The room - actually 3 rooms combined - was packed as MassHealth held its first listening session for its federal waiver application which includes its ACO proposal and much more. The session was held in conjunction with the regular meetings of two MassHealth advisory panels. Despite it being a late Friday afternoon before the first weekend of the summer, interest in the proposal was very high. Given the number of speakers, the session, which started at 2:30 was supposed to go to 4, dragged on until almost 5. A second session will be held in Fitchburg on Monday, June 27.
MassHealth staff started with this powerpoint presentation, which summarized the waiver application. A lot of money is at stake. MassHealth is seeking $1.8 billion over 5 years from the federal government to be used for Delivery System Reform Incentive Payments (DSRIP). These funds will support the transistion to ACOs (Accountable Care Organizations - see our blog post here for more on ACOs). Money will go to provider groups seeking to become ACOs, allowing them to pay for social services as well as medical care. Funds will also go towards integrating behavioral health and long-term care services, and other investments, In addition to the DSRIP money, the state is seeking $6.2 billion over 5 years for safety net providers and to pay for care for the uninsured.
Many speakers focused on the opportunity to expand MassHealth to provide assistance with the social determinants of health, like housing, nutrition and other social services. People representing YMCAs, the Housing and Shelter Alliance, the Pine Street Inn and other groups talked the critical role housing and other services play in promoting health. Similarly, Action for Boston Community Development suggested creating social service "hubs" to connect medical ACOs with smaller agencies which can focus on particular needs. The Boston Center for Independent Living and the Transformation Center talked about the needs of people with disabilities.
HCFA's Oral Health Integration Project spoke about the need to fully connect dental care and oral health with the primary care offered through ACOs.
HCFA's organizational comments, copied below, focused on three areas of immediate concern. Written comments are due by July 17. In the coming weeks, we will be circulating a sign-on letter for groups to join us in expressing broad community reactions to the waiver proposal. If you are interested in this, please contact Suzanne Curry of HCFA's staff.
Here are the comments we offered:
Health Care For All Talking Points – MassHealth Waiver Listening Session (Boston 6-24-16)
We have heard the strong emphasis from the administration on ACOs as a way to improve MassHealth’s “sustainability,” which, of course, is code for saving money.
We understand and support this goal, and we also understand the need to secure federal DSRIP funds. But we see ACOs as more than cost savings. It’s an opportunity to restructure care so that the focus is on promoting the health of MassHealth members. Health is more than just what doctors and hospitals do, though they are important. ACOs open the door to a MassHealth system that treats the member as a whole person, rather than as disconnected symptoms.
We’re pleased that the proposal is aimed at:
- Enacting payment and delivery system reforms that promote integrated, coordinated care and hold providers accountable for the quality and total cost of care;
- Improve integration of physical health, behavioral health and long-term services and supports, and related social services;
- Maintain near-universal coverage;
- Support safety net providers to ensure continued access to care for Medicaid and low-income uninsured individuals;
- Address the opioid crisis by expanding access to a broad spectrum of recovery-focused substance use disorder services.
Our comments today will focus on 3 areas where we think the waiver can be strengthened, consistent with the goals of the project.
Before I get to our three categories, I want to mention that we also have critical thoughts on the integration of oral health and dental care within the ACO structure. Those issues will be addressed by representatives of the oral health integration project which we lead. We also strongly support the comments you will receive from groups concerned with community health workers, the disability community and the public health community.
Transparency and Oversight
Our first category is transparency and oversight
We’re pleased that the proposal calls for ACOs to include members in their governance, and includes PFACs – patient and family advisory councils – as a requirement for every ACO.