Massachusetts Health Policy Commission
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This February edition of the
Transforming Care
newsletter celebrates the recertification of 14 accountable care organizations through the HPC certification process. This issue also previews insights from the accountable care organizations and features a patient story from Community Care Cooperative.
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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HPC Certifies 14 Accountable Care Organizations
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In December 2019, the HPC recertified 14 accountable care organizations (ACOs) through the HPC’s ACO certification process. The HPC is in the early stages of analyzing some of the key information from ACOs’ certification applications. Preliminary findings include:
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- The use of risk contracts with payers appears to have held steady from the first round of certification in 2017, with a slight uptick in the number of two-sided risk contracts and a corresponding decrease in the number of upside-only contracts. Overall, the majority of covered lives (91%) attributed to these 14 ACOs are in two-sided risk contracts.
- Despite the prevalence of two-sided risk contracts, a minority (6 of 14) of ACOs report that 10% or more of physician compensation is performance-based.
- Half of the recertified ACOs reported substantial progress on behavioral health integration, using a SAMHSA-AHRQ framework for characterizing the level of integration. These seven ACOs reported that 50% or more of their primary care practices could be characterized as ‘close collaboration in a partly integrated system’ or ‘close collaboration in a fully integrated system.’
- Similar to the first round of certification in 2017, most ACOs include at least one hospital among their Participants.
- Every ACO reported that it is implementing strategies to curb unnecessary utilization in areas of low-value care, particularly imaging services (13 ACOs) and inappropriate prescribing (12 ACOs).
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These 14 organizations comprise the first cohort to be recertified under the HPC’s first-in-the-nation set of statewide standards for ACOs. Initially implemented in 2017, these standards require delivery of cross-continuum care, implementation of performance improvement activities and population health management programs, and participatory governance that includes patient or consumer representation.
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Altogether, there are 17 HPC-certified ACOs in the Commonwealth, as three additional ACOs that were certified in 2018—Health Collaborative of the Berkshires, Merrimack Valley ACO, and Mount Auburn Cambridge Independent Practice Association—are eligible for recertification later this year.
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Massachusetts has been a leader in ongoing national efforts to transform care delivery. The HPC’s ACO certification program’s multi-payer standards for providers in the Commonwealth help to align the many ACO programs in the market and encourage care delivery transformation, payment reform, and investments by payers and providers in high-quality and cost-effective care. Certification is effective for two years. More information is available at the HPC’s
ACO Certification Program website
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ACOs Are Advancing Population Health Management Strategies that Look Beyond Medical Care
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Commitment to addressing the full spectrum of health and health-related needs of patient populations, including by working with non-medical providers in the community, is a hallmark of the ACO model. The HPC’s certification standards require that ACOs have population health management programs in place that address behavioral health and health-related social needs.
Twelve of the 14 recertified ACOs reported having a strategy for the integration of behavioral health services into primary care, either at the level of the ACO or at the level of the health system of which the ACO is a part. ACOs are pursuing a variety of models and programmatic focuses. Some ACOs have integrated behavioral health screening and treatment into more comprehensive care management programs, coupling the work of nurse care managers and care coordinators with that of community health workers (CHWs), prescribers, or behavioral health specialists.
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One ACO highlighted its implementation of a collaborative care model embedding social workers, consulting psychiatrists, and behavioral health support specialists in primary care settings to manage behavioral health conditions. Another ACO described its use of a “behavioral health home” model that incorporates primary care services into specialty mental health clinics. Three ACOs have focused their behavioral health efforts on depression in particular.
In addition to emphasizing behavioral health, ACOs have also rolled out programs to address non-medical contributors to health. Most ACOs highlighted initiatives to screen patients—in some cases all patients, but more often the MassHealth population specifically—for health-related social needs like food insecurity or housing instability. When social needs are identified through questionnaires, screening tools, or direct referrals, patients are connected with external community-based organizations and agencies by staff such as CHWs (in six ACOs) or social workers (in three ACOs).
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Some ACOs are using technology to connect patients to resources and to track referrals and follow up for community-based services. Four ACOs reported integrating coordination with social service providers and community-based resources into broader care management programs that also included behavioral health interventions.
As ACOs continue looking for ways to lower costs and improve care for the patients they serve, care models that also address the behavioral and health-related social needs of patients are likely to continue to expand and evolve.
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Community Care Cooperative Connects Patients with Complex Care Needs to Social Services
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Community Care Cooperative (C3), an HPC-certified ACO and
SHIFT-Care
awardee, is implementing
Healthy Connections
, a community-based, integrated care management program for patients who have been unsuccessful in other C3 care management programs
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Healthy Connections
deploys CHWs and care managers to homes and other community settings to assess medical and behavioral health needs as well as health-related social needs. CHWs and care managers work closely with patients to discuss their goals and connect them with resources.
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The
Healthy Connections
team engaged with “Sophie,” a homeless, pregnant woman in her late 30s, whose primary language was Spanish. Sophie had been previously lost to follow up while enrolled in another care management program at C3. The most recent phone number available for Sophie actually belonged to a friend, and through that friend the
Healthy Connections
CHW was able to reach Sophie. Soon after, Sophie was hospitalized and reached out to the CHW for support. Sophie did not have her own phone, which made communication with the CHW challenging. Still, the CHW followed Sophie through four facilities, regularly reaching out to assist her with housing and other services. Since Sophie was pregnant, she was quickly housed post-discharge at Entre Familias, a residential program for pregnant women. The CHW is still in close contact with Sophie, assisting with other identified social needs.
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The CHW credits persistence when reaching out to Sophie and her friend as the key to successfully connecting Sophie to services. Once Sophie knew that the CHW could be a resource, she and the CHW formed a relationship based in trust and the CHW was able to tailor her approach to Sophie’s unique needs.
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PUBLICATIONS, PRESENTATIONS, AND RECOGNITIONS
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2020 AcademyHealth National Health Policy Conference
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HPC staff delivered four poster presentations at the 2020 AcademyHealth National Health Policy Conference on February 10-11 in Washington, D.C.:
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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
March 11, 2020
State Health & Value Strategies
Webinar
March 11, 2020
Economic Mobility Exchange
Philadelphia, PA
March 18, 2020
MA Department of Public Health
Worcester, MA
March 31, 2020
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A sampling of resource materials and publications about accountable care organizations, produced by the HPC, other Commonwealth agencies, and non-profit organizations.
Health Policy Commission, 2019
Health Policy Commission, 2018
Health Policy Commission, 2018
Health Policy Commission, 2019
Blue Cross Blue Shield of Massachusetts Foundation, 2019
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Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109
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