Primary Care and Behavioral Health Integration: Brief Overview of Massachusetts Efforts 6/13/2019 CONFIDENTIAL – Do Not Distribute
AGENDA Introduction and Overview of the Health Policy Commission Some Context and History: MassHealth PCMH and BHI Initiatives HPC’s PCMH PRIME Certification Program CONFIDENTIAL – Do Not Distribute
Two independent state agencies work together to monitor Massachusetts’ health care performance and make data-driven policy recommendations Massachusetts Health Policy Commission Center for Health Information and Analysis (HPC) (CHIA) ▪ Data hub ▪ Policy hub ▪ Independent state agency overseen by a ▪ Independent state agency governed by an 11- Council chaired by the Secretary of Health and member board with diverse experience in health Human Services care ▪ Duties include: ▪ Duties include: – Collects and reports a wide variety of – Sets statewide health care cost growth provider and health plan data benchmark – Examines trends in the commercial health – Enforces performance against the benchmark – Certifies accountable care organizations and care market, including changes in premiums patient-centered medical homes and benefit levels, market concentration, and – Registers provider organizations spending and retention – Conducts cost and market impact reviews – Manages the All-Payer Claims Database – Holds annual cost trend hearings – Maintains consumer-facing cost – Produces annual cost trends report transparency website, CompareCare – Supports innovative care delivery investments CONFIDENTIAL – Do Not Distribute 3
The HPC: Main Responsibilities Monitor system transformation in the Commonwealth and cost drivers therein Make investments in innovative care delivery models that address the whole- person needs of patients and accelerate health system transformation Promote an efficient, high-quality health care delivery system in which providers efficiently deliver coordinated, patient-centered, high-quality health care that integrates behavioral and physical health and produces better outcomes and improved health status Examine significant changes in the health care marketplace and their potential impact on cost, quality, access, and market competitiveness CONFIDENTIAL – Do Not Distribute 4
The HPC employs four core strategies to advance its mission RESEARCH AND REPORT CONVENE INVESTIGATE, ANALYZE, AND REPORT BRING TOGETHER STAKEHOLDER TRENDS AND INSIGHTS COMMUNITY TO INFLUENCE THEIR ACTIONS ON A TOPIC OR PROBLEM WATCHDOG PARTNER MONITOR AND INTERVENE WHEN ENGAGE WITH INDIVIDUALS, GROUPS, NECESSARY TO ASSURE MARKET AND ORGANIZATIONS TO ACHIEVE PERFORMANCE MUTUAL GOALS CONFIDENTIAL – Do Not Distribute 5
AGENDA Introduction and Overview of the Health Policy Commission Some Context and History: MassHealth PCMH and BHI Initiatives HPC’s PCMH PRIME Certification Program CONFIDENTIAL – Do Not Distribute
PCMH PRIME in Context: MassHealth Payment Innovations and the PCMH Model 2014 2018 2011 Patient-Centered Primary Care Accountable Care Payment Reform Medical Home Organization program 4 Initiative 2,3 Initiative 1,2 • Building on PCMHI, • Further emphasis on integrated practices integrated BH • Multi-payer care through care across domains such as demonstration project coordination, co- BH and LTSS and additional aimed at promoting location, or full- emphasis on SDH adoption of the integration • Patients attributed to ACOs patient-centered • Increased practice medical home model through primary care physicians readiness for • • ACOs accountable for cost and Practices followed 3 accountable care year transformation quality of care through a variety of through experience with plan with goal of prospective payment and shared risk, care coordination, applying for NCQA savings/risk models building PC infrastructure PCMH Recognition • Emphasizes many aspects of the • Capitated payment for • Practices received PCMH model, e.g. the BH/LTSS primary care services with PMPMs for medical CP program aims to improve care option to include BH, home activities, and coordination quality performance upside-only shared • DSRIP funding supports ACO incentive, and shared savings investment in primary care savings/risk for non-PC spending 1 “Participating Practices”. Massachusetts Patient Centered Medical Home Initiative, Executive Office of Health and Human Ser vices. http://www.mass.gov/eohhs/gov/commissions-and-initiatives/healthcare-reform/pcmhi/about/participating-practices.html 2 Harris, Julian. “Transition to Alternative Payment Methods: From Patient Medical Homes to the Primary Care Payment Reform Initiative”. MassHealth, Executive Office of Health and Human Services, December 18, 2012. http://www.mass.gov/anf/docs/hpc/pcmhi-and-pcpr-presentation-to-the-hpc.pdf 3 Henriquez, Claudia. “Lessons Learned in Primary Care Payment Reform and Practice Transformation”. MassHealth, Executive Office of Health and Human Services, June 2017. https://www.masspartnership.com/pdf/PCPRandPracticeTransformation-June2017.pdf 4 “MassHealth Accountable Care Organization (ACO) Models: Questions and Answers”. MassHealth, 7 Executive Office of Health and Human Services. September 30, 2016. https://www.mass.gov/files/documents/2016/09/pn/aco-models-questions-and-answers.pdf
AGENDA Introduction and Overview of the Health Policy Commission Some Context and History: MassHealth PCMH and BHI Initiatives HPC’s PCMH PRIME Certification Program CONFIDENTIAL – Do Not Distribute
HPC PCMH Certification Statutory Language “The commission, in consultation with the office of Medicaid , shall develop and implement standards of certification for patient-centered medical homes. In developing these standards, the commission shall consider existing standards by the National Committee for Quality Assurance or other independent accrediting and medical home organizations. The standards developed by the commission shall be based on the following criteria: (1) enhancing access to routine care, urgent care and clinical advice though means such as implementing shared appointments, open scheduling and after-hours care; (2) enabling utilization of a range of qualified health care professionals , including dedicated care coordinators, which may include, but not be limited to, nurse practitioners, physician assistants and social workers, in a manner that enables providers to practice to the fullest extent of their license; (3) encouraging shared decision-making for preference-sensitive conditions such as chronic back pain, early stage of breast and prostate cancers, hip osteoarthritis, and cataracts; provided that shared decision-making shall be conducted on, but not be limited to, long-term care and supports and palliative care; and (4) ensuring that patient-centered medical homes develop and maintain appropriate comprehensive care plans for their patients with complex or chronic conditions, including an assessment of health risks and chronic conditions. (5) such other criteria as the commission deems appropriate.” Commonwealth of Massachusetts, Legislature. An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. Chapter 224 of the Acts of 2012, 6 August 2012. 9
Why focus on behavioral health integration? Treatment gaps impact health outcomes and costs • In Massachusetts, treatment gaps and delays for behavioral health treatment persist. Among Massachusetts residents reporting any mental illness (AMI), 46.2% did not receive mental health treatment or counseling. 1 • The presence of a behavioral health condition can exacerbate a chronic medical condition, increase total health care costs, and complicate disease management. 2 • Cost implications of behavioral health and chronic disease co-morbidities are significant. Medicaid patients with both depression and diabetes have twice the average healthcare spending as patients with diabetes alone. 3 Integration may improve quality and close gaps • Primary care is an appropriate setting for identifying many behavioral health conditions • Integrating appropriate screenings, treatment, and care coordination for behavioral health conditions into primary care visits may help reduce the need for higher-cost behavioral health care and additional medical care, and lead to better health outcomes 1 Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Massachusetts, 2015. HHS Publication No. SMA-16-Baro-2015-MA. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. http://www.samhsa.gov/data/sites/default/files/Massachusetts_BHBarometer.pdf 2 Mental Health Financing in the United States, A Primer, April 2011. The Kaiser Commission on Medicaid and the Uninsured. Data based on SAMHSA Spending Estimates Project, 2010. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8182.pdf 3 Unutzer, Jurgen et al. The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. Health Home: Information Resource Center. Brief May 2013. http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/HH-IRC-Collaborative-5-13.pdf 10
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