A newsletter of the MassHealth Primary Care Clinician (PCC) Plan

Spring 2024

Included in this newsletter:

1. Naloxone: Opioid Overdose Prevention and Management
2. Peer Specialists in Care Management
3. The Impact of Social Determinants/Drivers of Health (SDoH) on Health Equity
4. Crisis Services Available at Community Behavioral Health Centers (CBHCs)
5. 2023 Virtual Health Equity Forum - Health Equity, Behavioral Health, and the Pandemic: What We Learned and How to Move Forward
6. 2023 Virtual Integration and Quality Forum - Maternal Mental Health: Bridging Specialties to Improve Outcomes
7. Reminder to Update Provider Information

2) Peer Specialists in Care Management

What is a Certified Peer Specialist?

Certified Peer Specialists (CPSs) are trained individuals who use their lived experience to encourage, engage with, and support others with behavioral health, addiction, and/or trauma challenges. They use the recovery model and the principles and values of peer support to provide hope and be role models of recovery. MBHP has recently incorporated the CPS role into the Care Management model to support wellness and recovery by empowering individuals in their recovery journey. CPSs accomplish this by utilizing strengths-based and trauma-informed practices that offer hope. Through skill building, coaching, and role playing, the CPSs support individuals to identify community resources that meet their needs in addition to promoting recovery. Peer relationships often include shared cultural characteristics, such as age, gender, ethnicity, language, sexual orientation, or other identity-shaping life experiences that increase common language, mutual understanding, respect, trust, confidence, and safety.

The Importance of a Peer Model in Care Management

Peer programs help provide non-clinical resources to support individuals in their recovery. The greatest strength of CPSs is their ability to share their story, which helps individuals seeking support identify with another person’s situation, set of circumstances, or position along a continuum of steps or phases associated with recovery and wellness. This is truly meeting individuals where they are. CPSs can empathize with others in a situation they also experienced. It affords the CPS credibility, helps people in recovery know they can trust in the process, and lets them see firsthand others who have successfully recovered. CPSs work with individuals, their Care Managers, and providers to encourage personal development, foster independence, and help individuals develop the necessary skills to promote and guide their own recovery – this is a systemic and strategic approach to whole-person care. 

The Valuable Outcomes of the Peer Model in Care Management

Peer support improves quality of life; increases and improves engagement with services and treatment; and increases whole health, self-confidence, and advocacy, which also leads to overall positive feelings of self-worth. Individuals are able to realize that they are not alone in their recovery, and that they too are capable, understood, and accountable for the next steps in their journey. 

MBHP will be following these best practices for Certified Peer Specialists working within the Care Management program by:      

• Ensuring Certified Peer Specialists are certified within the Commonwealth.
• Providing trainings to CPSs that meet state requirements for continued education and growth.
• Supervising CPSs through the milieu team, both individually and via group support. 
• Supporting CPSs on complex cases through consultation and monthly integrated rounds to support peer competency development.

For more information on Certified Peer Specialists, call 800-495-0086, Ext. 706870.

3) The Impact of Social Determinants/Drivers of Health (SDoH) on Health Equity

According to the World Health Organization, social determinants of health (SDoH) are “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Outcomes such as mortality, morbidity, life expectancy, healthcare expenditures, health status, and functional limitations can all trace roots to social determinants that prevent adequate healthcare, exacerbate existing health conditions, or directly influence poor health behavior. According to the Robert Wood Foundation in February 2019, these factors can drive as much as 80 percent of health outcomes, making it imperative that primary care and other providers screen patients for SDoH needs routinely.

A variety of screening tools, available online at no cost, include but are not limited to:

• The Protocol for Responding to & Assessing Patients’ Assets, Risks and Experience (PRAPARE). PRAPARE is a national standardized patient risk-assessment protocol designed to engage patients in assessing and addressing SDoH.  
• The Bright Futures Toolkits provides links to commonly used screening tools, including tools specific to SDOH in the pediatric population. 

MBHP can assist your PCC Plan Members with SDoH needs, including through the Integrated Care Management Program (ICMP), an enhanced program for PCC Plan Members with complex medical, mental health, and/or substance use disorders. Clinical staff provide integrated medical and behavioral health care management that can include direct, face-to-face care management visits with Members. Referrals to ICMP can be made on the MBHP website.

While not specifically designed to address SDoH needs, the MA Behavioral Health Help Line (BHHL) is also available to all individuals and families in the Commonwealth and can connect individuals to the full range of mental health and substance use disorder treatment services offered in Massachusetts, including outpatient, urgent, and immediate crisis care. Individuals can call or text for real-time support, initial clinical assessment, and connection to the right evaluation and treatment; they can also chat with BHHL clinicians.

USING Z CODES (cms.gov) is an infographic that explains how using ICD-10 codes to gather SDoH data can enhance patient care, improve care coordination and referrals, support quality measurement, identify community/population needs, support planning and implementation of social needs interventions, and monitor SDoH intervention effectiveness.

On February 13, 2024, MBHP conducted a webinar entitled “Social Determinants of Health: Implications for Physical and Behavioral Health Health Care.” During this webinar, participants learned to explore the five pillars of social determinants of health (SDoH), recognize and understand how SDoH impact health inequities and inequalities, describe the impact of SDoH on physical and mental health outcomes, and identify strategies to assess and address SDoH that may be affecting patient populations. You can view the webinar recording and also the PowerPoint presentation and SDoH PCC Plan Resource Guide.

4) Crisis Services Available at Community Behavioral Health Centers (CBHCs)

Community Behavioral Health Centers (CBHCs) are a key component of the MA Roadmap for Behavioral Health Reform and include 26 coordinated hubs for mental health and substance use disorder (SUD) treatment across Massachusetts. 

Anyone in Massachusetts, including LGBTQIA+, Black, Indigenous, and People of Color (BIPOC), individuals who are Deaf or hard of hearing, individuals with disabilities, and individuals whose first language is not English, who is going through a mental health or SUD crisis can walk into or call their closest CBHC. CBHCs provide an important alternative to the emergency department (ED), and these one-stop shops offer a wide range of immediate and routine confidential behavioral health care in a supportive, non-traumatizing environment. People who reach out to the MA Behavioral Health Help Line (BHHL), either through phone call or text at 833-773-2445, or online chat, may also be directed to a local CBHC.

Available services at a CBHC include:

Adult and Youth Mobile Crisis Intervention (AMCI/YMCI) services are provided by trained professionals who assess individual needs, provide immediate assistance, and determine the best path forward. The MCI team can meet people in the community and are also available to people who walk into the CBHC. This 24/7 crisis support can be used by anyone who may be experiencing a behavioral health emergency, regardless of health insurance status. 

Community Crisis Stabilization (CCS) is a less-restrictive alternative to inpatient hospitalization, offering a home-like, friendly, and safe environment for people in need of short-term, overnight crisis care. CBHCs offer people of all ages CCS programs with services including individual, group, and family therapy, medication management, crisis intervention, and future crisis prevention planning. CCS is covered by MassHealth plans and some commercial insurers.

Routine Outpatient Services are comprehensive outpatient mental health and substance use disorder services available every day of the week, both in-person at CBHCs and via telehealth, with extended hours. Services include same-day mental health and substance use urgent evaluation, assessment, and individualized treatment; individual/family/group therapy; psychiatric medication consultations; peer support services; medication for addiction treatment; care coordination; referrals to treatment; and timely follow-up appointments.

You can find a directory of local CBHCs at mass.gov and on the BHHL website or by calling the BHHL at 1-833-773-2445 or MassRelay at 711 for Deaf or hard of hearing users.

Another alternative to the ED is Behavioral Health (BH) Urgent Care, which provides non-emergency access to more treatment services when and where people need them outside of usual operating hours. BH Urgent Care is also available via telehealth. BHUC providers can be found on the Massachusetts Behavioral Health Access (MABHA) website.

5) 2023 Virtual Health Equity Forum - Health Equity, Behavioral Health, and the Pandemic: What We Learned and How to Move Forward

The 2023 Virtual Health Equity Forum was held on Thursday, September 21, 2023. The Forum focused on the intersection of health equity, behavioral health, and the COVID-19 pandemic. The keynote address was given by Mr. Michael Curry, President and CEO of the Massachusetts League of Community Health Centers. His address focused on the ways in which the COVID-19 pandemic illuminated the weakness in the healthcare system in the United States and increasing health inequities faced by minorities. He shared his personal experience with family, friends, and community members turning away from lifesaving healthcare due to fear, isolation, and history of mistreatment. Mr. Curry shed light on the power of community in advancing health equity for all. This was followed by a panel discussion on personal and professional experiences of how COVID-19 impacted behavioral health. Panelists participated in a moderated Q&A where they answered questions about how race, ethnicity, culture, gender, sexuality, socio-economic class, and disability played a role in the evolution of inequity during and after the COVID-19 pandemic. For more information, view a Webex recording of the Health Equity Forum (using the password sZGYsrY2).

6) 2023 Virtual Integration and Quality Forum - Maternal Mental Health: Bridging Specialties to Improve Outcomes

The 2023 Virtual Integration and Quality Forum was held on Wednesday, November 1, 2023. The Forum included an interactive discussion focused on strategies for offering accessible, affordable, culturally appropriate perinatal care that can improve outcomes. The two panel discussions included clinicians who have expertise with and commitment to providing high-quality perinatal care. The panels discussed strategies to improve perinatal outcomes related to behavioral and physical health. For more information, view a Webex recording of the Integration and Quality Forum (using the password gRBZTMg2).

7) Reminder to Update Provider Information

For Primary Care Clinicians

PCCs are required to notify MassHealth of any changes to their status as a PCC, including, but not limited to:

• Voluntary withdrawal from the PCC Plan or MassHealth for any reason.
• Changes to information contained in the PCC Plan Provider Application, including but not limited to changes to your corporate structure.
• Changes to address and/or other demographic information.
• Changes to hours of operation or designation of PCC specialty.
• Changes to the managed care contact identified to represent the PCC on matters related to the fulfillment of the PCC contract.

Notification of changes must be sent in writing to the MassHealth Provider Enrollment and Credentialing unit at least 14 days in advance of the effective date. Mail to:

           MassHealth Provider Enrollment and Credentialing

           PO Box 278

           Quincy, MA 02171-0278

           Or Fax: (617) 988-8974

For Behavioral Health Providers

When behavioral health providers have changes in pertinent practice information such as address, phone number, accepting new patients, etc., please update your information with MBHP as soon as changes are made. This will ensure our Provider Directory is as up-to-date as possible. The request for such changes must come from the practitioner. Please call the National Provider Service Line at 800-397-1630 for address changes or terminations, payor information and W-2s, additional locations, or any other relevant updates.