Grant Partners

Ecu-Health Care will provide public health outreach, application assistance, and support for accessing primary care providers. One-on-one training will educate clients on the individual mandate, minimum creditable coverage policies, and affordability regulations.

The Massachusetts Law Reform Institute will advocate on the following key issues: ensuring affordable and accessible health care for vulnerable populations, improving the administration of public coverage programs, ensuring Affordable Care Act implementation benefits low-income and vulnerable populations, protecting the rights and enhancing services for those dually eligible for Medicaid and Medicare. The program will ensure elders have access to services to prevent or delay institutionalization and that consumers have a voice in health care reform.

Hilltown Community Health Centers will assist clients to access and maintain health insurance coverage, aiding them in learning how to stay enrolled in the public programs for which they are eligible. The program will also connect clients with a primary care physician and address prescription costs.

Brockton Neighborhood Health Center (BNHC) will target high risk patients, defined as those having had two or more emergency department visits and/or psychiatric hospitalizations within six months, and/or patients presenting to the urgent care department two or more times within six months without consistent follow-up with a primary care provider. BNHC’s Primary Care Behavioral Health Model aims to increase patient access to behavioral health services, enhance coordination between primary care and behavioral health, and improve health outcomes. Partners include Good Samaritan Medical Center and Brockton Hospital, inpatient psychiatric units, community mental health clinics, and insurance companies.

Judge Baker Children's Center (JBCC) will implement the Modular Approach to Therapy for Children (MATCH) in four outpatient clinics in the Greater Boston area as a step toward bringing the model to scale in Massachusetts.  In addition, JBCC will compare the costs of treatment using MATCH with typical treatment costs at the participating sites.  MATCH will be utilized to treat children with multiple complex disorders, including some combination of anxiety, depression, post-traumatic stress, and disruptive conduct, including the problems associated with attention deficit-hyperactivity disorder.  Treatment Response Assessment for Children (TRAC) will be used as an outcome measurement system that guides clinicians through the implementation of MATCH.  

Visiting Nurse Association of Greater Lowell will deliver home health care services, self-care education and coaching, and tele-monitoring to high-cost patients identified by the Lowell General Physician Hospital Organization (PHO) and Lowell Community Health Center. The project will serve 100 “high utilizers” in its first year and will triple in size by its third year. Targeted patients will be those diagnosed with congestive heart failure, chronic obstructive pulmonary disease, or diabetes. In-home assessment, coaching, and monitoring will be provided to patients who do not qualify for these services under current payment and benefit guidelines because they are not homebound and do not have acute, but rather chronic conditions. The project’s goal is to demonstrate the cost-effectiveness of these services.

A Collaborative Practice Model for Improving Pediatric Mental Health Value:  The Alliance Foundation for Community Health will develop a new method of identifying youth at risk for low quality/high cost mental health treatment. The sample for this study will be drawn from the 101,000 youth under age 20 insured by Network Health. The project will also look within diagnosis groups to compare treatments and expenditures across race/ethnicity, language, geography, and other characteristics. In the second phase of the effort, the project will identify primary care providers who have the largest number of high-expenditure youth and work with them and families to develop more cost-effective approaches to treatment.

Mercy Medical Center’s Health Care for the Homeless program (Mercy HCH) will collaborate with hospital emergency departments in Hampden, Hampshire, and Franklin counties to “re-direct” homeless persons who are “high-end utilizers” of emergency department services to access health care services through Mercy HCH’s clinical team.  Mercy knows the area’s homeless well and has documented cases where individuals are going to emergency rooms more than 20 times per month. Mercy HCH staff will work with these homeless individuals to obtain stable housing and resolve chronic conditions such as substance abuse and mental health issues.  Over the three-year grant period, the five participating hospital emergency departments will “re-direct” 120 homeless individuals to more appropriate care through the program.

The Boston Public Health Commission will use funds to train staff of city agencies and consumers on how to navigate the health care system and a newly launched web-centric resource database will be developed to help locate referral organizations.  Customized 'My Health Portfolios' will educate consumers on facts to consider when obtaining health care.

Community Health Center of Franklin County will provide a comprehensive continuum of services including community outreach, enrollment and eligibility assistance, transportation assistance, Spanish interpretation, case management, and care coordination. The health center will target residents affected by significant social and geographic barriers to care, as well as new immigrants, migrant workers, and non-English speakers.

Family Health Center of Worcester will initiate the Consumer Self-Sufficiency Program to improve access to health care and insurance coverage for low-income individuals and families, and increase patient self-sufficiency in navigating the health care system and obtaining the appropriate level of preventive and acute health care.

Massachusetts League of Community Health Centers will serve as a key resource to its membership as cost containment and payment reform continue to reshape the health care environment. The League will conduct a multi-tiered advocacy strategy on a statewide level, including analyzing and disseminating policy information, engaging its members on key issues, and collaborating with other organizations and coalitions that share community health and primary health care goals.

Caring Health Center will target refugees, immigrants, and other linguistic and cultural minority groups who face barriers to enrollment and health care navigation. The health center provides comprehensive primary medical care and dental services to residents in the medically underserved city of Springfield and its surrounding areas.

Holyoke Health Center will serve 300 patients at high-risk for preventable hospitalization, re-hospitalization, unnecessary emergency department visits, or adverse drug events due to diabetes. The project will begin with identifying patients with diabetes with an unnecessary emergency room visit and recent hospitalization at Holyoke Medical Center, or eight or more prescriptions for diabetes.  A partnership with the Massachusetts Medicaid program will identify high-cost patients and work to understand how to predict which are amenable to disease management programs, leading to more effective, lower-cost services.