UMass Medical School experts to present on practice transformation, behavioral health integration, hepatitis C medications at AcademyHealth conference

June 20, 2016

UMass Medical School experts will present on a variety of topics, including practice transformation, perioperative surgical home care, new medications for hepatitis C and behavioral health integration, at the annual AcademyHealth Research Meeting June 25-28 in Boston.

Experts from Commonwealth Medicine, the health consulting division of UMass Medical School, will be presenting and displaying posters at the conference.

Saturday, June 25

Implementing Outcome-Based Quality Measures for Community-Based Services Using Assessment Data
10 to 10:15 a.m.

Publicly funded home and community-based services (HCBS) are increasing due to federal and state policies supporting older adults and individuals with disabilities living outside institutions. A study analyzed routinely collected state assessments of 49,400 elders who received services in fiscal 2014 from six federal and state-funded programs offered through the Massachusetts Executive Office of Elder Affairs. Researchers found the data of sufficient quality and reliability to warrant continued work on quality measurement implementation. The study found that pooling individual assessments enables states to measure outcome patterns and service needs by program and vendor. States can evaluate outcomes, compile best practices, guide policymakers in program development and help vendors provide services that meet clients’ needs.

Marybeth McCaffrey, JD, UMass Medical School
Rebecca Laes-Kushner, MA, MPA, UMass Medical School
Kelly Love, JD, UMass Medical School
Ann Lawthers, PhD, UMass Medical School

Paving the Way for Practice Success Under Value-Based Payments: Implementing the Southern New England Practice Transformation Network
11:45 a.m. to 12:30 p.m.

The Southern New England Practice Transformation Network is a complex, large-scale care transformation effort requiring a multi-faceted approach and alignment with current efforts and aims at the practice, health systems and state levels. Engaged leadership at each level is required for successful implementation. Focused attention to working collaboratively across multiple provider networks, independent practices and other stakeholders is an important element of the implementation strategy. Engaging clinicians who are not already participating in value-based payment contracting, such as Accountable Care Organizations, is challenging since many are wary of change. Researchers said finding the value proposition that captures the “What’s in it for me?” is essential.

Judith Steinberg, MD, MPH, UMass Medical School
Valerie Konar, MBA, MEd, UMass Medical School
Frederick Perro, MBA, MS, UMass Medical School
Pamela Senesac, PhD, SM, RN, UMass Medical School
David Polakoff, MD, MSc, UMass Medical School

The Interaction of Physical Disability with Pregnancy and Childbirth
Noon to 12:15 p.m.

An increasing number of women with physical disabilities are choosing to become pregnant, but there is limited knowledge about the impact of physical disability on the health and function of these women during pregnancy and childbirth. Researchers concluded that although the women experienced some impact of their disabilities on their pregnancies, they generally felt that pregnancy was a positive experience overall. Careful planning and management of the pregnancy were key. Education of women and clinicians is necessary to achieve optimal outcomes.

Linda Long-Bellil, PhD, JD, UMass Medical School
Monika Mitra, PhD, Brandeis University
Suzanne Smeltzer, EdD, RN, FAAN, Villanova University College of Nursing
Lisa Iezzoni, MD, MSc, Mongan Institute for Health Policy at Massachusetts General Hospital

Sunday, June 26

Do Hospitalized Patients Choose Home Care? Experiences Recruiting for a Public Reporting Study
12:15 to 1:45 p.m.

While state and national quality reports have proliferated over the past decade, the volume of data is outpacing our ability to ensure that reports are used to inform consumer decision-making. Researchers undertook a mixed-methods study to create and test a web application designed to help users choose home health agencies based on logistical information and comparative data. Many policymakers believe that a large pool of patients exists whose choice of provider may be informed or guided by public reporting. Researchers’ experience recruiting hospitalized patients for this study suggests that the number of patients actually choosing agencies at hospital discharge may be relatively small. Although patients’ ongoing relationship with an agency can be beneficial for care coordination and the researchers may have narrowly focused on a population more likely to have prior experience with home care, the proportion of patients choosing agencies at hospital discharge is likely to further shrink as physician practices, hospitals, and health plans increasingly develop preferred provider contracts and refer patients to those providers.

Melissa Clark, PhD, UMass Medical School
Rosa Baier, MPH, Brown University School of Public Health
Emily Cooper, MPH, Healthcentric Advisors
Stefan Gravenstein, MD, MPH, Case Western Reserve University School of Medicine
Andrea Wysocki, PhD, MPP, Mathematica Policy Research
Vincent Mor, PhD, Brown University School of Public Health

Implementing Behavioral Health Integration in Primary Care Practices: Measuring Progress, Understanding Challenges
4 to 4:20 p.m.  

Each primary care practice presents its own set of needs and challenges for behavioral health integration. Transformation support consultants can help practices address these challenges. Researchers’ initial findings suggest a lack of correlation between achievement of behavioral health integration milestones and performance on quality measures. Linking achievement of integrative milestones to behavioral health quality outcomes may support the effectiveness of integration as a whole, and demonstrate the importance of transformation consultation efforts in large-scale primary care reform.

Joshua Twomey, PhD, UMass Medical School
Judith Steinberg, MD, MPH, UMass Medical School
Joan D. Johnston, RN, CIH, CPE, PCMH CCE, UMass Medical School
Amy Leary, UMass Medical School
Amy Norman-Harmon, BA, UMass Medical School
Jean Carlevale, RN, BSN, UMass Medical School

Monday, June 27

Perioperative Surgical Home (PSH): A New Paradigm in a Surgical Episode of Care
8 to 9:30 a.m.

A Perioperative Surgical Home (PSH) is a patient-centered, physician-led, multidisciplinary, team-based system of coordinated care for surgical patients. The PSH helps increase the quality of care, reduce complications and costs, and increase productivity. UMass Medical School launched a PSH pilot in June 2015 focusing on urologic cancer patients. Researchers concluded the pilot is moving toward improved efficiencies, improved patient and physician satisfaction, and decreased cost of care. They also found teamwork is needed and it is important to identify key personnel who are engaged, motivated, enthusiastic and reliable.

Valerie Konar, MBA, MEd, UMass Medical School
Judith Steinberg, MD, MPH, UMass Medical School
Sai Cherala, MD, MPH, UMass Medical School
Shubjeet Kaur, MD, MSc, HCM, UMass Medical School
Mitchell Sokoloff, MD, FACS, UMass Medical School

Risk Adjustment for Medicaid Payment Reform: Adding Social Determinants of Health Data to Diagnostic Cost Group Models
8 to 9:30 a.m.

Massachusetts plans to implement an alternative payment model for its Medicaid program, MassHealth, by 2017. Researchers sought feasible improvements to MassHealth’s risk adjustment model for predicting total costs of care for enrollees in both its FFS (Primary Care Clinician, PCC) and managed care organization (MCO) plans. Researchers examined adding measures of social determinants of health (SDH) variables – both individual-level and neighborhood-level – and explored the ability of models built on PCC data to predict costs in the MCO population. They concluded that some social determinants of health data can modestly improve Medicaid payment models.

Arlene S. Ash, PhD, UMass Medical School
Judith Steinberg, MD, UMass Medical School
Georgianna Willis, PhD, UMass Medical School
Jianying Zhang, MD, MPH, MSc, UMass Medical School
Randall Ellis, PhD, MSc, Boston University

Linking Health Across the Systems: Worcester Prevention Wellness Trust Fund Experience
6:30 to 8 p.m.

In 2014, the Worcester Division of Public Health received a Prevention Wellness Trust Fund (PWTF) grant from the Department of Public Health to improve care for elderly falls, pediatric asthma and hypertension in 26 census tracts in Worcester. The project aims to improve health outcomes by linking clinically prescribed activities to the home- and community-based resources through community health workers. In the first year Worcester PWTF has shown improvement in screening patients for these three conditions. Community-based groups have shown improvement in services provided to high-risk individuals. Researchers concluded the community-based providers and clinical providers can work collaboratively to engage patients in healthy behaviors that can improve health outcomes. This kind of linkage can lead to change of health culture and help bend the cost curve.

Sai Cherala, MD, MPH, UMass Medical School
Tracy Kennedy, Esq., City of Worcester Division of Public Health

Monitoring Access and Adherence to New Medications for Hepatitis C for Medicaid Members
6:30 to 8 p.m.

Sofosbuvir and simeprevir, new direct-acting antiviral medications, are highly effective in treating chronic hepatitis C virus (HCV) infection. MassHealth, the Massachusetts Medicaid program, has implemented policies and programs to maximize their benefit for members with HCV. While MassHealth requires prior authorization for treatment, access is not restricted to those with advanced disease or to those without active substance use disorder, as in many other state Medicaid programs. Because strict adherence is required to achieve sustained virological response, MassHealth initiated a clinician outreach program to support adherence. Researchers sought to understand HCV medication utilization and adherence in these programs. Treatment with new antivirals was requested for a small proportion of MassHealth members with HCV during the first months of availability. Requests varied by clinical and demographic characteristics. Among those who initiated treatment, the majority of members maintained high adherence to HCV regimens.

Karen Clements, ScD, MPH, UMass Medical School
Robin Clark, PhD, UMass Medical School
Pavel Lavitas, PharmD, BCPS, UMass Medical School
Parag Kunte, MPH, UMass Medical School
Camilla Graham, MD, MPH, Beth Israel Deaconess Medical Center

Bonnie Greenwood, PharmD, BCPS, UMass Medical School
Kimberly Lenz, PharmD, UMass Medical School
Paul Jeffrey, PharmD, UMass Medical School

Older Dual Eligibles with High Medicaid Expenditures Have Multidimensional Needs
8 to 9:30 a.m.

Researchers examined population characteristics, disease profiles, health care utilization, and expenditures for elders dually eligible for Medicare and Medicaid with high Medicaid expenditures, as well as patterns of persistent high expenditures. Findings can be used to assist states in developing care management programs for elders with complex care needs. A relatively small group of older duals have complex needs and incur high Medicaid expenditures. Half of those members’ Medicaid expenditures were attributable to a wide range of community-based long-term services and supports, suggesting that these members could benefit from enhanced care management.

Wen-Chieh Lin, PhD, UMass Medical School
Robin Clark,
PhD, UMass Medical School
Gideon Aweh, MS, UMass Medical School
Heather Posner, MSPH, UMass Medical School
Stephen Kurtz, MS, UMass Medical School

Public Insurance is a Risk Factor for Overall and Primary-Care Sensitive Emergency Department Use: Massachusetts All-Payer Claims Database 2011-12
8 to 9:30 a.m.

An exploration of emergency department use versus primary care use among nonelderly people with private versus public insurance using the 2011-12 Massachusetts All Payer Claims Database found that, despite near-universal insurance, Massachusetts rates of primary-care sensitive emergency department use remain high. People with public insurance are more likely than those with exclusively private coverage to have primary-care sensitive emergency department visits and multiple emergency department visits in a year. Less than half of emergency department visits were for the kinds of injuries or emergencies thought to be unavoidable, although the algorithm has limitations and needs to be updated to remain relevant.

Lisa Lines, PhD, MPH, RTI International, UMass Medical School
Arlene S. Ash, PhD, UMass Medical School
Peter Lazar, BS, UMass Medical School
Nisha Kini, MPH, UMass Medical School
Jianying Zhang, MD, MPH, MSc, UMass Medical School

A Longitudinal Look at Medicaid Members with High Expenditures: Who Remains in the High Cost Group? Who Doesn’t? Who Returns?
3:35 to 3:55 p.m.

The objective of this study was to understand longitudinal expenditure patterns among Medicaid members who have the highest health care costs. Understanding which members have persistently high expenditures from year to year and those whose expenditures follow different patterns can help providers and policymakers to better target treatment and care management. Patients with high expenditures are a diverse group. Most of those identified in a single year continued to have high expenditures for years to come. Despite the persistence and diversity of characteristics, different patterns of expenditures can be identified, allowing providers and policymakers to tailor services and incentives to particular groups.

Robin Clark, PhD, UMass Medical School
Wen-Chieh Lin, PhD, UMass Medical School
Stephen Kurtz, MS, UMass Medical School
Gideon Aweh, MS, UMass Medical School
Sharina Person, PhD, UMass Medical School
Heather Posner, MSPH, UMass Medical School