and system performance
• care transition and coordination
• high-priority setting and clinical focus areas: 
  • behavioral health
  • post-acute care
  • community and population health. 

All proposed measures will be made public, and the Committee will review the proposals at a future meeting. Any Committee member will then have the opportunity to request that the SQAC formally consider any of the proposed measures for inclusion in the Standard Quality Measure Set through a nomination process. The formal consideration will involve an evaluation of how well a measure meets the priorities described above, as well as an evaluation of the measure’s validity and practicality (the review process and principles are outlined in the Committee Bylaws). 

If you are interested in proposing a measure for consideration, please submit ideas before March 16^th on this website: https://www.surveymonkey.com/s/SQACNomination1.  The site outlines the required information, including technical information about the measure, and information about how the measure is currently being used. 

Stakeholder participation in the nomination process and the work of the SQAC more broadly will help ensure the success of the overall initiative.  We thank you very much for your contributions to this collective effort.   Please email sqac@massmail.state.ma.us if you have any questions and we look forward to reviewing your submissions. 

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The role of the Office for Human Rights (OHR) at the Department of Developmental Services

By DDS Commissioner Elin Howe

Many of you may be familiar with the mission and work of the Department of Developmental Services but may be less familiar with the Department’s Office for Human Rights (OHR). This important office oversees a system of safeguards to affirm, promote and protect the human and civil rights of the people that the Department supports. OHR ensures that DDS clients are engaged to the greatest extent possible in directing their own lives and is dedicated to helping individuals overcome obstacles so they may lead vibrant, satisfying lives. OHR provides support and oversight to the Department's human rights agenda, and works with other offices and divisions across state government to identify and clarify rules and regulations that affect individual human rights.

The core values of our Human Rights agenda include rights of:

• Dignity
  
• Self-determination
  
• Habilitative Care and Competent Treatment
  
• Communication
  
• Relationships
  
• Privacy
  
• Personal Safety
  
• Personal Property
• Education
  
• Employment
• Compensation
  
• Community Membership

OHR stands firmly on the principle that individuals have the right to be treated with respect and must have the opportunity to make meaningful choices and informed decisions about their lives. Individuals have the right to privacy in numerous areas including: during care of their personal needs; in all forms of communication; during personal visits within one’s home and personal space, and confidentiality with the exchange of their individual information. All DDS clients have the right to equal access to opportunities for education and employment; and all individuals who are employed have the right to be fairly compensated for the work that they do.

Each DDS client is appointed a Human Rights Officer who is responsible for managing trainings and support for the client and his or her family on issues related to community living and issues at home. These officers also offer advice, information, and guidance to direct DDS staff on human rights issues. The Department also works within Human Rights Committees to help service providers determine how they will affirm, promote, and protect the human and civil rights of DDS clients. These committees also monitor and review the activities of providers to ensure that these rights are preserved. Human Rights Committees are fully empowered under Department regulations to take action as needed to uphold these rights, particularly as they relate to any limitation of an individual’s movement, or other restrictions being placed on an individual. There is also a statewide Human Rights Advisory Committee (HRAC) that advises me, as well as the OHR Director on efforts to fulfill the obligations of the office to protect human rights.

If you would like more information about OHR, please email the Director for Human Rights at DDS, Tom Anzer: Tom.C.Anzer@state.ma.us

 

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State plan for managing Alzheimer’s advances

By Elder Affairs’ Secretary Ann Hartstein

Last week the Massachusetts Alzheimer’s Disease and Related Disorders State Plan was released by the Executive Office of Elder Affairs (EOEA) and the Alzheimer’s Association Massachusetts /New Hampshire chapter. The plan provides recommendations, resources, goals and strategies to improve the lives of individuals affected by Alzheimer’s. The report was developed over the past two years by a statewide Advisory Committee that convened advocates, caregivers, participants with early stage Alzheimer's, stage agency representatives, and institutional and community agencies working with men and women with this difficult disease.  The recommendations reflect enduring concerns as well as priorities that were developed out of four listening sessions and seven focus groups convened throughout the state, collectively involving more than 400 participants.  “Alzheimer’s is the most common type of dementia-causing illness and the sixth leading cause of death in the United States,” said Health and Human Services Secretary Dr. JudyAnn Bigby. “Massachusetts alone has 120,000 seniors who suffer from Alzheimer’s disease which doesn’t include the many thousands with younger-onset Alzheimer’s or other related dementias.” 

The Advisory Committee identified five major areas of concern and ways that Elder Affairs and the Alzheimer’s Association will work with state wide and local agencies,  medical groups and advocacy groups  as well as and interested citizens to implement recommendations in those areas. The Advisory Committee recommendations are designed to address these concerns and include strategies to accomplish these goals. The key recommendations from the State Plan are:

• Improve access to services and information for people with Alzheimer’s;
• Improve and expand support and education for family caregivers;
• Develop an infrastructure for enhanced quality of services within the medical community;
• Improve public awareness surrounding risk factors and risk reduction for Alzheimer’s disease;
• Create a set of statewide recommendations, guidelines and minimum standards surrounding quality of care in all care settings.

I very am pleased about this report and invite you to read it in its entirety. The recommendations provide a framework for the entire Massachusetts plan around Alzheimer’s and the future for all of us as we work together to meet the needs of  the increasing number of people affected by this disease.

 

To read the full report visit: http://www.mass.gov/elders/

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Through collaboration with Department of Public Health, MassHealth members quit smoking while saving the Commonwealth $3 for every $1 spent

By Secretary of Health and Human Services Dr. JudyAnn Bigby 

Some of you may have heard the great news last week from George Washington University, which released a study showing that that for every dollar MassHealth spends helping its members quit smoking, it saves the Commonwealth $3.12 in expenses for hospitalizations due to acute cardiovascular conditions. This remarkable return on investment is a victory the Commonwealth at large and reflects the positive impact of Massachusetts health care reform. It also demonstrates that investing in prevention reaps cost savings much sooner than anticipated.

The GW study was based on analyses of the Medical Expenditure Panel Survey, the Behavioral Risk Factor Surveillance System, and other previously published health studies.  It estimated cost savings for cardiovascular-related hospitalizations and did not include other costly longer-term illnesses caused by tobacco, such as cancer. A decline in cardiovascular hospitalizations and the associated cost savings were evident just a little over a year after smokers’ use of the benefit.

Clearly, investing in prevention strategies is essential to health care cost containment as we move forward with health care reform in Massachusetts.

MassHealth and the Department of Public Health (DPH) Tobacco Cessation & Prevention Program worked together to design a barrier-free benefit that includes all FDA-approved medications to quit smoking and behavioral counseling.  MassHealth has made this benefit available to its members since July 2006 as part of health care reform.

In making the announcement about this study, Governor Deval Patrick said, “While we have always known that helping people quit smoking is an investment in their health, this study shows that our efforts are also a sound financial investment for the Commonwealth, This represents another positive outcome of health care reform in Massachusetts.”

A major component of the success of this benefit is how MassHealth and DPH promoted it: through radio and transit ads and targeted outreach to MassHealth members and health care professionals. Massachusetts already had smoke-free workplaces, had a relatively high cigarette tax at the time the benefit was introduced, and has cultivated a non-smoking social norm, all of which have contributed to smokers wanting to quit.

The study’s findings are based on an independent assessment conducted by researchers from the George Washington University School of Public Health and Health Services, led by Professor Leighton Ku, and funded by Partnership for Prevention, a nonprofit organization that supports evidence-based public health prevention efforts.   The study was published in the peer-reviewed online journal PLoS One, at http://dx.plos.org/10.1371/journal.pone.0029665.

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$26.75 Billion waiver agreement with CMS will strongly support integrated health care in Massachusetts

By Health and Human Services Secretary Dr. JudyAnn Bigby

Earlier this week, Governor Patrick announced that the federal Centers for Medicare and Medicaid Services (CMS) has renewed Massachusetts’ 1115 Research and Demonstration Waiver Agreement, commonly referred to as the Waiver. Yesterday’s announcement of a $26.75 billion, three-year agreement gives Massachusetts an additional $5.69 billion in spending authority and strongly supports our commitment to promoting integrated systems of care and establishing alternative payment models.  

The milestone agreement also ensures the ongoing success of Massachusetts’ historic health care reform initiative, through which more than 98 percent of the Commonwealth’s residents, and 99.8 percent of children, have health insurance. The waiver fully funds our ongoing health care reform implementation and includes more than $500 million annually in federal support for Commonwealth Care and the Health Safety Net, and more than $300 million annually in other federal support for services to low-income and uninsured populations.

I am pleased to share a few of the important features of the new waiver agreement, which will be active until June 2014. The waiver includes several innovative programs that expand services for certain children, develop integrated systems of care and alternative payment systems, and position the Commonwealth to reduce the cost of medical care and the rate of growth over time.

Under this agreement, we will promote delivery system and payment transformation with the state’s key safety net hospitals. The waiver includes $120 million annually in new federal funding to support the transformation of the hospitals into integrated delivery systems, and envisions transitioning away from fee-for-service payments toward alternative payment arrangements that reward high-quality, efficient and integrated care. This feature of the waiver agreement reflects the principles outlined in the Governor’s comprehensive health care cost containment bill, which he filed earlier this year.  

Massachusetts will also establish a Pediatric Asthma Payment Pilot, which will support a bundled payments to providers for services to improve asthma outcomes in children  not traditionally covered, including home visits by community health workers and supplies for reducing environmental triggers in the home. Efforts like these have been shown to help keep kids with asthma healthy and out of the emergency room with acute asthma exacerbations.   

The waiver also authorizes federal Medicaid reimbursement for medically necessary Applied Behavioral Analysis-based treatment services to children with a diagnosed autistic disorder; these services are provided through the Commonwealth’s Early Intervention program.

We will also initiate an innovative “Express Lane” eligibility program that will streamline procedures for renewing eligibility for parents with children who are enrolled in the Supplemental Nutrition Assistance Program (SNAP) program. We estimate that approximately 140,000 MassHealth members may be eligible for this Express Lane renewal, and by sharing documentation between state agencies, we will ease the administrative burden on both consumers and government and prevent children from losing coverage unnecessarily. 

Some clarification may be necessary when it comes to our duals demonstration project (read my post from last week about this initiative here), independent of the 1115 waiver process. The Commonwealth will move forward with this important initiative. MassHealth and the federal government are working together to design and implement a new care model for individuals aged 21-64 who are eligible for both MassHealth and Medicare, so that they receive all of their benefits in a seamless, integrated manner. When we submitted our draft 1115 waiver renewal overview document in 2010, it appeared that we would need 1115 waiver authority to pursue a duals demonstration. However, in July 2011, CMS released a state Medicaid Director's letter that provided an alternative process for duals demonstrations that does not require 1115 authority. As is mentioned in our 1115 waiver approval letter, we withdrew our request for 1115 authority, given that it is no longer required.  

We look forward to implementing these innovations in Massachusetts and making meaningful steps to improve patient care and control costs for everyone.   

I want to thank Governor Patrick for his leadership on behalf of Massachusetts, as well as our congressional delegation for their strong support. My heartfelt appreciation also goes to the entire MassHealth team for their extraordinary commitment to making this agreement a reality. It was through a lot of hard work and dedication that this agreement was achieved, through which Massachusetts will be able to promote more integrated care while controlling costs.    

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Another step forward to integrate care for MassHealth and Medicare members

By Secretary of Health and Human Services Dr. JudyAnn Bigby

I am delighted to update you on a very important MassHealth initiative. Readers of “Commonwealth Conversations: Health and Human Services” may have read about this initiative in June. MassHealth and the federal government are working together to design and implement a new care model for individuals ages 21-64 who are eligible for both MassHealth and Medicare, so that they receive all of their benefits in a seamless, integrated way. 

Last week, MassHealth published a draft Demonstration Proposal that outlines our approach to this demonstration. For more information, read our proposal online (click on “Related Information” to find it). 

Fundamentally, we want this proposal to assist dual eligible individuals, ages 21-64, who choose this new option to experience improved quality of care and greater access to long-term community support services and behavioral health care. The new care model will:

• Ensure that eligible individuals receive all of their MassHealth and Medicare benefits through a single program;

 

• Enable dual eligible individuals to use new services that MassHealth and Medicare do not currently cover, including home modifications, peer supports, and expanded behavioral health services;

 

• Provide each dual eligible individual with a care team that is responsible for helping the member access and manage acute medical, primary care and behavioral health services, and provides access to a coordinator of long-term supports and services;

 

• Assign a team member to track and coordinate all of the providers involved in providing services and keeps the primary care team informed.

Behind the scenes, the new integrated care organizations (ICOs) that will be delivering this option will focus on ensuring that each member gets the right care at the right time and place. This means the ICOs will help people manage chronic illnesses, disabling conditions, and other health and wellness challenges from day to day, so they can avoid emergencies and hospitalizations and maintain functional status. The ICOs will be held accountable by MassHealth and Medicare for helping members stay as healthy as possible. The ICOs will also need to partner with others to ensure members receive the full spectrum of services, including Independent Living Centers (ILCs), Aging Service Access Points (ASAPs) home health agencies and behavioral health providers. In addition, primary care teams may include community health workers, peer specialists, and others who have expertise in helping individuals with disabilities.  

Numerous people and many organizations are involved in ensuring the success of this initiative. Input from members, advocates, community-based organizations, medical providers, health plans, and others has shaped MassHealth’s draft Demonstration Proposal. MassHealth has convened public meetings, sought feedback from members, received written comments, and has had countless conversations to inform this dialogue. Each stakeholder has a viewpoint worthy of consideration, and can play a role in making this program optimally beneficial to dual eligible individuals. We look forward to engaging in ongoing public dialogue, as we continue designing and proposing an implementation strategy.

After we receive public comment about our draft Demonstration Proposal, we will revise it before submitting it to CMS for ongoing negotiations about the details. There are upcoming public hearings on the proposal. Following are the details:

 –               December 16, 2011, 1 pm to 4 pm
                   Worcester Public Library
                   Saxe Room
                   3 Salem Square
                   Worcester

–                January 4, 2012, 10 AM to 1 PM*
                   State Transportation Building, Conference Rooms 2 & 3
                   10 Park Place
                   Boston 

*Please note:  change from the previously announced time 

Stay up to date with this project by visiting www.mass.gov/masshealth/duals and look for further updates in this blog space. We also welcome feedback from you!  Email your comments to: duals@state.ma.us.  I look forward to providing you more updates in the future.

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