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.

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.

This report includes findings from the evaluation of the 2015 Fostering Effective Integration grant program. The goals of the evaluation were to determine 1) how grantees defined “success” for their integration efforts, 2) grantee perceptions of the critical components of effective integration programs, 3) common barriers to integration, and 4) measures grantees used to assess programs.

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.

This report, prepared by Robert Belfort and Alex Dworkowitz of Manatt, Phelps & Phillips, LLP, provides a review of the primary Massachusetts and federal privacy laws relevant to the exchange of information among physical and behavioral health providers and an assessment of technological and operational challenges faced by providers seeking to integrate care through enhanced data exchange. The report proposes ways in which existing laws could be clarified or amended to better facilitate information exchange and identifies potential operational strategies for minimizing the restrictive impact of existing privacy laws without compromising patient privacy.

The Foundation hosted a webinar with authors Robert Belfort and Alex Dworkowitz of Manatt, Phelps & Phillips, LLP to review key findings from this report on Wednesday, March 30th. Click here to access the webinar slides.

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.

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.

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. Incorporating the input from the focus group, it concludes with a discussion of the top three priorities that, if addressed, would have the most significant impact on removing barriers to integration. This report is intended to serve as a resource summarizing key issues and potential opportunities for policymakers to improve the integration of physical and behavioral health care services.

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. This report, which focuses on how to better align the city of Boston’s addiction and recovery services with demonstrated best practices, will serve as a roadmap for the Mayor’s Office of Recovery Services.

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.

Findings from this report were featured at a Foundation event held on December 9, 2014, MassHealth Matters: Priorities for the New Administration. Click here to learn more about the event and to see a copy of the slide presentation of the report by Patricia Boozang, Managing Director of Manatt Health Solutions.

Click here to watch the MassHealth Matters video.

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. The Commonwealth of Massachusetts and the Centers for Medicare and Medicaid Services (CMS) have jointly contracted with three health plans to provide all medical, behavioral health, dental, pharmacy, and long-term support services covered by Medicare and Medicaid and any other services as determined by the member's care plan.

This fact sheet provides a comprehensive description of One Care. The November 2014 edition includes updated information on the risk sharing arrangement and a summary of the findings from the Early Indicators Project consumer survey. The infographic includes updated One Care enrollment by health plan, rating category and geography as of October 1, 2014. Also included is new data on disenrollment, rating category enrollment penetration and rating category enrollment within each One Care Plan. MMPI plans to update the enrollment infographic on a regular basis as new information becomes available.