Improving Care Coordination between Accountable Care Organizations and Community Partners: Early Findings from the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Program

Abstract

Research Objective: The Massachusetts’ Medicaid and Children’s Health Insurance Program (MassHealth/MH) initiated the Delivery System Reform Incentive Payment (DSRIP) program in 2017, as part of its section 1115 Demonstration, to coordinate care for Medicaid members, reduce healthcare costs and improve patient outcomes. Central to this program was a requirement that Accountable Care Organizations (ACOs) develop relationships with all behavioral health and at least 2 long-term care service MH contracted Community Partner agencies (CPs) operating in their service areas to be responsible for coordinating care and developing care plans for members. This presentation will describe barriers and facilitators to developing ACO-CP relationships identified in the first 1.5 years of program implementation. Study Design: This paper focuses on ways in which ACOs and CPs are responding to new contracting requirements and programmatic expectations related to the MA 1115 DSRIP. Semi-structured interviews were conducted with individuals in leadership positions at all 17 ACOs and 27 CPs by pairs of trained interviewers, in person, or via video or teleconference. Interview data were analyzed qualitatively, using a framework approach informed by the literature, the program logic model, and the evaluation design. Population Studied: ACOs/CPs nominated 2 to 3 individuals best positioned to speak to implementation topics including governance and organizational structure, workforce development, ACO-CP relationships, provider engagement, care coordination, quality improvement, and environmental factors including the role of MassHealth. Ninety-four interviews were conducted with 99 interviewees across the 44 organizations. The majority of interviewees were female and typically held managerial roles, ranging from program managers to executives. A majority were with their organizations prior to or at the time of DSRIP inception. Principal Findings: Communication and information sharing were identified as key ingredients to coordinating member health care between ACOs and CPs; the absence of effective means to communicate and share information were identified as major barriers. Strategies for enhancing communication included scheduling regular meetings to discuss shared patients (i.e., within and between organizations), designating points of contact (e.g., staff liaisons), and clarifying roles regarding member-facing activities. Information sharing was found to be most effective when organizations agreed on processes, particularly around the use of electronic medical records or other information exchange technologies. ACO and CP interviewees indicated that successful communication and information sharing led to the development of stronger and more positive partner relationships (e.g., between an ACO and the CPs with which they share information and coordinate care well). Participants also described ways in which MassHealth has actively responded to challenges within the original design of the ACO-CP relationship to improve coordination and member experience. Conclusions: Designated points of contact, well-conceived and executed communication strategies, and effective information exchange are essential for developing relationships and coordinating care between ACOs and community-based organizations. Implications for Policy or Practice: States need to consider the complexity of coordinating care with multiple community-based agencies and the importance of standardized processes for effective information sharing when promoting care coordination between health care and human service entities. States should also incorporate means of ongoing technical support and rapid cycle feedback to allow for continuous policy improvement in Medicaid delivery systems.