INSIDE THE ISSUE

> Telehealth Parity Cliff
> Telehealth Helps Fight OUD
> AG Addresses Boarding Crisis
> Bring ARPA-H to Mass.
> Apply for AHA Equity Award
> ACHE of MA Conference Nov. 1

MONDAY REPORT

Providers Seek Lifeline, Not Shove, as They Near Telehealth Cliff

On January 1, 2023, the provider community will face a “cliff” when the telehealth payments they receive for primary care and chronic disease management services to patients will no longer be equal to the payments they receive for providing in-person care.

While some insurers – Point32Health (Harvard Pilgrim Health Care and Tufts Health Plan) and MassHealth – have announced that they’ll continue to pay at parity with in-person visits even after the New Year, the state’s largest insurer, Blue Cross and Blue Shield of Massachusetts, recently announced that come January 1, providers will be subject to a payment cliff; BCBSMA will reduce its payments for primary care and chronic disease management provided via telehealth by 20% in 2023.

Instead, Blue Cross, which controls about 38% of the insurance market in Massachusetts, announced that it is offering a new “Virtual Care Team Feature” in its plans, which incentivizes members to choose a virtual primary care provider and receive most care remotely through what it calls “two national healthcare providers” – Carbon Health and Firefly Health. While the details are still in development, BCBSMA’s creation of a telehealth primary care network that could draw people away from their existing primary care providers (who are having their telehealth payments cut by 20%) is raising concerns – especially among physician practices and community health centers.

To assess the current telehealth situation, it’s important to look at its recent history. Telehealth use spiked during the pandemic as patients stayed away from physician offices and hospitals, getting their care instead through virtual visits with their caregivers. The state recognized the importance of telemedicine at the outset of COVID-19, with emergency orders mandating that insurers cover and reimburse it on par with in-person visits. In 2020, the legislature passed, and the governor signed into law, Chapter 260, which decreed that behavioral health visits via telehealth must be covered in perpetuity on par with in-person visits. Coverage and reimbursement parity was also extended to primary care and chronic disease management services, but only through January 1, 2023. Any requirement for parity for all other services delivered via telehealth ended on September 13, 2021, although many insurers have continued reimbursing on par with in-person visits. On April 1, 2022, BCBSMA once again used its market power to reduce reimbursement for all other telehealth services except for certain treatment for neurodevelopmental disorders and behavioral healthcare (which has a state-mandated parity requirement) and primary care/chronic disease management (which, as noted, has a parity requirement until January 1, 2023).

“Just because the law permits you to reduce reimbursement, doesn’t mean you should do it,” said MHA’s Senior Director of Managed Care Karen Granoff. “While the statutory requirement for payment parity for certain services expires on December 31, MHA was pleased to see that Point32Health has chosen to continue to reimburse all telehealth services in parity with in-person visits. That decision is backstopped by preliminary data from the state’s Health Policy Commission, which shows that telehealth is not increasing costs or utilization. It also shows that some insurers understand that hospitals, primary care physicians, and community health centers are facing the most drastic workforce shortages and capacity constraints in recent history. We are not out of the pandemic yet, patients still rely on telehealth to visit their trusted caregivers, and the need for continued cooperation throughout the care continuum still exists.”

Granoff continued, “The promise of telehealth in terms of convenience, increased productivity, increased time in school, adherence to visits, and savings to the patient is real. We believe it is a mistake for the state’s largest insurer to devalue these telehealth benefits given the overwhelming good they have proven to be to patients and the healthcare system during the Public Health Emergency. When that emergency declaration ends, telehealth will still be needed to preserve patient access and avoid disruptions in continuity of care.”

Trahan Seeks Guidance for Telehealth’s Use to Fight OUD

As has been well-documented, the addiction crisis in America worsened during the pandemic with more people than ever dying from overdoses, and with those deaths widening the disparities between races, ethnicities, and other factors. The federal government responded to the crisis by introducing a series of flexibilities, including allowing the initiation of buprenorphine in opioid treatment programs through the use of audio-only telemedicine. But that permission depends on the Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration issuing the necessary public guidance documents. Last week, U.S. Representatives Lori Trahan (D-Mass.) and Ann McLane Kuster (D-N.H.) called on the agencies to issue that guidance forthwith.

“The current unpredictable future of coverage for audio-only telehealth for buprenorphine creates additional barriers for patients and uncertainty for healthcare professionals in an already underserved workforce as the need for addiction specialists with clinical knowledge of [medication assisted treatment] continues to grow,” they wrote.

“MHA is strongly supportive of this measure as it will improve access to substance use disorder treatment and further unlock the promise of telehealth for patients who may face obstacles seeking that care through in-person appointments,” said MHA’s Senior Vice President, Government Advocacy & General Counsel Mike Sroczynski.

AG Healey Announces Grant to Help Alleviate Boarding Crisis

As MHA has noted for the better part of a year (see story below), 500-700 behavioral health patients, many of them children, are routinely “boarded” in hospital emergency departments and other units as they await an inpatient psychiatric bed.

Last week, Massachusetts Attorney General Maura Healey announced a $2.9 million Mental Health Diversionary Services Grant program to support non-profits in the state that can provide services to divert patients in need of urgent mental healthcare to access treatment without needing to go through a hospital’s ED.

“This grant program will help connect patients in crisis with more immediate mental health support while alleviating the strain on overwhelmed hospitals,” Healey said.

In announcing the grant, the AG’s Office cited MHA’s role in bringing attention to the crisis through its weekly publication of boarding data.

Groups eligible for the grant funding include community- or home-based crisis or urgent mental health services; non-clinical mental health crisis alternatives, such as respite services; and home-based intensive support and care coordination following a patient’s discharge from a hospital’s ED. Grantees may use the funds to create new programming, expand capacity of current programs/services, or sustain capacity where current funding sources have fallen short.

MHA’s Senior Director, Healthcare Policy, Leigh Simons Youmans, said MHA was “incredibly grateful” for the AG Healey’s creation of the grant, which is funded through settlement money arising from her agreements with five health insurance companies and two companies that manage behavioral health coverage for insurers on cases involving the companies’ compliance with behavioral health parity laws, as well as the accuracy of health insurers’ provider directories.

“This is exactly the type of investment that will help connect patients with the resources they need while they are in crisis and help relieve pressure from hospitals during a tremendously fragile time,” Youmans said. “We’ve often said that addressing the boarding crisis will take a partnership among everyone involved with our healthcare system. The legislature, Baker Administration, and Attorney General have all stepped up when it was needed the most.”

Applicants for the grants may seek up to $250,000 over a two-year period. Interested applicants can visit the AG’s website for more information and for application instructions. Applications must be received by 5 p.m. on November 16, 2022.

80 Groups Unite to Say ARPA-H Should Be in Massachusetts

The Advanced Research Projects Agency for Health (ARPA-H) was created earlier this year by the Biden Administration to push the limits of biomedical and health research in an effort to treat and cure diseases, ranging from cancer to Alzheimer’s to diabetes. ARPA-H is modeled on the innovative Defense Advanced Research Projects Agency, or DARPA. While federal funds have been appropriated to create ARPA-H, the decision as to where it will be headquartered has yet to be decided, with many in Congress insisting it be located outside of the Washington, DC Beltway.

In Massachusetts, the Coalition for Health Advances and Research in Massachusetts (CHARM) was created to coordinate the commonwealth’s effort in bringing ARPA-H to the Bay State. MHA is part of the CHARM steering committee.

Last week’s letter specifically states that Massachusetts “has the density of resources necessary for ARPA-H to thrive – talent, leading research universities, teaching hospitals, and life sciences companies.” The letter has been shared with the new Director of ARPA-H, Dr. Renee Wegrzyn; U.S. Health & Human Services Secretary Xavier Becerra, and members of the Massachusetts Congressional Delegation, among others.

“Our hospitals and health systems are proud to be part of a world-class innovation sector that is already working closely together each and every day to make extraordinary things happen for patients,” said Steve Walsh, president and CEO of MHA. “This collaboration – between state officials, healthcare institutions, higher education, and the life science community – is what helped the commonwealth lead during the darkest days of COVID-19. And it’s the same sense of community that would make Massachusetts the premier base for this agency from day one. ARPA-H is all about being bold and changing lives, and no one is better positioned to do both.”

Apply for the AHA’s Equity of Care Award

The American Hospital Association’s Institute for Diversity and Health Equity is accepting nominations for the Carolyn Boone Lewis Equity of Care Awards, which recognize “outstanding efforts among hospitals and healthcare systems to advance equity of care to all patients and to spread lessons learned and progress toward diversity, inclusion, and health equity.”

This year’s awards have been revised to allow facilities to apply within the category that best represents their equity progress. Those categories are: 1) the Transforming Award (recognizes a hospital system that is implementing strategies to influence equity in the surrounding community ecosystem); 2) the Emerging Award (recognizes a hospital that is leveraging the Health Equity Roadmap resources to dismantle structural barriers in their care delivery system and the communities they serve); and 3) the Small/Rural Hospital Excellence Award (recognizes a hospital or health system that has demonstrated excellence in advancing health equity in rural or small communities).

To begin the application for the Carolyn Boone Lewis Equity of Care Award, please click here. Lewis was the first African American and first hospital trustee to chair the AHA Board.

In Massachusetts, MHA and its hospital members, working in coordination with MassHealth and state government, have taken the nation-leading effort of baking equity improvements into the commonwealth’s five-year Medicaid waiver, which the federal government recently approved. That groundbreaking waiver agreement means that providers will be held accountable for meeting diversity, health equity, and inclusion goals as part of the payment contract they have with the Medicaid system.

ACHE Conference Set for November 1

Register now for the ACHE of MA Fall Conference, Journey to Equitable Health: How Do We Get There and Who is Leading the Way?, which takes place Tuesday, November 1 at the MHA Conference Center in Burlington. Hear from experts about strategies for addressing health disparities in care delivery, how data can be used to highlight opportunities for improvement, and ideas for leveraging community resources. The keynote speaker is Thea James, M.D., executive director of Boston Medical Center’s Health Equity Accelerator, and an MHA Board of Trustees member. The conference will feature an in-depth panel discussion, moderated by Joy Calloway, interim CEO, Planned Parenthood for Greater New York/Past Executive Director, National Association of Health Services Executives. The expert panel includes Michael Curry, CEO, Mass League of Community Health Centers; Tonya Hongsermeier, M.D., chief clinical innovation officer, Elimu Informatics; Estevan Garcia, M.D., CMO, Mass. DPH.

John LoDico, Editor