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.

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 five-part series of issue briefs describes MassHealth’s impact on the health and finances of its members, families, and communities, as well as on the wide variety of stakeholders and sectors outside of the traditional health care realm that benefit from the program, including:

• the Commonwealth’s schools and school‐aged children, teens, and young adults;
• the state’s economy and businesses, including how MassHealth supports working families, reduces uncompensated care costs, and draws federal funds into the state;
• the behavioral health care system, addressing how MassHealth provides coverage, access, and delivery of services across the full behavioral health care continuum; and
• justice-involved persons, describing how MassHealth supports re-entry into the community.

Key findings from this series were featured at a Foundation virtual event on Wednesday, June 30^th from 2:00-4:00 pm. Click here to view event materials.

Housing First programs offer chronically homeless individuals immediate housing as a foundation for the delivery of a range of other supportive services, such as mental health and/or substance use disorder services and social service supports. This report summarizes a study examining the effect of the Housing First model on health care utilization and costs among chronically homeless individuals enrolled in MassHealth. The findings from this study demonstrate the effectiveness of a permanent housing and supportive services program in reducing total health care utilization and costs among chronically homeless individuals.

In Massachusetts, MassHealth is implementing a number of reforms as part of its most recent Medicaid 1115 demonstration waiver extension to transform the delivery of care for most members and address the social determinants of health (SDOH). In light of the new interface between health care and social service delivery fostered by the MassHealth program redesign, it is important to understand how community-based organizations (CBOs) perceive the entry of health care organizations into their domains of social service delivery. While health care providers’ perspectives are frequently reported on, less is known about how CBOs view the opportunities and challenges associated with these new relationships.

This report aims to address this knowledge gap by summarizing the findings from a qualitative study that sought to better understand how CBOs are responding to the health care sector’s movement into SDOH programming in Massachusetts. Data was collected through 46 key informant interviews with CBO representatives from a range of social service sectors across the state. Informed by the study findings, this report outlines recommendations for health care leaders and policymakers to support the integration of health care and social service delivery.

This guidebook is designed to help health care administrators and providers better understand the types of social services available in Massachusetts, the organizations that provide such services, and their key sources of funding. This resource is intended to facilitate greater coordination between these organization types, and especially with MassHealth ACOs as they seek to integrate, better coordinate with social services, improve health outcomes, and reduce health care costs.

Based on valuable feedback from stakeholders, this guidebook has been revised. Among the updates made to the guidebook, this version includes a new section on facilitating agencies that directly provide or provide linkages to multiple types of social services.

Given the impact that social factors have on health status and expenditures, and the shift toward value-based payment models that reward providers based on outcomes, health care organizations (HCO) and community-based organizations (CBO) across the country are increasingly working together to address patients’ social needs. In Massachusetts, MassHealth is investing in accountable care organizations and community partners to integrate physical health, behavioral health, and long-term services and supports and also funding certain approved “flexible services” that address health-related social needs that are not otherwise covered as MassHealth benefits.

Based on a review of promising HCO-CBO partnership models, this brief outlines characteristics of effective HCO-CBO partnerships and provides recommendations to guide the development of successful collaborations between health care and social service organizations. 

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.

In recent years, integrating treatment for mental health and substance use disorders (SUD) with primary care has been the subject of extensive research testing a number of different integration models and specific interventions. While many of these approaches have shown promise in demonstrations or clinical trials, the true test of value is in real-world settings where there are competing demands on scarce resources, strict fidelity to intervention protocols is difficult, and patients have multiple urgent needs. This report, prepared by a team led by Robin Clark and Deborah Gurewich of the University of Massachusetts Medical School, describes the process of providing integrated care for patients with SUD at three sites in central Massachusetts: Edward M. Kennedy Community Health Center, Family Health Center of Worcester, and Community Healthlink. It identifies common practices that improve care coordination for individuals with SUD and concludes with overarching key findings from the study.

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.