Monday July 2, 2012

BOSTON

Massachusetts is taking major strides forward in transforming health care for families and individuals in Berkshire County and across the commonwealth. By emphasizing integrated, whole-person care, the Patrick-Murray ad ministration is ensuring that we will again lead the nation in the next phase of health care reform.

Building on Governor Deval Patrick's health care cost containment efforts, one of our most innovative new initiatives focuses on a group of people who face particularly significant challenges. This group includes adults between 21 and 64 with physical, behavioral, or developmental disabilities. These individuals are sometimes referred to as "dual eligibles" be cause they are eligible for, and receive health care coverage from MassHealth -- the Massachusetts Medicaid program -- as well as Medicare.

Their stories are unique, and their treatment plans they will receive under our innovative new "duals" initiative will also be unique. The duals demonstration is currently in a competitive procurement process to select health care organizations to provide integrated, coordinated care to 111,000 dual eligible individuals, while improving efficiency and controlling costs.

Among those individuals is Amy, a 50-year-old MassHealth and Medicare member who suffers from long-standing multiple sclerosis, with complete paralysis in both legs and partial paralysis in her arms.


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She has struggled over the years with depression and depends on a wheelchair to get around.

Amy sees a variety of different doctors on a regular basis. Her doctors do the best they can to help her, but lack an easy system to communicate with each other, resulting in missed opportunities to coordinate her care. Her medical providers aren't able to work closely with her personal care attendant, who helps Amy take care of basic daily functions like dressing and eating. She would like to join a peer-led depression support group, but she is not sure how to find one -- or whether there would be transportation available to help her get to meetings.

Amy's needs for health care are significant. But perhaps even greater is her need for a comprehensive, integrated health care plan that really addresses her unique circumstances, and a team of professionals well versed in caring for people with individuals working together for her.

The Patrick-Murray administration's new "duals" program will help Amy and the more than 111,000 other individuals in the commonwealth ages 21 to 64 who rely on both MassHealth and Medicare for their care. This population includes nearly 4,000 individuals living in Berkshire County. Under this initiative, these individuals will have a new option for accessing their health care benefits through Integrated Care Organizations (ICOs), which will be selected through a highly selective application process.

ICOs will provide medical and behavioral health care, as well as community support services, like peer support, non-medical transportation and home care services. Starting with the launch of the program in April 2013, each member will work with an interdisciplinary care team that includes a primary care doctor, specialists, a behavioral health clinician if needed, and care coordinators who can help them access both medical and community support services. Working together, the care team will develop a unique, individualized care plan for Amy and every member they serve.

ICOs will be accountable for providing and arranging Mass Health-and Medicare-covered services using a combined Medicare-Medicaid "global" payment, instead of multiple, fragmented payments for individual services. The ICO will be responsible for the total care of each person. This global payment will allow ICOs the flexibility to customize care, including offering alternatives to high-cost services like emergency department visits for non-emergencies, when the alternative would better meet a person's needs.

These types of integrated care systems are similar to the ones included in the Massa chusetts health care cost containment legislation, spearheaded by Governor Patrick and currently being finalized in the Legislature.

For Amy, enrolling in an ICO will make a real difference. The ICO would arrange for an assessment of Amy's medical and functional needs, and work with Amy to identify the right people to be on her care team. They could also talk with Amy about her goals to continue living independently and feel less depressed. The team would design a care plan with Amy that might include more support from her personal care attendant, seeing her MS doctor regularly, attending a behavioral health support group once a week and training her in the best use of her wheelchair.

The Patrick-Murray administration's commitment to providing accessible, high quality, integrated care has never been stronger. Initiatives like this will ensure we are able to deliver the right care for members like Amy as we strive to improve the health of the Commonwealth's most vulnerable residents.

Dr. Bigby is secretary of the Massachusetts Department of Health and Human Services. Some of the details associated with the MassHealth member have been changed in respect to privacy.