Browse by Topic: Delivery System/Safety Net

This chart pack, prepared by Manatt Health Solutions, provides an examination of the current state of long-term services and supports (LTSS), an area identified as a priority for reform by MassHealth (Massachusetts Medicaid). MassHealth accounts for nearly half of all spending on LTSS, amounting to $4.5 billion annually, and equal to 12 percent of the state budget. Using previously unpublished LTSS data, the chart pack examines MassHealth LTSS spending and utilization, access and affordability, workforce capacity and quality.

This primer, prepared by Ellen Breslin of Health Management Associates, includes an explanation of how state Medicaid programs generally pay their MCOs, the overall process for setting Medicaid managed care capitation rates and the various tools that states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.

In March 2010, President Obama signed The Patient Protection and Affordable Care Act (ACA), which included significant changes impacting health insurance coverage across the United States. Although many elements of the ACA were based on Massachusetts’ health insurance reform, there were still many decisions and activities that Massachusetts needed to address in order to comply with the new federal Medicaid and health insurance marketplace requirements, most of which were required to be effective as of January 2014.

The “ Making Health Care Affordable” (MHCA) three-year grant program concluded in 2014. Margaret Houy and Kate Bazinsky of Bailit Health Purchasing, LLC report on the impact of the BCBSMA Foundation’s funding initiative. The goal of MHCA was to fund interventions aimed at containing costs while increasing access and quality of care. Bailit examines how the Foundation’s objectives were met, what factors led to successful program implementation, common barriers faced by grantees, and which programs may have generalizability.

UPDATED (July 2015) chart pack, prepared by the Center for Health Law and Economics at the UMass Medical School, includes summary data on MassHealth enrollment and spending and is designed to support use of the charts in presentations. Updated edition includes MassHealth enrollment as of March 2015 and spending from state fiscal year 2014.

Social determinants of health, which encompass social, behavioral and environmental influences on one’s health, have taken center stage in recent health policy discussions. While research indicates that greater attention to these non-medical factors may improve health outcomes and reduce health care costs, translating this evidence into actionable recommendations for policy makers and others has been challenging.

This report, prepared by Sharon Long and Thomas Dimmock of the Urban Institute, further analyzes the 2013 Massachusetts Health Reform Survey (MHRS) by comparing the experience of adults with public coverage to adults with employer-sponsored insurance (ESI) coverage across a number of access and affordability measures. Findings from the analysis show problems with access to care were more prevalent for adults with public coverage than for those with ESI.

This report, prepared by Margaret Houy and Michael Bailit of Bailit Health Purchasing, LLC, provides a comprehensive review of the policy and regulatory barriers that impede behavioral health integration in Massachusetts and identifies potential options for addressing these barriers. This report is divided into three sections – licensing, privacy, and, reimbursement barriers – and was developed through a review of reports and other secondary sources, agency regulations and checklists, and interviews and a focus group with key stakeholders.

In 2014, the Foundation partnered with the city of Boston to conduct a thorough analysis of the scope of Boston's substance use addiction problem and selected DMA Health Strategies to conduct the research. With the Mayor’s Office, the Foundation also assembled an Addiction Recovery Advisory Group comprised of addiction experts and community stakeholders to work closely with the researchers.

Peter Hussey, Courtney Armstrong, and Eric Schneider of the RAND Corporation conducted interviews with seven health plans and five Accountable Care Organizations (ACOs) to determine their support for innovative delivery system models including payment arrangements, program development strategies, and the criteria decide whether or not to support these programs.

Unless Congress acts, federal funding for the Children’s Health Insurance Program (CHIP) will run out soon after September 2015. On March 26, the U.S. House of Representatives passed legislation that would fund CHIP for two more years. The Senate is expected to take up the bill in mid-April. This report, written by Robert Seifert of the Center for Health Law and Economics at the University of Massachusetts Medical School, examines the serious implications for Massachusetts if federal funding for CHIP is not extended.

Megan Burns and Michael Bailit of Bailit Health Purchasing, LLC, provide a comprehensive review of payment reform in Massachusetts and, in particular, how the changing landscape is affecting safety-net providers. For this report, safety-net providers—those providers characterized by serving a high percentage of Medicaid beneficiaries and uninsured individuals—includes both community health centers and hospitals.

This report, written by Robert Seifert, Michael Grenier, and Jean Sullivan of the Center for Health Law and Economics at the University of Massachusetts Medical School, summarizes the history of the MassHealth 1115 waiver and examines the key components of the new waiver extension, organized around five themes: coverage, services, delivery redesign, support for the safety net, and looking to the future.

Responsible for the health care coverage of nearly two million residents and $13.7 billion in related expenditures, the future of MassHealth matters to all of us. This report, by Manatt Health Solutions, includes a series of recommendations that emerged through interviews with consumer advocates, providers, insurers, business leaders, public officials, and policy experts as priorities for the next governor.

One Care is Massachusetts’ demonstration project for adults with disabilities between the ages of 21 and 64 who are dually eligible for Medicare and Medicaid. October 1, 2014 marked the first year anniversary of the demonstration, which is slated to run through December 31, 2016.