Competency Area #1: Respect, understand, and engage MassHealth members

The key elements that comprise Competency Area #1 are outlined below. These can be used as touchpoints in determining whether your TA project helps advance your ACO or CP in this competency.

Core Competency #1

Member characteristics, preferences, and needs: ACOs and CPs understand the social, cultural, linguistic, and access characteristics, as well as the overall preferences and needs, of the unique population(s) of MassHealth members they serve in order to ensure that they are capable of engaging every MassHealth member enrolled in their ACO or CP using a person-centered approach that is responsive to the member’s individual circumstances, accommodation needs, and complexity of care.

Responsive models of member engagement and care: ACOs and CPs design and implement models of member engagement and care that are responsive to the social, cultural, linguistic and access characteristics, as well as the overall preferences and needs, of the unique population(s) of MassHealth members they serve in order to ensure that all members gain the maximum benefit from the services available to them, regardless of their individual circumstances or the complexity of their care.

Responsive models of organizational governance: ACOs and CPs design and implement models of organizational governance that enable MassHealth members to inform the decision-making of ACOs and CPs.

Risk stratification: ACOs and CPs apply member data and qualitative insights into member characteristics, preferences, and needs to design, implement, evaluate, and refine risk stratification models that enable them to better understand, engage, and care for the unique population(s) of MassHealth members they serve.

External partnerships, including clinical-community linkages: ACOs and CPs develop and maintain partnerships with a broad range of external organizations, including hospitals, specialist providers, oral health providers, state agencies, social services agencies, and community-based organizations of all sizes, in order to maximize their capacity to address the care coordination, complex care management, health needs, and health-related social needs of every MassHealth member enrolled in the ACO or CP.

ACO/CP Integration: ACOs and CPs develop and maintain shared values, incentives, data, and workflows across ACO-CP partnerships in order to ensure that MassHealth members with the most complex behavioral health, long-term services and support, and health-related social needs benefit from comprehensive and seamless systems of care while leveraging the unique expertise and competencies of both entities.

Next: Competency Area #2

Project Examples

Strengthen ACO member identification and outreach: An ACO engages a TA vendor to help better understand the members it serves in an effort to improve the experience of members at the ACO and ensure that MassHealth member voices are heard and valued. The TA vendor helps the ACO to assess the current process for member identification, outreach, and onboarding and design new processes that better enable the ACO to address the social, cultural, linguistic, and overall access needs of persons from diverse backgrounds and/or with complex needs.

Integrate CHWs into ACO workflows: An ACO engages a TA vendor to help integrate community health workers (CHW) into workflows in three primary care practices in order to better understand, engage, and care for MassHealth members. This TA project can lead to improved member engagement because CHWs help build trust with MassHealth members based on shared experience. When CHWs are fully integrated into these practices’ workflows, they can bring their unique understanding and knowledge of members back to the larger health care team, thus improving the care coordination and addressing health-related social needs for a subset of the ACO’s members. This project also addresses Competency Area #2 in that it enlists and develops care team insights and capabilities.

Build ACOs’ relationships with community-based organizations: An ACO works with a TA vendor to build relationships with social service organizations in order to ensure strong linkages between the ACO’s members and groups that can address their non-medical needs. The TA vendor will help the ACO identify community-based organizations capable of addressing key health-related social needs for members; initiate relationships and establish shared goals with selected community-based organizations; and develop streamlined processes by which ACO staff and providers can refer members to their services.

Design and strategic development of CP Community Advisory Board: A CP engages a TA vendor to support the design and strategic development of its Community Advisory Board to promote inclusion, access and understanding of its CP members. The CP will integrate these findings into their care processes to better serve members. This project also addresses Competency Area #5 in that it generates qualitative insights into member needs and preferences to inform the development of responsive models of care coordination and complex care management.