In 2023, the Foundation released a statewide Health Equity Action Plan, which proposed a vision and framework for achieving a racially and ethnically equitable health care delivery system in Massachusetts. To advance the Action Plan and as a step towards more coordination and cross-system learning among Massachusetts stakeholders, the Foundation, in collaboration with Manatt Health, developed the Massachusetts Health Equity Initiative Inventory and accompanying brief explainer. The Inventory is an interactive resource in Microsoft Excel that contains over 140 interventions and programs being implemented to address racial, ethnic, and linguistic inequities in Massachusetts’ health care delivery system. Each initiative featured in the Inventory includes a brief description and information on outcomes, where available. Users can sort initiatives by various categories, including:

• clinical area of focus, 
• population, 
• geographic region, 
• funding source, and 
• type of implementing entity.

The Inventory was developed as a tool for organizations across the health care delivery system in Massachusetts looking to start or advance their health equity work, offering examples and promising practices of initiatives across various areas of focus. It can also be used by other stakeholders, including state agencies, policymakers, and funders to inform programmatic and funding priorities. 

As organizations adopt and update their health equity initiatives, the Foundation will periodically update the Inventory and will keep the most up-to-date version on its website. If you would like to submit an initiative or update information related to an existing initiative, you can do so via this form.

On Tuesday, December 3rd, 2024, the Foundation hosted a webinar on the Inventory. During the webinar the speakers discussed the impetus for the Inventory, shared key takeaways and lessons learned from compiling this resource, and highlighted how it may be used by organizations in various phases of their health equity journey. The webinar also featured a demonstration of how to use this interactive tool. Click here to access a recording of the webinar and a copy of the webinar slides.

NOTE: This report is also available in English. Click here to view the report in English.

A la luz de los crecientes esfuerzos de MassHealth y otras agencias de Medicaid para colaborar con las personas que han vivido la experiencia de Medicaid y con el fin de mejorar los resultados de salud y avanzar en la equidad, la Fundación encargó dos reportes informativos. El primer reporte, Estrategias para Involucrar Significativamente a los Miembros de MassHealth para Informar las Decisiones de Programas y Políticas, se publicó en junio de 2024 e hizo una serie de recomendaciones para reforzar la estrategia general de participación de los afiliados de MassHealth.

Este segundo informe examina en profundidad una herramienta específica de participación de los afiliados: Los Consejo de Asesores Comunitarios (CABs). Los CABs son grupos de personas, incluidos miembros actuales y antiguos de Medicaid, que participan en un diálogo estructurado, coherente y a largo plazo para informar sobre el diseño de políticas y programas de Medicaid. MassHealth, las organizaciones de atención administrada y las organizaciones de atención responsable ya emplean CABs para informar programas específicos de MassHealth, y MassHealth ha anunciado su intención de crear CABs para todo el programa.

Este informe busca identificar prácticas prometedoras para el diseño y la implementación de CABs en el contexto de MassHealth. Basándose en un análisis de entorno, entrevistas con partes interesadas y conversaciones con los propios miembros de MassHealth, este informe delinea principios rectores o “north stars” [estrellas del norte] para establecer CABs. También detalla recomendaciones prácticas para diseñar y operar CABs eficaces.

NOTA: Este informe también está disponible en inglés. Consulte nuestra página de inicio en español para este informe aquí. 

In light of increased efforts by MassHealth and other Medicaid agencies to engage with individuals who have lived experience with Medicaid and in order to improve health outcomes and advance equity, the Foundation commissioned two informative reports. The first report, Strategies for Meaningfully Engaging MassHealth Members to Inform Program and Policy Decisions, was released in June 2024 and made a series of recommendations to strengthen MassHealth’s overall member engagement strategy. 

This second report takes a deeper look at one specific member engagement tool: Community Advisory Boards (CABs.) CABs are groups of people including current and former Medicaid members that engage in structured, consistent, and long-term dialogue to inform Medicaid program and policy design. MassHealth, managed care organizations, and Accountable Care Organizations already employ CABs to inform specific MassHealth programs, and MassHealth has announced its intention to create a program-wide CAB.

This report aims to identify promising practices for design and implementation of CABs in the context of MassHealth. Based on an environmental scan, stakeholder interviews, and conversations with MassHealth members themselves, this report outlines guiding principles or “north stars” for establishing a CAB. It also details practical recommendations for designing and operating effective CABs. 

Recognizing that member input is essential for effectively improving health outcomes and advancing equity, MassHealth and other Medicaid agencies across the country are increasingly engaging with members to inform program and policy design. MassHealth currently employs a variety of approaches for soliciting member feedback on program design and policy changes, and has signaled its commitment to strengthening its member engagement approach.

This report aims to inform MassHealth’s efforts to strengthen its overall member engagement strategy. The report:

1. Outlines a framework for understanding different strategies along a continuum of community involvement for engaging with individuals with lived experience.
2. Summarizes MassHealth’s current approach to engaging with members.
3. Describes a set of guiding principles for building a meaningful statewide Medicaid member engagement strategy.
4. Introduces a series of recommendations for building and strengthening MassHealth’s current member engagement strategy.

This is the first of two reports in a series on member engagement. The second report, which takes a deeper look at one specific member engagement tool – Community Advisory Boards (CABs) – will be released this summer.

Federal law requires states to recoup costs from certain Medicaid members’ estates – the money and possessions left after someone dies – if they received long-term services and supports (LTSS), such as care in a nursing facility or at home. But some states, including Massachusetts, exceed the federal minimum and recover the cost of all Medicaid-covered services that are provided to members over age 55. This means far more members are affected because it is not just limited to those who use LTSS. By limiting the passing down of assets – including homes – the practice of estate recovery may perpetuate wealth disparities and intergenerational poverty. While MassHealth has made reforms in recent years to reduce the burden of estate recovery on impacted members and families, more can be done.

These materials are intended to educate stakeholders, policymakers, and others about MassHealth’s estate recovery program. They include:

• An issue brief that describes Massachusetts’ estate recovery policy and practices and what is known about its impact on members and their families. The brief also identifies policy and programmatic options that the state could pursue to reduce the burden of estate recovery.
• A series of qualitative profiles that tell the stories of how estate recovery has impacted four individuals in Massachusetts after the loss of a loved one.

Peer supports are an important component of the health care system in Massachusetts. Peers provide a vital bridge to services by offering empathy, information, encouragement, and navigational assistance to people who face linguistic and cultural access barriers, stigma, absence of a support network, and other challenges. Peers are part of the communities they serve and often share lived experiences with the individuals they work with, making them uniquely qualified to foster trust in the health care system where it might be lacking. The nature of peers’ work is often well known in their own professional and programmatic circles, but understanding of their role is less clear across the broader health care system. This brief provides an overview of the primary professions that comprise the peer workforce in Massachusetts, where they work, and the various approaches to training, certification, and payment of these providers.

This report proposes a statewide Health Equity Action Plan that offers an organizing structure, process, and set of practical steps for collectively achieving a racially and ethnically equitable health care delivery system in Massachusetts. The Health Equity Action Plan is accompanied by a toolkit, which includes an illustrative set of interventions and best practices that providers, health care delivery system leaders, and other stakeholders can deploy to achieve the envisioned system.

The focus of this report is on racial and ethnic inequities in the health care delivery system and therefore can be considered a first phase in a larger system-wide effort to eliminate all inequities that affect people’s health.

Racial and ethnic disparities in health care access, quality, and outcomes have been well documented in Massachusetts and across the country. Solutions for reducing inequities in health require investments of time and resources for which there will always be competing priorities. In understanding the value of these investments, it is critical to recognize that in addition to the human toll, they represent a significant economic burden to individuals and families, health care providers, employers, public and private sector payers, and the overall Massachusetts economy. This study, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation in collaboration with the Health Equity Compact, aims to quantify that economic burden.

Problem Management Plus (PM+) is a proven, scalable, and cost-effective low-intensity mental health intervention that can be delivered by trained non-clinical workers for people who are experiencing common mental health conditions, such as anxiety or depression, or stressful life problems. PM+ fills a gap in the behavioral health services system by providing early intervention and potential prevention of more acute behavioral health service needs. As a model that relies on building the capacity and diversity of the behavioral health workforce, it holds promise for enhancing access to community-based mental health supports.

This issue brief is designed to define and describe the PM+ intervention and its origins and identify preliminary considerations for implementing it in the United States. Together with the Foundation’s Advancing Community-Driven Mental Health (ACDMH) grant program, this report advances the Foundation’s strategy to test and disseminate models of care that increase access to behavioral health services and expand capacity of the behavioral health workforce. Through ACDMH, the Foundation is providing support to community-based organizations to adapt and implement the PM+ intervention with the aim of expanding access to culturally appropriate low-intensity mental health supports among racially, economically, culturally, and socially marginalized communities.

Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state’s uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state’s overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.

The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage.

Behind the Data: Voices of the Uninsured
The Foundation recently released a 3-minute video featuring four Massachusetts residents who describe their experiences without health insurance. The video is also available with English subtitles and Spanish subtitles (con subtitulos en Español).

Click here to view

Massachusetts’ historical achievements in bold and innovative health care policy have positioned the state as a national leader in transforming health care coverage, access, affordability, and quality. Yet despite decades of progress, the COVID-19 pandemic made it impossible to ignore that not all Massachusetts residents are able to access, afford, or experience health care equally.

In early 2022, anticipating the election of a new governor and slate of legislative leaders, the Blue Cross Blue Shield of Massachusetts Foundation in partnership with Manatt Health solicited perspectives on health reform priorities from a broad and diverse group of health care stakeholders, including consumer, provider, health plan, business, and labor representatives. This report synthesizes the findings from these stakeholder interviews, describing five health care priorities for the new governor and legislative leaders to immediately pursue: 1) addressing systemic racism and inequities in health; 2) ensuring consumer affordability of health care; 3) confronting the mental health crisis for children and youth; 4) improving the affordability of and access to long-term services and supports (LTSS); and 5) solving severe health care workforce shortages, particularly in the paraprofessional LTSS and behavioral health workforce.

The report explores each theme in detail and identifies specific action steps incoming state leaders can take to address these challenges. An accompanying executive summary and infographic provide a high-level overview that can be used by a wide audience. 

The behavioral health workforce in Massachusetts is in crisis. The COVID-19 pandemic has increased the prevalence of behavioral health issues and demand for services, exposing and aggravating the vulnerabilities of Massachusetts’ behavioral health workforce and delivery system. Health care, including behavioral health care, has been among the industries hardest hit by the “Great Resignation,” exacerbating workforce shortages that predated the pandemic. These dynamics fuel an urgent call to action for Massachusetts to grow and support a workforce that can meet the pressing demand for behavioral health care in the Commonwealth. Informed by a literature review, the development of an inventory of promising models nationwide, and interviews with local and national stakeholders and experts, this report outlines seven concrete recommendations to expand Massachusetts’ behavioral health workforce, increase its diversity, maximize its potential to meet the needs of all people in the Commonwealth, and strengthen its resilience.

Massachusetts administers much of MassHealth through an 1115 Demonstration waiver, approved by the Centers for Medicare and Medicaid Services (CMS), which it has extended several times since it was originally approved in 1995. In December 2021, Massachusetts submitted a request to CMS to extend its Demonstration for another five years. While this request largely aims to continue and improve upon the programs and initiatives that are a part of the current Demonstration, an area of specific focus within the proposed extension centers around advancing health equity within the MassHealth program. As part of this request, MassHealth seeks to promote health equity by both building on current program elements and introducing new strategies such as investing in certain populations that experience persistent health inequities and creating incentives for ACOs and hospitals to measure and reduce health inequities.

This report describes the proposed MassHealth Demonstration extension, what it means for MassHealth coverage moving forward, and implications for members, providers, and other stakeholders.

This brief provides an updated snapshot of the need for behavioral health care and experiences accessing it in the Commonwealth as of 2020/2021, based on a new survey commissioned by the Foundation.  This survey was fielded by NORC at the University of Chicago between December 2020 and March 2021 and gathered information on the need for and access to behavioral health care among Massachusetts adults ages 19 and older and their close relatives. The survey gathered information on the experiences of Massachusetts adults during the 12 months prior to the survey, which covered the period January 2020 through March 2021. Given the timing of the survey and its 12-month look-back period, the survey collected information over roughly the first year of the COVID-19 pandemic. The survey also included a series of questions focused explicitly on the link between the COVID-19 pandemic and the need for behavioral health care.

This primer serves as a foundational resource to broaden the collective understanding of racial and ethnic health inequities and disparities in the Commonwealth as part of our new focus area of Structural Racism and Racial Inequities in Health. The primer is intended to support discussion about how our health care system and other systems that impact health enhance or undermine health, and to facilitate the development of solutions to strengthen those systems to serve all Massachusetts residents.

The primer presents a data-informed reflection of the racial and ethnic health inequities and disparities Massachusetts residents confront today. It offers a basis for further discussion and action, including to evolve and improve the data resources that shed light on racism and racial inequities in Massachusetts’ social and health care systems. The Foundation’s work in this focus area will aim to identify and elevate health care policies and practices that will advance health equity and reduce health disparities in the Commonwealth.

To the extent possible in the confines of a data-focused report, the primer acknowledges critical context about the historical and structural contributors to the racial and ethnic health inequities and disparities that exist today. Data limitations and gaps are noted throughout, identifying where new or improved data is needed to provide a comprehensive, cohesive, and actionable set of data to support the Commonwealth’s health equity goals.

This report presents the results of a study analyzing the impact of the Community Support Program for People Experiencing Chronic Homelessness (CSPECH) on the utilization and cost of health care services. CSPECH is an innovative program through which MassHealth reimburses community-based support services provided to chronically homeless individuals residing in permanent supportive housing. Findings show that coupling supportive services like the type provided by CSPECH with permanent housing can lead to substantial improvements in housing stability and significant reductions in the utilization of acute health care services.

Findings from this report were featured at a Foundation event held on March 8, 2017. Click here to learn more about the event.

Despite the near-universal health insurance coverage that the state has maintained for nearly a decade, pockets of high uninsurance remain for both adults and children in communities across Massachusetts. This brief, prepared by the Urban Institute, explores the relationship between community characteristics and the uninsured rate for people of all ages in Massachusetts and highlights the geographic and community context of the remaining uninsured. It also provides data to better target outreach and enrollment activities.

International comparisons of industrialized countries show that those with a higher ratio of social service spending relative to health care spending have better health outcomes. This finding is consistent with decades of research underscoring the importance of social, behavioral, and environmental factors on health outcomes. This report, prepared by a team led by Elizabeth Bradley and Lauren Taylor of the Yale Global Health Leadership Institute, examines the link between state-level spending on health care and social services and health behaviors and outcomes for Massachusetts compared with neighboring states and national averages.

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 a team led by Elizabeth Bradley of the Yale Global Health Leadership Institute and Lauren Taylor of the Harvard Divinity School, evaluates and synthesizes the evidence base for interventions that address social determinants of health, with special attention to innovative models that may improve health outcomes and reduce health care costs and that may be applicable in the Massachusetts policy context. Based on this review, there is strong evidence that increased investment in select social services (e.g., housing support and nutritional assistance), as well as various models of partnership between health care and social services (e.g., integrated health care and housing services), can result in substantial health improvements and reduced health care costs for targeted populations.

From 2008 through 2011, the Foundation supported 11 community-based coalitions across Massachusetts through its Closing the Gap on Health Care Disparities Initiative. This report, prepared by Mary Coonan and Terry Saunders Lane of The Center for Social Policy, University of Massachusetts Boston, explores areas of coalition development, system change, and public awareness. It articulates strategies that worked well, challenges that emerged, and factors that explain variation to inform foundations, community organizations, and health care institutions working to address disparities in health care and outcomes.