Health Care Reform Committee

Neuropsychologists in-the-know      

With the changes in healthcare priorities and in payment and healthcare delivery systems that came with the 2010 federal Affordable Care Act (ACA) and the 2012 Massachusetts healthcare law Chapter 224, neuropsychologists realized that we need to be aware of the healthcare environment in which we practice.  Both laws seek to improve each person’s experience of care by delivering patient-centered care (better care), reduce healthcare costs (better value), and improve the health of populations (better health outcomes).  Neuropsychologists need to consider how our services contribute to these goals in order to maintain our vital role in the healthcare of the people we serve.  Coordination of care with other clinicians is more important than ever.

Five past MNS Presidents and Board members have chapters in a 2019 book designed to educate clinicians regarding the role that neuropsychology plays in integrated healthcare.  According to the publisher, Springer, “This unique volume teaches those in the medical fields about the scientific value of neuropsychology in assessing cognition, the 6th vital sign, as part of well integrated collaborative care.  It offers physicians a comprehensive tour of the many dimensions neuropsychology can add to primary and specialized medical care across the lifespan.….The Physician’s Field Guide to Neuropsychology (Karen Sanders, Editor) is both a rigorous and an accessible reference for clinicians in diverse disciplines including general practice, family medicine, neuropsychology, pediatrics, gerontology, and sports medicine. …”

MNS Past Presidents Maggie Lanca, PhD and Karen Postal, PhD, current MNS Board member Flannery Geier, PsyD,  and former MNS Board members Emily Wilner, PsyD, and Jen Queally, PhD contributed chapters.  Dr. Lanca’s chapters include  A Model of Collaboration between Primary Care and Neuropsychology;  Neuropsychological Assessment of Adult Attention-Deficit/Hyperactivity Disorder – co-authored with Dr. Geier,  and Neuropsychology in the Twenty-First Century: The Rise of Multicultural Assessments -- co-authored with Dr. Wilner.  Dr. Queally’s chapter is entitled, The Integration of Neuropsychology in Pediatric Care Teams .  Dr. Postal writes on the topic of Effective Feedback Conversations.  Be sure to add this to your reading list --- and request it for or gift it to your hospital, clinic, or office library!

To learn the basic terms, trends, practice issues and solutions, and other information related to Patient Protection and Affordable Care Act (ACA for short), visit the IOPC Toolkit website: https://iopc.online/healthcare-reform-101

At the State Level
                                             
Massachusetts had a head start in implementing healthcare reforms. The federal Affordable Care Act (ACA) is modeled on the 2006 MA healthcare reform law, which required all citizens in the Commonwealth to have health insurance and established insurance exchanges. Furthermore, in 2012, MA Chapter 224 became law: An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. The schedule for implementing specific elements of this act, focused on healthcare delivery systems and payment reform, is at the end of the law.

Chapter 224 established the Health Policy Commission, which is charged with advancing “ a more transparent, accountable, and innovative health care system through independent policy leadership and programs.  Our goal is better health and better care at a lower cost across the Commonwealth.” The HPC monitors healthcare cost trends and sets annual goals for keeping cost increases low.  The Commission also solicits input from healthcare stakeholders in developing new models of care, such as Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO).  The HPC then sets the standards and certifies health care organizations as PCMHs or ACOs.  ACO certification standards are being updated for 2022-2023 certification.  In 2017, Massachusetts became the first state to have statewide, all-payer standards of care for care delivery.  PCMH certification stresses the importance of integrating behavioral health care in primary care settings.  

Electronic health records (EHR) are central to providing integrated care, according to state and federal laws. The Mass HIway is the Massachusetts Health Information Exchange (HIE) allows all healthcare clinicians to “push” (send) and “pull” (access and receive) patient information via this secure electronic communication network (with patient consent). An EHR system is not required to connect. For information on how to enroll and/or sign up to receive newsletter, go to: http://www.masshiway.net/HPP/index.htm

 

Although MA Chapter 224 states that all healthcare providers will implement fully interoperable electronic health records (EHR) systems that connect through the Mass HIway, it remains unknown how this will apply to solo and small-group behavioral health clinicians.  Connection requirements are being phased in and by the end of 2020, acute care hospitals, community health centers, and medium/large medical ambulatory care practices must meet connection requirements.  Individual clinicians are not required to connect -- only the organizations. The Mass HIway team will keep the healthcare community updated.  Announcements of connection deadlines will provide at least one year’s notice prior to connection deadlines. 

 

Any updates regarding EHR regulations and behavioral health will be posted here and on the MNS list serv. Medical practitioners governed by the Board of Medicine are further along in adopting EHR's than are behavioral health clinicians, although more and more behavioral health clinicians are making the move from paper to electronic records.  Various task forces are discussing how to reconcile the unique privacy concerns in behavioral health and the prevalence of solo behavioral health practitioners with use of EHR's.  Patients must give consent for their healthcare information to be transmitted via the MassHIway.  The Mass eHealth Institute is the state agency coordinating information technology innovation and use, working closely with the MA Executive Office of Health and Human Services (EOHHS).

At the Federal Level       

The ACA has survived numerous political and court challenges and remains the law governing healthcare in the US.  The transition from fee-for-service to quality or value-based delivery and payment systems has gone more slowly for Medicare than CMS had anticipated.  Nonetheless, Jeff Micklos, Executive Director of the Health Care Transformation Task Force sees progress in some areas:  “The system is making great strides in modernizing care delivery to better coordinate and manage care for patients with chronic medical conditions. Overall, the system is more focused on driving better population health by proactively addressing social needs that contribute to poor health in communities. Health care organizations know better than ever what it means to put patients first and involve them in their care delivery in a meaningful way and modern technology is helping patients more readily access the system….” (June 2019 e-newsletter) He reports that Medicaid programs have embraced innovation more quickly than Medicare.

The Health Care Transformation Task Force and another national stakeholder group, the Health Care Payment and Learning Action Network, monitor and educate health care organizations on how new care delivery and payment methods are working or not working.  As the COVID-19 pandemic has re-focused the spotlight on health disparities, these groups are  gathering and presenting information about “how prospective, population-based payment models can help reduce disparities in care and improve outcomes, and further modifications in care delivery and payment reform to help achieve equity” by examining healthcare responses to this pandemic. (LAN Summit October 23, 2020 agenda). You can visit the websites for these groups to learn more and sign up to receive updates and notices for conferences and webinars from them electronically. 

Questions? Or if you’d like to join the HRC, please contact the HRC Chair. (Can this be a live link to my email: coaklewelch@verizon.net  ? I don’t want my email listed on the website.)