1.89 Million Members

70% in Managed Care

$ 15 Billion In 2016

$1.4 Billion for Behavioral Health

40% of State Budget

62% Mental Health 14% Substance Use 24% Pharmacy

Covered Services and

Delivery Models

Financing and Payment Models

Network Development & Technical Assistance

Quality Measurement & Monitoring

Network Management

for Quality Improvement

•Behavioral Health Care Fully Integrated into Primary Care • Screening and Early

Intervention

•Chronic Condition Management

•Awareness-building and crisis prevention

Primary Behavioral Health Care

•Timely, Equitable Access to Full Range of Evidence-Based Mental Health & SUD Treatment •Open /Real-time Access to OP

Care

•Robust Care Coordination and teaming across continuum

•Evidence-Based Practice

Outpatient Behavioral Health Care •Range of crisis

stabilization services woven into fabric of local communities •Expansion of Urgent Care

•Enhanced Community-based ESP / Mobile Crisis Intervention

•Expansion of Select Diversionary Services

Urgent and Diversionary Care

•Safe, Timely, Equitable, Efficient, and Patient Centered Care for Acute Behavioral Health Episodes •Expanded Capacity and

Automated capacity management

•Enhanced Inpatient settings for Complex, Specialized Care

•Accountability for transitions

Inpatient Behavioral Health Care

•Recovery communities integrating housing, treatment, recovery and social supports •Care Planning with Inter-

agency Coordination

•Access to Community-Based Diversionary Services and Recovery Supports

•Access to Residential Care and Supportive Housing

Community Stabilization and Residential Care

Towards a Strong, Sustainable System of Community-Based Care: Improve Access, Coordination, and Continuity of Care Across the Continuum

Evolve Delivery Models, Identify Financing, Build Capabilities & Infrastructure

Access

•Network Adequacy

•Open Access

•Capacity Growth and Retention

Coordination & Continuity

•Bi-Directional Communication

•Effective Transitions of Care

•Wrap Services & Supports

Quality

•Performance Measurement

•Evidence-Based Practices

•Continuous Improvement

Within the Waiver: Strategies to Further Strengthen the System

Network/ System Design

ESP Optimization

ED Boarding Reduction

SUD System Redesign

Payment

Rate Normalization

Directed Payments for Specialized

Services

BH Payment Innovations

Quality Management

Quality Reporting & Monitoring

Network Development & Management

Technical Assistance for

Integration &Transformation

Towards a Strong, Sustainable System of Community-Based Care: Advancing Value-Based System Transformation “Within the Waiver”

Infrastructure within MassHealth & Delivery System

1115 Waiver Implementation & Alignment: • ACOs • BH/LTSS CPs • SUD Waiver • Managed

LTSS

Leveraging Digital to Support System Transformation: From Optimizing Access to Optimizing Intervention

Access

• Extend / expand workforce

• Enable timely access

• Reduce no shows

Integration

• Facilitate primary care/hospital consultation with psychiatry/addiction medicine/specialized BH

• Crisis intervention rapid response and triage

• Facilitate case management/collaborative care

Efficiency

• Concentration of most intensive face-to-face services and supports around highest risk members

• Remote/digital therapeutic interventions coupled with CSP, recovery, and peer supports

• Optimizing clinical workflows for intake and assessment

Extensibility

• Integration of platforms for digital self-management and social/peer support with real time alerts and tele-access to case management and clinical services

• Interoperability with scheduling, messaging, EHR, care management systems

Leveraging Digital to Support System Transformation: From Optimizing Access to Optimizing Intervention

Access

• Extend / expand workforce

• Enable timely access

• Reduce no shows

Integration

• Facilitate primary care/hospital consultation with psychiatry/addiction medicine/specialized BH

• Crisis intervention rapid response and triage

• Facilitate case management/collaborative care

Efficiency

• Concentration of most intensive face-to-face services and supports around highest risk members

• Remote/digital therapeutic interventions coupled with community service, recovery, and peer supports

• Optimizing clinical workflows for intake and assessment

Extensibility

• Integration of platforms for digital self-management and social/peer support with real time alerts and tele-access to case management and clinical services

• Interoperability with scheduling, messaging, EHR, care management systems

MassHealth MCEs currently provide coverage for telepsychiatry and teletherapy with

established patients.

We are conceptualizing the potential of mobile integrated health

to connect the EMS and ESP systems.

1115 Waiver provides DSRIP dollars to ACO and CP to support investment in technologies to

improve engagement and outcomes.

We are exploring how alternative payment models could allow for more flexible

combinations of live and virtual interventions.

Seeking Solutions that: - Demonstrate Efficacy - Understand themselves in the broader context of value-based care - Can successfully develop partnerships within the existing system