Massachusetts Health & Human Services Secretary Marylou Sudders has announced an initiative to improve access to ambulatory behavioral healthcare.
  
The current problem, according to a state outline of the proposal, is that people in need of behavioral healthcare may not know how to access it. That is, they are unsure of whether to contact their doctor, go to a hospital ED, call their insurance company or a hotline, or research options on the internet, among other decisions. They also may be embarrassed about seeking treatment, get lost in the maze of treatment acronyms, or have trouble finding a provider that takes their insurance coverage.
  
Sudders said the initiative is intended to “redesign the front door of behavioral health. Together, we will imagine a system that presents a no-wrong-door point of entry – a system with same-day access, that defines community-based emergency and urgent care responses and untangles the maze that has been created in the absence of a coherent system.”
  
The goal is to gather data and feedback through listening sessions in June and August, request written comments in August, create a roadmap for future action in September, and in the winter of 2019-2020 issue a policy roadmap of how the improved-access initiative would actually work.
  
The first listening session in a series of eight across the commonwealth is on Wednesday, June 5, from 4 to 6 p.m. at 1 Ashburton Place, 21st Floor. This EOHHS slide deck provides more details about the initiative and key questions EOHHS hopes to have answered as it further develops the plan.

DPH is proposing regulations that will require almost every prescription generated in Massachusetts to be issued in a federally compliant electronic format as opposed to being written on a paper pad.
  
The regulations are needed to implement Chapter 208 of the Acts of 2018 – that is, Governor Baker’s CARE Act that the legislature passed last July to fight the opioid epidemic.
  
Under the proposed rules, all prescriptions for drugs that fall under the federal Schedules II through V, as well as what Massachusetts terms some Schedule VI drugs, must be issued by electronic prescription. 
  
There are exceptions for compounded drugs, for prescriptions issued under a time-limited waiver for economic hardship or technological limitations, for prescriptions issued in certain emergency situations, and for Schedule VI drugs issued by a prescriber with only a Schedule VI Massachusetts Controlled Substance Registration, among others.
  
The regulations also contain provisions allowing a patient to choose to have a prescription partially filled. This is to permit patients to receive, for example, a strong opioid to counter pain in the short term without having to worry about extra, unneeded pills being left over and subject to future misuse.
  
A hearing on the proposed changes is scheduled for 9:30 a.m. on Thursday, June 27, in the Public Health Council Room, Second Floor, DPH, 250 Washington Street, Boston. MHA and member hospitals have been involved in the draft guideline process to date and plan to provide further feedback to DPH.

Currently if a hospital needs to cut a program in a service area because, for example, another facility in its integrated care network is better able to carry out the service, that hospital has to provide notice of the closure to the general public, employees, legislators, and any state agency that the closure may affect. In addition, the hospital must submit notice to the Health Policy Commission, which has the authority to share the information with the Attorney General’s office for further review.
  
However, under a proposed bill that had a hearing last week, hospitals would have to drastically expand the list of who would be notified, seek approval for the change from each nearby municipality, answer to a new “community oversight committee” made up of select employees and “a representative from a local interfaith organization”, as well as a host of other hurdles.
  
“There is already a robust – but reasonable – process in place that requires active engagement with stakeholders,” said MHA’s Senior V.P. of Government Advocacy Mike Sroczynski. “The new proposal would have the unfortunate effect of imposing barriers and delays that may prevent hospitals from making timely strategic decisions regarding services within an integrated care delivery system, including many Accountable Care Organizations and other value-based programs. This proposal would hamper hospitals’ ability to be agile in responding to today’s extremely dynamic healthcare landscape, and punish hospitals that make needed changes by prohibiting those that close a service from applying for expansion or other licensure.”

Researchers at Boston Medical Center (BMC) have performed the tough task of identifying the hows and whos of the statewide opioid epidemic that is killing nearly 2,000 people a year in Massachusetts.
 
The study from BMC’s Grayken Center for Addiction and published in Drug and Alcohol Dependence looked at 2,244 opioid-related overdose deaths from 2014 and 2015 where toxicology results were available. Seventeen percent of those deaths had only opioids present, 36% had opioids and stimulants (primarily cocaine), and 46% had opioids plus other substances, but not stimulants.
 
The Grayken Center says the study “shows that opioid-related overdose deaths involving another substance is now the norm, not the exception, in Massachusetts.” The study also noted who is most affected, saying, “individuals over the age of 24, non-rural residents, those with co-morbid mental illness, non-Hispanic black residents, and those with recent homelessness were more likely to have opioids and stimulants, such as cocaine or methamphetamine, in their systems at their time of death than opioids alone.”
 
“As a provider, these findings indicate a pressing need to address and treat not just opioid use disorder, but other substances that patients are misusing,” said lead author Joshua Barocas, M.D., an infectious disease physician at BMC and assistant professor of medicine at BU School of Medicine. “To truly make a difference in reducing opioid overdose deaths, we must tackle issues such as homelessness and access to mental health services. This means not only investing in treatment but also implementing tailored programs that address the specific barriers to accessing care.”

Healthcentric Advisors in partnership with the Massachusetts Coalition for the Prevention of Medical Errors on Thursday, June 20, is holding a program entitled “A Collaborative Approach to Reducing Readmissions: Harnessing the Patient Voice to Improve Care Transitions.” The 8:00 a.m. to 3:30 p.m. program will be held at the Boston-Natick Crowne Plaza, 1360 Worcester Street, Natick.
  
Registration is limited so sign up as soon as possible by clicking here.
  
More than 18 speakers will share strategies and successful interventions that have proven to be effective in reducing readmissions.

The Center for Health Information and Analysis (CHIA) last Thursday released its latest report on provider price variation in Massachusetts.
 
CHIA focuses on relative prices, calculating both payer-specific relative price (which enables comparison within a payer’s network) and cross-payer statewide relative price (which enables comparison across commercial payers).
 
To see the report and data for all hospitals, click here.

The Intersection of Human Trafficking and the Healthcare System:
What Caregivers Need to Know

Friday, July 12; 8:30 a.m. - 1:30 p.m.
MHA Conference Center, Burlington, Mass.

Human trafficking is an ongoing public health threat that often goes undetected. Health systems can play an important role in identifying and treating trafficking victims. From their immediate physical and emotional healthcare concerns to longer-term mental health and substance use issues, trafficking survivors often need a complex array of healthcare services. Mental health services are particularly important, as virtually all survivors have experienced some form of trauma. Because healthcare providers are in a unique position to identify victims and provide them with physical and psychological care, it’s critical that caregivers can identify the signs and find strategies to help their patients. At this conference, leading national and regional speakers – as well as a survivor of human trafficking – will provide an overview of this public health issue and discuss strategies and resources that providers can integrate into their organizations to better treat these patients. Click here to learn more and register.