In early 2023, Massachusetts began implementing its Roadmap for Behavioral Health Reform (Roadmap), a sweeping set of changes aimed at simplifying access and entry to the state’s outpatient behavioral health care system for all Massachusetts residents. The Roadmap reforms are designed to address challenges with the current behavioral health care system, including difficulty finding community-based providers and culturally relevant services, a lack of integrated mental health and addiction treatment, and a continued reliance on the emergency department for crisis and acute care.

Based on input from select Massachusetts stakeholders and early implementation data, this report describes the key components of the Roadmap and how they are intended to improve access to behavioral health care services. It also provides an update on implementation of the Roadmap, describes early successes and challenges, and identifies opportunities to strengthen implementation moving forward. 

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.

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’ 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.

In December 2021, Governor Baker signed Chapter 102 of the Acts of 2021 into law. This legislation, often referred to as the “ARPA bill,” appropriates close to $4 billion, including $2.55 billion in funding directly from the federal American Rescue Plan Act (ARPA). ARPA was passed in March 2021 to provide money to states to start recovering from the effects of the COVID-19 pandemic. Chapter 102 invests money from ARPA in many areas, including housing, infrastructure, education, and economic development. Health services received $950 million in the law, with funding for physical health, behavioral health, long-term care services, and public health initiatives. This issue brief summarizes the key components of Chapter 102 that will affect health and health care in Massachusetts.

The goal of this study was to better understand whether Primary Care Providers (PCPs) identify a need for a PCP-to-behavioral health (BH) provider consultation program for adult patients with mental health conditions and substance use disorders (SUDs), and whether they would utilize such a program. Additionally, the study sought to understand the type of BH conditions providers encounter, the proportion of adult primary care patients with BH needs, and the challenges PCPs face in supporting adult patients with BH conditions. These findings are intended to help stakeholders understand how a consultation program might be best structured to provide evidence-based support to PCPs and, in turn, their patients with BH needs.

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.

In response to the health and economic damage caused by the COVID-19 pandemic, Congress passed the American Rescue Plan Act (ARPA) in March 2021, which makes $1.9 trillion available to individuals, states and territories, counties, cities, community organizations, educational institutions, and other entities. Some funds are intended to shore up or even expand programs and agencies that have been depleted during the pandemic, while other funds are designated or available to create new programs. ARPA contains many health-related provisions, with particular focus on behavioral health services (inclusive of mental health and substance use care), the health care workforce, and programs that make health insurance coverage and health care available to more people. This summary focuses on the key components of ARPA that will affect health care in Massachusetts.

Addressing timely access to behavioral health care through the adoption of open access methods supports the well-being of people with behavioral health conditions, improves staff productivity, and increases financial stability for provider organizations. However, no study has previously documented the experience of provider organizations using this model in Massachusetts.

The report identifies organizations that operate open access today and highlights the approaches that have been most successful. The report also pinpoints keys to success for organizations to consider in adopting an open access model and offers policy recommendations to promote the broader adoption of open access in the Massachusetts behavioral health care system.  The case studies provide detailed descriptions of each model, describe the successes and challenges of implementation, and indicate how COVID-19 has impacted operations.

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.

Behavioral health urgent care services are a critical component of the broader behavioral health care delivery system. Developing and sustaining a robust set of behavioral health urgent care services across community-based settings will provide adults with more options for timely access to care and offer alternatives to emergency departments for treatment. This brief proposes a vision and framework for behavioral health urgent care and outlines a series of policy and programmatic recommendations to address workforce, clinical, payment, and administrative barriers to implementing behavioral health urgent care.  Addressing these barriers will advance access to and availability of behavioral health urgent care services for adults in Massachusetts.

This brief complements the Foundation’s Behavioral Health Urgent Care grant program, through which the Foundation is supporting Emergency Services Programs (ESPs) to bolster their capacity to deliver behavioral health urgent care services in Massachusetts. The work of the ESP grant partners and insights from other key stakeholders informed the proposed vision and key elements of the behavioral health urgent care framework as well as the recommendations outlined in this brief.

At the onset of the COVID-19 public health emergency, Massachusetts led the nation in rapidly deploying progressive policies to temporarily expand access to telehealth. These changes have enabled significant increases in adoption of telehealth, including telebehavioral health, for providers and consumers in a short period of time. Prior to COVID-19, utilization of telebehavioral health had not gained widespread spread traction in Massachusetts despite its potential as a means to dramatically improve access to behavioral health care services, particularly for vulnerable populations.

This report provides policymakers and other behavioral health stakeholders with an overview of the state’s current telebehavioral health landscape; a description of the attributes of an optimal telebehavioral health care delivery model; and a summary of the common barriers to provider and consumer adoption of telebehavioral health services in Massachusetts. It also outlines a series of policy and programmatic recommendations – including maintaining many of the temporary policy advances made during the COVID-19 pandemic – that will better enable the delivery of telebehavioral health care and support increased consumer engagement with and use of telebehavioral health services.

On October 18, 2019, Governor Charlie Baker submitted House Bill 4134, An Act to Improve Health Care by Investing in Value, to the Massachusetts Legislature. The bill proposes a comprehensive set of policies designed to address barriers to behavioral health care access, including the establishment of a new system that would incentivize providers and health plans to spend more of their funds on primary care and behavioral health services while rebalancing spending in other areas. This brief provides a summary of the provisions of the bill that specifically target behavioral health care delivery and access.

Since the Governor’s bill was filed, the state Senate has passed Senate Bill 2519, An Act Addressing Barriers to Care in Mental Health, which similarly includes several provisions intended to improve access to mental health care. The Senate’s summary of the bill is available here.

In January 2016, the Blue Cross Blue Shield of Massachusetts Foundation undertook a three-year grant-funded initiative to expand access to integrated behavioral health (IBH) and primary care services in Massachusetts – Fostering Effective Integration (FEI). Grants were awarded to a diverse cohort of eight providers in the Commonwealth with experience in delivering IBH care. This report describes the findings of an evaluation conducted by John Snow, Inc. (JSI) from January 2016 to December 2018. The evaluation results shed light on the impact of various models of IBH on access, outcomes, and cost depending on population and setting. Further, through the testing of innovative models of IBH care, the FEI evaluation describes several substantial lessons learned regarding:

• Linkages to primary care for patients with severe mental illness whose main point of contact with the health system is the behavioral health system;
• Strong engagement in IBH services and intensity of service use by adolescents;
• Improved access to behavioral health care for an older population; and
• Improved capacity to collect and use quality improvement data.

This report and companion chart pack document and describe the current behavioral health (inclusive of mental health and substance use disorder) care system for children, adolescents, and adults in Massachusetts; outline a new whole-person-oriented vision for behavioral health care in the Commonwealth; and propose a strategic approach and series of recommendations through which the state can advance this vision to achieve reform. This new vision for behavioral health care in Massachusetts addresses some of the most pressing challenges impacting how behavioral health care is delivered today. Among others, these include: barriers to accessing and navigating the behavioral health care continuum, inadequate coverage of behavioral health care services across payers, workforce shortages and capacity issues, unnecessary regulatory burden and redundancy, fragmented administrative and payment functions, and lack of monitoring and accountability for behavioral health outcomes.

To develop this new vision, researchers interviewed and facilitated discussion groups with state and national behavioral health experts, stakeholders, and thought leaders, and conducted a comprehensive landscape scan of the current public and private behavioral health care system in Massachusetts. Researchers identified the system’s many strengths and persistent weaknesses and then constructed a “model” system to guide the new vision.

Findings from this report were featured at a Foundation event held earlier today. Click here to learn more about the event.

This collection of materials is the latest in a series by the Urban Institute summarizing the findings from the 2018 Massachusetts Health Reform Survey (MHRS). The Foundation began conducting the MHRS in fall 2006 to support the evaluation of Massachusetts’ 2006 health care reform bill. The survey has been fielded periodically since 2006 – most recently in spring 2018 – to monitor key measures pertaining to health insurance coverage and health care access and affordability among non-elderly adults (ages 19-64) in Massachusetts. For the first time in 2018, the MHRS included several questions pertaining to access to care for mental health (MH) and substance use disorder (SUD) services.

The 2018 MHRS highlights the state’s ongoing success at maintaining near-universal health insurance coverage since the passage of Massachusetts’ 2006 health care reform law. However, the survey’s core measures demonstrate that opportunities for improvements in access to and affordability of health care for the state’s residents remain and the new questions on MH/SUDs highlight the significant barriers to care and gaps in access to care faced by those seeking MH/SUD services. The survey findings are a reminder that the goals of health care reform are not fully achieved by simply reducing the number of people who are uninsured. New strategies are needed to improve access to care and reduce the burden of health care costs for Massachusetts adults and their families, particularly for the most vulnerable.

Findings from the 2018 MHRS were featured at a Foundation event held on December 11, 2018. Click here to learn more about the event.

This year’s results are presented in a variety of publications including:

This series of reports describes the results of a comprehensive mixed-methods study, Access to Outpatient Mental Health Services in Massachusetts. The study sought to quantify the wait times for outpatient mental health office visits in Massachusetts, better understand the experiences of clients seeking an appointment, and identify facilitators and barriers to accessing mental health services. Study findings are based on primary data from multiple sources, including qualitative data from stakeholder interviews and client focus groups and quantitative data from surveys of clinicians and administrators at organizations providing outpatient mental health services.

Findings from this study were featured at a Foundation event held on October 31, 2017. Click here to learn more about the event.

This primer is designed to increase understanding of the behavioral health care system in Massachusetts and the issues affecting access to care for individuals with mental health and substance use disorders. It is intended to serve as a foundation for future work focused on behavioral health system solutions.

This resource provides a brief background on the state’s behavioral health system, a historical overview of policy changes that have affected access to behavioral health care, and a review of prevalence data highlighting trends in mental health and substance use disorders. The remaining sections present state specific data on four primary factors affecting access to behavioral health care: 1) workforce capacity; 2) system capacity; 3) affordability; and 4) quality. This primer concludes with a review of the gaps in available data on these topics and behavioral health care generally, which limits the ability to provide a comprehensive account of the behavioral health system and client access.