MassHealth Reform and the 1115 Waiver
Republished from the April 20, 2016 Edition of the Republican by Shira Schoenberg
BOSTON -- Gov. Charlie Baker's administration is planning to overhaul Massachusetts' $15 billion-a-year Medicaid program.
"The current structure is not sustainable," said Secretary of Health and Human Services Marylou Sudders. "It's the same structure we had since the mid-1990s. Rumor has it health care has changed since the mid-90s."
The restructuring will move MassHealth away from a fee-for-service model and toward the use of accountable care organizations. Accountable care organizations are groups of health care providers -- primary care doctors, specialists, behavioral health clinicians, community organizations and others -- who work together in a coordinated way to provide services to patients. The organizations are paid a sum of money by MassHealth to keep a population of people healthy, a break from the current system where doctors are paid per service.
MassHealth members will choose an affordable care organization based on where their primary care doctor is enrolled.
Massachusetts Medicaid Director Dan Tsai said that today, patients with complex illnesses have several doctors dealing with their physical health, several doctors dealing with behavioral health, providers for long-term support services and multiple care coordinators.
"None of them talk to each other, and the member's left trying to navigate the system," Tsai said. "Part of the idea of an accountable care organization is you get people on a care team working together around the member instead of the member being left in the gaps of the system."
Since taking office, Sudders has talked about the need to slow the growth in spending on MassHealth, which covers 1.84 million Massachusetts residents and makes up 40 percent of the state budget. Total spending on MassHealth has grown by double digits annually every year since 2011.
"If it stays on this historic cost trend, it will crowd out every other social service and other things that are important to the overall health of the commonwealth," Sudders said.
The state is negotiating with the federal government to get $1.5 billion, of which the state will contribute $250 million, that will be available to providers that move toward accountable care organizations. The money will go to incentive payments for providers; improvements to the way health care is delivered; services to meet social needs, such as air conditioners for asthmatic children; and payments to community-based organizations that provide behavioral health care and long-term support services.
The state money will come from an increase in a fee paid by hospitals, and hospitals will get a corresponding $250 million annual increase in MassHealth reimbursements.
Doctors who choose not to join affordable care organizations can stay in the old system, but will not be eligible for the extra money.
Today, Tsai said there are "minimal" numbers of health care providers using these types of accountable care organizations.
"Our goal is as many members as possible get access to the more integrated coordinated care experience," Tsai said.
Neither Sudders nor Tsai would say how much money they anticipate saving from the new structure, which will ramp up over a five-year period. But they said the goal is to slow the rate of growth of MassHealth. In accountable care organizations, the entire team saves money if they have good outcomes and lower costs. This eliminates the incentive to approve unnecessary services and eliminates situations where, for example, multiple doctors order the same test.
"Our goal is as many members as possible get access to the more integrated coordinated care experience." -- Dan Tsai
"There is a lot of inefficiency that results from uncoordinated care," Tsai said.
At a public listening session that state health officials held Wednesday, Sudders told health care advocates that if no changes are made, "This time next year, you all will be in this room yelling at me ... that I'm looking at benefit reductions."
One unique feature in Massachusetts' proposal is it would integrate not only physical care, but also mental health services, by allowing the federal money to go to community-based organizations that work with health care providers. It would also require accountable care organizations to offer substance abuse treatment.
Vic DiGravio, president of the Association for Behavioral Healthcare, called that integration "unprecedented."
"We're optimistic the plan recognizes the centrality of behavioral health in a way state government hasn't in the past," DiGravio said.
The new accountable care organizations would be available in October 2017.
Wednesday's public session drew a couple hundred advocates representing various parts of the health care system, and some of them provided feedback to state health officials.
Ray McCarthy, chief financial officer of Baycare Health Partners and Baystate Medical Practices in Springfield, worried how a system that requires doctors and hospitals to take on additional risk would work, when many providers are already losing money caring for MassHealth patients.
"When your current cost structure is still not meeting its margin from a break-even standpoint, how to engage physicians, hospitals and long-term support services is going to be a challenge," McCarthy said.
McCarthy said he hopes the restructuring will change the reimbursement structure to ensure that providers covering MassHealth patients break even.
Brian Rosman, research director at Health Care For All, a health care access advocacy group, asked the administration to consider including dental care in provider networks.
Henry East-Trou, executive director of the Gandara Center in West Springfield, which provides behavioral health services to Latinos, blacks and other diverse groups, asked how the restructuring would affect linguistic and cultural minorities.
Joe Finn, president of the Massachusetts Housing and Shelter Alliance, asked for more outreach to homeless individuals. "The whole vision or dream of integrated care is illusory to the thousands of people who lack housing or whose home is on the streets or in shelters across the commonwealth," Finn said.
Al Norman, executive director of Mass Home Care, said in an interview that his organization wants to make sure doctors who are paid to provide care are not also deciding which services a patient needs. Norman is advocating for an independent consultant to evaluate someone's needs and determine what community support services are required.
"These are the same hospitals and doctors who have for decades put people on a conveyor belt from hospital to nursing homes, so giving them the keys to a system that includes long-term care is very worrisome," Norman said.
Dr. Ruth Potee and the Voices of Recovery - A Truly Amazing Night!
From the Lowell Sun
Lowell House, a center dedicated to curbing substance abuse, sponsored the forum and invited police, government and medical representatives to set up tables to offer services before and after the event. In front of a crowd of roughly 150, Potee wanted to provide the basic information needed to help anyone struggling with an opioid addiction, including how to notice the signs and how to best deal with someone close who has a strong addiction.
The Lowell House also featured a panel of local people in various stages of recovery, and each spoke about their experiences to the large crowd at the Elks Club on Old Ferry Road. “People in our community are dying at a record rate. We will have a third more people die of overdoses than we did last year. Without the wonderful work of the people in our city — the health department, the police, the fire, our City Council and agencies like Lowell House — this would be far worse,” said Bill Garr, chief executive officer at Lowell House.
Download her slides by clicking the link below.
Talk to Parents at Schools - Addiction and Rising Opioid Use - Marijuana - Potee Main event (2016-12-08).pptx
Recovery Matters - Best New Cable Show
Lowell House's cable show "Recovery Matters" was named the best new cable show in Lowell by LTC. The twice monthly show covers a range of important topics on addiction and recovery including shows about why people become addicted and what to do if you find drugs in your child's room. Guests include everyone from DA Marian Ryan to Megan's House founder Tim Grover.The award was presented at an event at LTC on November 17th.
View Recovery Matters Episodes
Stigma-busting Moment at "Celebrate Recovery!" Breakfast
DA Program Aims to Help Addicts
Lowell House is about to embark on a new program as partners with DA Marian Ryan. The Addiction Diversion Alternatives Program or ADAP will target individuals with substance use disorder after they commit a minor crime but before they face prosecution. It will allow those individuals to focus on treatment, avoid a criminal record and move on to productive life. Read about the program in this recent Boston Herald Article:
The Massachusetts Opioid Epidemic
Facing Addiction in America
"There is a strong scientific as well as moral case for addressing substance use disorders with a public health model that focuses on reducing both health and social justice disparities, and it aligns strongly with an economic case. Now is the time to make this change, for the health and well-being of all Americans."
---From the newly released Surgeon General's Report "Facing Addiction In America"
Read the full report https://addiction.surgeongeneral.gov/
Sun: Stories of strength mark Lowell House celebration
April 4, 2016
By Prudence Brighton, Sun Correspondent
UPDATED: 04/04/2016 08:17:25 AM EDT
LOWELL -- The stories of addiction challenge us because "it is a problem we all have to face," U.S. Rep. Niki Tsongas said Saturday night.
The stories of three women, in particular, were what helped Tsongas "begin to understand the depths of human suffering" caused by addiction.
The women who told those stories, Louise Griffin, Joanne Peterson and Melissa Weiksnar, were recognized Saturday night at the Living in the Light gala celebration marking the 45th anniversary of Lowell House.
The three were honored for their work as mother advocates in finding solutions to the scourge of addiction, while Tsongas received the Lowell House Lifetime Achievement award.
"This is the greatest trio of women I've ever seen," said Bill Garr, the executive director of Lowell House, which provides addiction support programs and services to Greater Lowell.
Peterson, of Raynham, is the mother of a son in long-term recovery and is the founder of Learn to Cope, a peer-support group for family members of those struggling with addictions. Peterson saw addiction as a young girl with siblings who struggled with substance abuse. Then as a mother, she saw her son experimenting with drugs and developing an opioid addiction.
"It's in my genetics," she said.
She founded Learn to Cope in 2004 in Randolph. It now has 23 chapters, mostly in Massachusetts and Rhode Island.
A chapter recently opened in Idaho and soon one will open in Alaska.
In the beginning, members rotated meetings at their homes, often sitting on the porch of one of their houses. "We called ourselves the porch girls, and we still have those porch get-togethers," Peterson said.
Unfortunately, the numbers attending the meetings have grown. "We lost more people in the last year than I have ever seen," Peterson said.
Weiksnar, of Carlisle, compiled her daughter's journal entries into "Heroin's Puppet: The Rehab Journals of Amelia F. W. Caruso." Weiksnar gives frequent talks at schools and organizations about her daughter's ordeal and the perils of drug use.
Weiksnar has learned that students want science and real-life stories. She remembered a letter a student wrote after one of her talks: "What happened to you made me sad, but it opened my eyes." The writer went on to promise to stay away from drugs.
Louise Griffin, of Lowell, founded the Zack's Team Foundation after her son, Zachary Gys, died of an opiate overdose in 2013.
Griffin recounted the scarcity of beds in detox units across the state. "As the mother of an addict, your days are spent trying to find that one available detox bed. So we call and we call."
Saturday night's Living the Light Live Auction and Silent Auction were raised for Zack's Team. The foundation provides scholarships to help people with addictions afford long-term treatment. It is also partnering with Lowell House to open a sober-living home for men in the city.
Also on Saturday night, Sean Daniels, artistic director of the Merrimack Repertory Theatre, reprised his monologue in "The White Chip," a play he wrote about his own history of alcoholism. The play had its world premiere at MRT and will go on tour before it opens off Broadway in New York.
Daniels is also featured in a new video, "Everyone Knows Someone," which underscores the scope of the addiction epidemic. The video debuted at the event.
Read more: http://www.lowellsun.com/todaysheadlines/ci_29722687/stories-strength-mark-lowell-house-celebration#ixzz44xpuaxrD
The Massachusett's Department of Public Health has just published their updated numbers for "Fatal Opioid Related Deaths in Massachusetts" in 2014, and it's astounding!
August 7, 2015 - The Department of Public Health issued updated numbers of deaths by opioid and heroin deaths in Massachusetts - the numbers are eye-opening. The number of unintentional deaths from these powerful and potent drugs has nearly doubled since 2012 and increased by 20% since the end of 2014. Statewide, 1256 individuals unintentionally lost their lives in this period; in Middlesex County, 214 people lost their lives to this epidemic as opposed to 106 in 2012. See the full statistical summary by clicking on this link:
The Governor's Opioid Working Group Publishes a Comprehensive and Far Reaching Report to the Governor and the Citizens of the Commonwealth
June 22, 2015 - The Governor's Opioid Working Group, after months of hearings, interviews, and meetings, has released their report with a comprehensive, well-researched report on solutions to the current opioid crisis plaguing communities like Lowell and surrounding towns. Here's a peek at the short-term ( six months to one year) prioritized recommendations:
Prevention- Increase educational offerings for prescribers and patients to promote safe prescriber practices, Develop targeted educational materials for schools, Appoint members to the drug formulary commission, Integrate information about the risks of opioid use and misuse into school athletic programs, Conduct a public awareness campaign
Intervention - Improve the PMP, Outreach to prenatal and postpartum providers to increase screening for women with a substance use disorder, Improve reporting of overdose death data, Enhance data transparency including EMS data, Encourage naloxone to be co-prescribed with opioids, Amend civil commitment process, identify hot spots for targeted intervention, using EMS,hospital, and police data, Promote the Good Samaritan law
Treatment - Develop a central statewide database of available treatment services,Transfer section 35 civil commitment responsibility from DOC to EOHHS, Increase the number of office-based opioid treatment programs, Require DOI to issue bulletins on chapter 258 of the Acts of 2014 prior to Oct. 2015.Pilot recovery coaches in emergency rooms and hot spots, Bulk purchase opioid agonist and naltrexone therapies for correctional facilities, Add 100 new ATS/CSS Beds, Open Recovery High School in Worcester.
Recovery - Promulgate chapter 257 rates for recovery homes effective July 2015, Establish a single point of accountability for addiction and recovery policy at EOHHS, Suspend rather than terminate MassHealth Coverage during incarceration, Certify alcohol and drug free housing, Enforce the requirement that BSAStreatment programs accept patients on an opioid agonist therapy
To download the full report, please use the link below: