 |
 Launch of the MassHealth ACO Program
Seventeen health care organizations across the state have executed agreements to participate in a major restructuring of the MassHealth program. The Accountable Care Organizations (ACO) program is a major component in the state's five-year Medicaid waiver bringing in $1.8 billion in new federal investments to restructure the current MassHealth system. Effective March 1, 2018, ACOs - networks of physicians, hospitals, and other community-based health care providers - will be financially accountable for cost, quality, and Member experience for over 800,000 MassHealth Members.
"ACO agreements will directly lead to better and more coordinated care for MassHealth Members across the Commonwealth," said Governor Charlie Baker. "Under the new agreements, ACOs will be held accountable for the cost of their services and overall health outcomes of their patients. These changes, coupled with our nation-leading level of coverage and the $50 billion federal Medicaid waiver our administration successfully secured last year, will help ensure that Massachusetts continues to lead the country in affordable, quality health care."
To promote continuity of care, Member enrollment in ACOs will be based upon their relationship with their current primary care provider. Additional information on Member attribution and the ACO program can be found in this MassHealth provider bulletin
.
The ACO program supports MassHealth's commitment to:
- Improve quality and Member experience and integrate the full spectrum of care including medical care, behavioral health, and long-term services and supports (LTSS),
- Provide clinical and community-based support for populations with behavioral health and long-term health care needs,
- Shift incentives to hold providers accountable for quality and total cost of care for a population of patients,
- Invest in primary care and community workforce development,
- Allow for innovative ways of addressing social determinants of health, and
- Expand access to substance use disorder treatment, including treatment for co-occurring disorders.
Since December 2016, six ACOs have been participating in the
MassHealth ACO Pilot program
covering approximately 160,000 Members. Additional information on MassHealth's planned restructuring and payment reforms for its 1.9 million Members may be found on the
MassHealth Innovations website
.
|
An Insider's Guide to the New Community Partners: Community-Based Mental Health in the Evolving World of ACOs
With the transition to an Accountable Care Organization (ACO) system of health care, the role of Community Partners (CPs) will become integral to the care of Members in managed care organizations. CPs provide care coordination and support so Members can bring all elements of their health and wellness together. There are two types of CPs: Behavioral Health (BH) CPs and Long-Term Services and Supports (LTSS) CPs. BH CPs have expertise helping Members ages 21-64 with serious mental illness or substance use disorders. LTSS CPs provide services to Members ages 3-64 with complex, long-term needs such as requiring assistance with activities of daily living (bathing, eating, etc.) or needing durable medical equipment. Members will be identified as needing CP supports through claims-based analysis, or they may be referred by a provider or can self-refer.
Through a competitive procurement process, 18 BH CPs and 8 LTSS CPs were selected for contracting with MassHealth. CPs are scheduled to begin providing services to Members starting June 1, 2018. More information on the selected CPs as well as provider training and other pertinent ACO information can be found on the
MassHealth Innovations website
.
|
The Importance of Metabolic Screening for Adults on Antipsychotic Medications
MBHP and the PCC Plan want to make sure that Members being treated with antipsychotics are adequately monitored for metabolic syndrome. Treatment with some second-generation antipsychotics has been found to cause an increase in body weight which is associated with increased insulin resistance and concordant elevation of serum lipids. People with schizophrenia and/or bipolar disorder are at greater risk for metabolic syndrome compared to the general population.
1
,
2
Diabetes screening is a high priority for people with either or both of these diagnoses, and the added risk associated with antipsychotic medications contributes to the need for routine screening, which can lead to earlier identification and treatment of diabetes - resulting in better health outcomes.
Successful completion of screenings in accordance with clinical standards of care can only be achieved with PCC involvement.
- recommend scheduled monitoring of metabolic risk factors
- suggest clinicians switch the patient to a second-generation antipsychotic medication with a lower weight gain liability if the patient experiences a weight gain of ≥5% of initial weight
Please consider the following:
- Continue to review psychiatric/mental health history and psychiatric medications with each Member and schedule monitoring visits in accordance with the recommended schedule for patients on second-generation antipsychotics.
- Once established, continue to review current psychiatric medications and check for adherence and regimen simplification.
- Encourage Members to share the names and contact information for providers of his/her mental health team and establish a clinical relationship using the two-way communication form and other pathways in order to promote better care coordination inclusive of the results of metabolic monitoring (weight (BMI), waist circumference, blood pressure, blood glucose, and lipids).
- Address other cardiovascular co-morbidities and risk factors such as smoking.
- Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., et al (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209-1223.
- Cohn, T., Prud'homme, D., Streiner, D., Kameh, H., & Remington, G. (2004). Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Canadian Journal of Psychiatry, 49(11), 753.
|
Stress Reduction for Patients
Extreme weather, disturbing headlines, uncertainty regarding health care legislation and other concerns - all exacerbated by the 24-hour news cycle - are causing many people to report increased anxiety. Although stress is an unavoidable fact of life, there are some simple steps Members can take to lessen its negative impact on their health. Providing resources and tips on stress management can address some of these concerns and promote general well-being.
In addition to suggesting commonsense measures such as paring down clutter, reducing caffeine intake, and getting enough sleep, mindfulness and relaxation techniques - many of which can be self-taught - can be a valuable addition to a stress management toolbox. In general, relaxation techniques involve directing attention towards something soothing and focusing awareness on the body. They may include visualization, progressive relaxation, and deep breathing exercises. For resources and patient handouts on stress and stress management, visit the following links:
|
Care Coordination Consult Codes Reimbursable
Calling family members, emailing school counselors, and talking to service providers: these are just a few examples of all the care coordination activities outpatient therapists find themselves doing for their young clients outside of the clinical office visit. It really adds up--did you know that you can now get paid for this work at the same pro-rated rate as an in-office visit? While MassHealth has always reimbursed for care coordination activities through consult codes, the rate hasn't reflected the true value of this work. Until now.
Beginning in 2016, MassHealth directed its Managed Care Entities (MCEs) to reimburse consult codes (Family, Case, and Collateral) at the same (pro-rated) rate as a 60-minute office visit. In effect, 60 minutes of care coordination is now equivalent to 60 minutes of in-person therapy. Through this change in policy, MassHealth fully recognizes the value and importance of care coordination activities that outpatient therapists have been doing all along. MassHealth also recognizes that outpatient therapists could benefit from having more information on care coordination and how to use consult codes to reflect all the good work they are doing.
In partnership with the Children's Behavioral Health Knowledge Center, the MassHealth MCEs, and the Donahue Institute at UMass, MassHealth developed this interactive online training to:
- Outline the basics of the Children's Behavioral Health Initiative (CBHI) hub service system
- Describe the logistics of hubs in terms of complexity of needs
- Illustrate care coordination activities within each hub
- Clarify an outpatient provider's relationship to youth within each hub
- Explain how to use consult codes that support care coordination activities
|
|
|
|
|
|
