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Provider Connection
A newsletter of the MassHealth Primary Care Clinician (PCC) Plan Spring/Summer 2016
Quick Links to Articles
Improving Access to Substance Use Disorder Services
New High-Dose Opioid Limit
Integrating Care for Members
Provider Trainings
Informed Consent: Why it is Important
MBHP is now part of Beacon Health Options
  
Resource Links
  
 
  
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Important Numbers

 

Eligibility Verification System (EVS)

1-800-554-0042

 

Emergency Services Program (ESP)

1-877-382-1609

 

MassHealth Customer Service

1-800-841-2900

 

MBHP

1-800-495-0086

 

Integrated Care Management

Program (ICMP)

1-800-495-0086, Ext. 454165 or

(617) 790-4165

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Improving Access to Substance Use Disorder Services
In response to the opioid epidemic in Massachusetts, a simplified array of substance use disorder (SUD) levels of care were established.  Providers can assist patients seeking timely access to services through the Massachusetts Behavioral Health Access (MABHA) website.  The website enables behavioral health and health care providers to locate potential openings in mental health and substance use disorder services for the purpose of referring individuals to those available services.
The SUD services that are searchable on the MABHA website include:
  • Inpatient Detoxification Service/Level 4 Medically Managed Intensive Inpatient Treatment
  • Acute Treatment Services (ATS)
  • Clinical Stabilization Services (CSS)
  • Transitional Support Services (TSS)
  • Medication Assisted Treatment (MAT) - Methadone Treatment, Buprenorphine (suboxone), Naltrexone (vivitrol)
  • Structured Outpatient Addiction Program (SOAP), Intensive Outpatient Program (IOP), Partial Hospitalization (PHP)
To search for SUD providers on the MABHA website, click on "Find SUD Services" on the toolbar at the top of the page.  A log in is not required.
 
Pharmacy Corner
New High-Dose Opioid Limit
The MassHealth PCC Plan reduced the high-dose opioid limit to 120 mg of morphine equivalents on March 7, 2016.  Higher doses require prior authorization.  The prescribing of high dose opioids
(>120 mg/day of morphine or equivalents) for chronic non-cancer pain is not supported by strong evidence and has been associated with increased risk for adverse events and overdose.  MassHealth also implemented a prior authorization on methadone prescriptions for any Member who was not already stable on the medication.
Additional information about the PCC Plan pain initiative and Dear Prescriber letter
 
Integrating Care for Members
If you do not have a care management program at your practice, the Integrated Care Management Program (ICMP) addresses the complex needs of PCC Plan/MBHP Members.  Our ICMP team of nurses, community health workers, peer specialists, social workers, and other mental health professionals supports both PCC Plan/MBHP Members and providers by providing telephonic and face-to-face care management.  This support helps Members connect to services in the community to alleviate many of their social issues, resulting in better management of all complex conditions and improvement in their overall wellbeing.   
PCC Plan/MBHP Members are identified by the MBHP risk-stratification algorithm that uses historical claims data.  Members can also enter the free, voluntary ICMP through provider referral or self-referral.  ICMP staff will alert providers directly for urgent or emergent situations.  Input and guidance from the provider and his/her team is always a welcome component of the care management plan.  
 
Trainings
Intimidated by the specter of payment reform and worried how you can sustain success in the future?  Feel that you need to make changes in your practice, but you're not sure where to start?
Join the Southern New England Practice Transformation Network (SNE-PTN).  Each participating practice is assigned a Quality Improvement Advisor who tailors free technical assistance to the transformation goals of the practice.  SNE-PTN is funded by CMS as part of the national Transforming Clinical Practices Initiative.  Learn more at www.sneptn.org or contact Ron Adler, Physician Lead for Clinician Recruitment and Engagement, SNE-PTN: Ronald.Adler@umassmemorial.org

Webinar: Screening for Risky Drinking

Screening for Risky Drinking in the Adult Population: Identifying and Addressing Unhealthy Alcohol Use in the Clinical Setting
Presented by the MassHealth PCC Plan and Massachusetts Behavioral Health Partnership (MBHP)
In this webinar, the rationale for screening in the clinical setting for risky drinking as a means to reduce risky drinking and its associated harms was reviewed.  The presentation included a review of evidence-based screening tools, instructions for providing effective brief interventions for patients who screen positive for risky alcohol use, and case examples that enhance clinical and operational concepts of implementation.
PowerPoint Slides: Screening for Risky Drinking in the Adult Population: Identifying and Addressing Unhealthy Alcohol Use in the Clinical Setting
Informed Consent: Why it is Important
Informed consent is not merely a legal and/or ethical requirement, but can be a useful tool for engaging Members and ensuring collaborative relationships.  Informed consent requires that a physician (or other medical provider) must tell a patient all of the potential benefits, risks, and alternatives involved in any surgical procedure, medical procedure, or other course of treatment, and must obtain the patient's written consent to proceed.  The concept is based on the principle that a physician has a duty to disclose information to the patient so he or she can make a reasonable decision regarding treatment.  The Department of Mental Health observes that informed consent "is integral to person and family-centered approaches and principles of recovery and resiliency."  When an individual is able to fully participate in decision making about medications and other treatment, the result is better understanding and follow-through on treatment, and ultimately, a more empowered Member and better outcomes.
For more information on informed consent:
  
MBHP is Now a Part of Beacon Health Options

 

You may have recently noticed changes in MBHP materials.  ValueOptions, the parent company of MBHP, and Beacon Health Strategies have merged to become Beacon Health Options (Beacon).  The merger brings together two mission-driven companies that share the same vision - to improve the health and wellbeing of individuals coping with mental health and substance use disorders through recovery-focused programs and effective partnerships with you, our providers.
 
MBHP continues to give behavioral health providers and primary care clinicians the most comprehensive, up-to-date information about our standards of service delivery so that our providers can give the highest quality care to our Members.  The integration of care for Primary Care Clinician (PCC) Plan Members who have medical, mental health and substance use disorders, and complex co-morbid needs, allows us to help people live their lives to the fullest potential.
  
For questions about MBHP or Beacon, call the MBHP Member Engagement Center at 1-800-495-0086.