June 17, 2020

Best Practices: Helping Our Most Vulnerable, At-Risk Patients

Recent investment in behavioral health in Massachusetts, including a redesigned MassHealth program, with Accountable Care Organizations (ACOs), Managed Care Organizations (MCOs) and Behavioral Health Community Partners (BH CPs) has created opportunities to improve services and quality of life for patients with complex needs. “The ACOs we selected demonstrate a strong commitment to improving care for the members they serve and will be held to high standards for quality and access of care,” noted Dan Tsai, Assistant Secretary and Director of the MassHealth program, at the time of the redesign rollout in June 2017.

Best Practices and Perspectives

As a participating ACO, Mass General Brigham, along other providers from across Massachusetts, shared best practices and their perspectives on the current state of integrated behavioral health care in a new white paper sponsored by Eliot Community Human Services. This report focuses on three key areas of insight: how successful care teams are using an integrated care lens to build relationships and practice dynamic collaboration; deploying integration with innovation and using technology, IT and information exchange.

To keep patients healthy, on vital medications and out of the hospital, the solution is knowing patients’ needs, identifying the right resources and having behavioral health staff embedded in the primary care practice. “Our embedded social worker is like a partner in my practice – that’s how closely I work with her,” said Salina Bakshi, MD, a primary care physician at Massachusetts General Hospital.

Dr. Bakshi also incorporates a population health mindset by combining concepts of social determinants of health with professional collaboration, big data and policy making to address the targeted needs of communities.

Mental Health Challenges

Strategies used by mental health experts to meet ongoing challenges faced by people with severe mental illness have gone largely unaddressed in the standard primary care model. “I think of the case of a woman who had experienced past domestic violence: her concern was moving to a higher-level apartment to feel safer,” says Alexy Arauz-Boudreau, MD, a primary care physician at MassGeneral Hospital for Children, Medical Director for Primary Care & Population Health Management and Medical Director of MGH/MGPO Medicaid ACO. “If someone has a history of trauma, is that feeling paranoia? Yet without having a basic sense of security, it’s almost impossible to begin a clinical treatment plan,” said Dr. Arauz-Boudreau.

Value, Accountability and Transformation

Finally, the report addresses value and accountability and the need to implement a value-based care model to achieve successful person-centered mental health care.

The MassHealth redesign brought together behavioral and physical health and put a spotlight on care integration. It also showed that we need to rethink and reallocate mental health resources, as well as delivery that requires planning, analytics and collaboration. Each of the experts interviewed agreed – in a mental health care system in desperate need of sweeping and sustainable change, it is time for real transformation.


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