Massachusetts Health Policy Commission |
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This edition of the Transforming Care newsletter focuses on presentations from the Care Delivery Transformation (CDT) Committee meeting on February 9, 2022, including an awardee presentation from the Moving Massachusetts Upstream (MassUP) Investment Program and an update on the Cost-Effective, Coordinated Care for Caregivers and Substance Exposed Newborns (C4SEN) Investment Program. It also features recent publications from the HPC and other state agencies, including reports on quality measure alignment, nurse midwifery care, and doula support services in Massachusetts.
Materials from the CDT meeting, including an agenda, presentation slides, and a recording of the proceedings, are available on the HPC’s website
Let us know if there are care delivery transformation topics or work in the Commonwealth that you would like the HPC to showcase in this newsletter. We would love to hear from you!
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MOVING MASSACHUSETTS UPSTREAM INVESTMENT PROGRAM |
Hampshire County Food Policy Partnership Launches
Food Policy Council
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"Investments and projects like the Food Policy Council are so critically important. None of us alone can improve social determinants of health for everyone, but working together, we can learn, we can make progress, we can reach the outcomes that we hope to reach, and through projects like MassUP, we can create templates for change that other people, other communities, and other projects can use and learn from."
-Jeff Harness, Chief Community Relations and Communications Officer, Cooley Dickinson Health Care
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The Hampshire County Food Policy Partnership, funded as part of the HPC’s Moving Massachusetts Upstream (MassUP) Investment Program, launched their Hampshire County Food Policy Council during a series of events in January 2022. The Partnership’s goal is to improve regional food security and address the systemic lack of access to healthy food in Hampshire County. Partner organizations in Hampshire County have a long history of working together on food access and other public health issues and are using MassUP funding to address food insecurity by establishing a resident-driven and resident-led food policy council.
Jeff Harness of Cooley Dickinson Health Care, Caitlin Marquis of the Collaborative for Educational Services, and Kia Aoki, a resident leader on the Hampshire County Food Policy Council, presented on behalf of the Hampshire County Food Policy Partnership at the HPC’s recent Care Delivery Transformation Committee meeting.
Highlights from the presentation include:
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Community empowerment is critical to program success. Speakers from the partnership explained grounding their approach in the sociocracy model, which places community members at the center of decision-making and trains them to embody those roles in future initiatives. “We tried to think about how to form a food policy council really putting those folks who are most deeply feeling the negative impacts at the center of the design,” said Caitlin. Speaking to the experience as a community resident, Kia said, “I'm just a normal person living in low-income housing and I have all this opportunity coming up to see real change for people in my community.” “[The Hampshire County Food Policy Council] gave us equal power to make decisions about what happens and how it happens."
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Mental health is essential to community health. “We think of mental health as both a cause and consequence of poor food security,” shared Caitlin. While food insecurity is traditionally linked to chronic disease and poor physical health outcomes, the partnership places an equal emphasis on mental health care in their work. Kia added "there's no question that good physical and mental health are requirements for thriving, affluent, self-sustaining communities. The Food Policy Council is partnering with us to make that a reality for everyone that has been traditionally left out of those conversations."
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Health systems play a unique role in addressing the wellness of their communities. Traditional health care models often emphasize treatment rather than upstream, community-based solutions. However, as Jeff shared, “community-based solutions move us toward better outcomes for people and communities, and ultimately [are] a better use of financial resources.” Health systems can serve many roles in developing healthier communities: as funders, as employers, as partners, and as advocates. As Jeff explained, “We can use our credibility and our voice to be advocates for policies and budgets that support public health and social determinants of health.”
The MassUP Investment Program was developed by the HPC in collaboration with the Department of Public Health, Office of the Attorney General, Executive Office of Elder Affairs, MassHealth and Executive Office of Health and Human Services. The goal of the MassUP Investment Program is to build and/or expand partnerships between health care systems and community organizations to address two key social determinants of health: economic stability and mobility, and food systems and security.
Profiles of the four MassUP partnerships that offer an overview of each partnership and their approaches to addressing upstream causes of health inequities in their communities can be found on the HPC’s MassUP webpage, along with more information about the program.
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COST-EFFECTIVE, COORDINATED CARE FOR CAREGIVERS AND SUBSTANCE EXPOSED NEWBORNS INVESTMENT PROGRAM |
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Reflections on the Start of Program Implementation |
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The Cost-Effective, Coordinated Care for Caregivers and Substance Exposed Newborns (C4SEN) Investment Program supports innovative care models that promote collaboration among providers to improve access to high-quality, efficient, and culturally sensitive care for both substance exposed newborns and their caregivers. A total of $1.46 million has been awarded to five Massachusetts hospitals to support their C4SEN initiatives over a 24-month performance period. Awardees are almost one-third of the way through program implementation and have been enrolling patients for several months. C4SEN awardees have faced obstacles posed by the ongoing COVID-19 pandemic, including hiring difficulties and strained staff capacity. As the pandemic limited face-to-face contact, telehealth proved to be critical in engaging patients in the program. HPC staff shared those and other updates in a presentation at the HPC’s recent Care Delivery Transformation Committee meeting.
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Each of the five C4SEN awardees is taking a unique approach to building or expanding services for their enrolled families:
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Baystate Franklin Medical Center is developing a new multidisciplinary clinic for family-centered care to coordinate and co-locate interactions among providers, families, and early intervention services.
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Berkshire Medical Center is providing individualized care coordination services to caregivers, spanning Berkshire obstetrics and gynecology providers, local pediatric practices, medication for opioid use disorder providers, and community-based social supports.
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Mercy Medical Center is building new referral pathways, provider communication, and a care coordination model to streamline provision of opioid use disorder treatment, medical care, and non-hospital-based services for caregivers and substance exposed newborns, and to improve patient experience, including through the introduction of a new technology platform.
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South Shore Health is expanding existing care coordination and support services for caregivers by bolstering patient assistance funds, introducing two care coordinators and a doula, and providing pregnancy and parenting education sessions and postpartum support groups.
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Southcoast Health is deploying two family advocates and a program coordinator to facilitate communication with providers and community agencies to increase cross-system collaboration and improve access to prenatal and postpartum care.
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The story of a caregiver from the New Beginnings initiative at Southcoast Health illustrated the impact of the work led by the C4SEN awardees:
The caregiver experienced a relapse midway through her pregnancy and was referred to New Beginnings for assistance. She was eager to engage with and participate in the program, requesting virtual meetings on a weekly basis. It was during these check-ins that she shared her concerns around the involvement of the Department of Children and Families (DCF) in evaluating her fitness and ability to retain custody of her baby after delivery.
The New Beginnings team worked with DCF to ensure that she was fully prepared for the required post-delivery investigation. As a result of this preparation, she was able to bring her baby home after delivery. She continues to engage often with New Beginnings, proactively contacting the team between regularly scheduled appointments with questions and updates on her progress. In describing her experience working with the team, the caregiver shared, “It felt good knowing I had someone on my side…It was truly a blessing to my family to have [the program staff] advocating for me and being there for me whenever I needed them to be.”
More information on the progress of the C4SEN Investment Program can be found on the HPC's C4SEN webpage.
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PUBLICATIONS, PRESENTATIONS, AND RECOGNITIONS |
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HPC Releases a Case Study on the Pediatric Physicians' Organization at Children's Telemedicine Initiative |
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The HPC has released a Health Care Innovation Spotlight on the Pediatric Physicians' Organization at Boston Children's Hospital (PPOC). In 2017, PPOC launched a telemedicine initiative through the HPC’s Health Care Innovation Investments Telemedicine Pilot Program. The initiative supported PPOC in connecting pediatric patients who lacked local access to psychiatric care to child and adolescent psychiatrists at Boston Children’s Hospital. With the infrastructure developed during and after the Telemedicine Pilot Program, PPOC was equipped to address the growing need for pediatric behavioral health services during the COVID-19 pandemic. The PPOC Health Care Innovation Spotlight provides insights and lessons learned from the experience of rapidly scaling PPOC’s telemedicine program, including the benefits of telehealth for children, families, and clinicians.
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HPC Releases DataPoints on Quality Measure Alignment Taskforce Efforts |
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The HPC released two new issues in its DataPoints Series. The first, released in February, highlights the work of the Executive Office of Health and Human Services’ (EOHHS) Quality Measure Alignment Taskforce ("Taskforce") and findings on payer adoption of the Massachusetts Aligned Measure Set. Massachusetts has been engaged in a voluntary process of aligning quality measures used in global budget-based risk contracts with the goals of reducing administrative burden on providers and payers and focusing quality improvement efforts on high priority areas. This DataPoints issue, prepared in collaboration with CHIA, includes data on payer adoption of the Massachusetts Aligned Measure Set.
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In the latest issue of the DataPoints series, released in March, examines commercial out-of-pocket (OOP) spending associated with giving birth in Massachusetts, covering the full scope of care from pregnancy through postpartum. The analysis found that commercially-insured patients, especially those employed at smaller firms, are bearing a growing share of the cost of pregnancy, delivery, and postpartum care. High OOP spending is particularly burdensome for lower-income residents, who are also disproportionately likely to forgo needed care due to cost. Additionally, rising OOP costs raise racial equity concerns: birthing people of color continue to experience disproportionately high rates of perinatal morbidity in MA, which can come with significant financial costs.
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HPC Releases Findings on Certified Nurse Midwifery Care in Massachusetts |
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As part of a continuing emphasis on improving maternity care in Massachusetts, the HPC has examined the role of certified nurse midwives in birth care. Despite favorable outcomes associated with midwifery care, and the potential of midwife-led care to help to address ongoing racial disparities in birth outcomes, rates of midwife-attended births in the U.S. remain low.
As of 2017, 17% of Massachusetts births were attended by certified nurse midwives—a higher rate than the U.S. as a whole (10%), but far below rates of midwife-attended births in other high-income countries (50-75%).
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Examining in-hospital births in 2017, the HPC found that:
- 33 of the 44 hospitals that provided obstetric care in Massachusetts as of 2017 also offered midwifery services. However, rates of midwifery care varied by hospital, from zero to nearly 70%.
- Hospitals with higher rates of midwifery care saw lower cesarean and episiotomy rates as well as lower spending: a 10% increase in midwife-attended births in Massachusetts would result in 3,560 fewer cesarean births, 860 fewer episiotomies, and $530 less in spending on each episode of prenatal, delivery, and postpartum care.
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For the full findings, please view the HPC’s recently published chartpack and an animated video short.
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2023 Health Care Cost Growth Benchmark Hearing
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The HPC and the Joint Committee on Health Care Financing co-hosted the 2023 Health Care Cost Growth Benchmark Hearing, soliciting available data, information, and testimony to help determine the Health Care Cost Growth Benchmark for calendar year 2023. The hearing examined new data on health care spending in Massachusetts in 2020 and an early look at national trends in 2021, the first comprehensive look at the COVID-19 pandemic’s unprecedented impact on the health care system.
A recording of the hearing proceedings can be found on the HPC's YouTube Channel
The next scheduled HPC Board meeting is Wednesday, April 13, 2022, at 12:00 PM. During this meeting, the Board will vote to set the 2023 benchmark, in consideration of the data and testimony presented at yesterday's hearing
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Betsy Lehman Center Releases a Report on Doula Support Services in Massachusetts
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Findings from the report include:
- Doula support services are largely paid out of pocket, making it difficult for doulas to keep costs affordable for consumers while also earning a living wage.
- In addition to economic barriers, other factors that complicate efforts to expand use of doula services include workforce development issues and consumers’ lack of familiarity with doula services.
- Doulas and consumers call for accessible, equitable doula support services and a commitment from the health care system to explicitly address racism and discrimination in birthing care.
- Limitations of and expense associated with current training and certification standards must be addressed, particularly for doulas who will work with Black birthing people.
The full report is available on the Betsy Lehman Center website.
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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
April 13, 2022
April 11 – 17, 2022
National Council for Mental Wellbeing
April 11 – 13, 2022
The Perinatal – Neonatal Quality Improvement Network of Massachusetts (PNQIN MA)
May 4, 2022
American Hospital Association
May 10 – 12, 2022
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A sampling of resource materials and publications produced by the HPC, other Commonwealth agencies, and non-profit organizations.
MA Health Policy Commission, 2022
MA Health Policy Commission, 2022
MA Health Policy Commission, 2022
MA Health Policy Commission, 2022
MA Health Policy Commission, 2022
MA Health Policy Commission, 2022
MA Health Policy Commission, 2022
Black Mamas Matter Alliance, 2021
Betsy Lehman Center for Patient Safety, 2022
ASNNA Race, Food Fitness Opportunity Research Collaborative (FFORC), Center for Health Promotion and Disease Prevention SNAP-Ed Connection, U.S Department of Agriculture, 2022
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Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109
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