Trend | Care Process Redesign

Keeping an eye on Massachusetts

Trend | Care Process Redesign

Keeping an eye on Massachusetts

Some health systems seeking outcomes and cost data on populations with access to and availability of behavioral health services are watching Massachusetts. Several payer-provider collaborations launched in that state at the start of 2018 are seeking to better manage Medicaid risk across millions of lives.

The premise of these partnerships in Massachusetts is the emerging concept in managing risk: connecting hospital-led organizations with multispecialty physician practices, community resources and behavioral health resources. When a patient presents with a behavioral health condition and one or more comorbidities, these other organizations can reach out within the community to access the resources to help manage the behavioral health condition, while at the same time continuing to treat the chronic physical conditions that are core to the health system’s capabilities. By linking the provider groups in contracts that share financial risk for managing the cost of care for the patient population, incentives can be aligned between organizations.

For example, when patients present in the ED experiencing psychiatric emergencies, physicians are empowered to help connect them to community resources that can address underlying issues. This requires building partnerships with mental health specialists who can respond to patients experiencing mental health crises as well as other outpatient resources and inpatient treatment options. These partnerships can contribute to reductions in future ED visits and allow hospitals to manage patients’ health when they do present in the ED versus merely managing patient flow through the ED.

See related article: Why behavioral health should be part of a holistic healthcare approach


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