INSIDE THE ISSUE

> Healey/Driscoll
> AG Addresses Boarding
> FOCUS ON WORKFORCE: BILH
> Chapter 127 Obligations
> School Nurse Shortage
> Loan Repayment Available
> Behavioral Health Help Line
> Transitions

MONDAY REPORT

Governor Healey Sets Workforce, Healthcare Among Top Priorities

In her generally upbeat inaugural speech, Governor Healey also addressed the challenges her administration will face, from rising housing costs to crumbling infrastructure. Healey, who previously served as Attorney General and who, in that position, had a significant measure of authority on healthcare matters, also spoke about the current pressures on patients and providers.

“Our health system is the envy of the world,” she said “Yet our hospitals are desperate for staff. Patients are boarding in emergency rooms — spending hours and days in an agonizing wait for care. We sense the shadows of a mental health crisis, and too many suffering from substance use. Our companies are eager to expand, but they can’t find workers with the skills they need. Communities and people are yearning to grow and thrive, but they haven’t been given the tools to do it.”

To address the workforce challenges affecting healthcare and other sectors, Healey said that in her first budget she will create and fund “MassReconnect” that will offer free community college to students over 25 who don’t have a college degree. “We’ll also enhance early college opportunities and increase funding to our state university system so everyone can afford a higher degree,” she said.

The new governor’s healthcare comments, along with her years of close work within the healthcare arena throughout her tenure as AG resonated well with those in the health community.

“This incoming administration knows healthcare,” said Steve Walsh, MHA’s president & CEO. “As Attorney General, Governor Healey advocated for patients every day – particularly as it related to health equity, substance use disorder, and the opioid crisis. So we expect the administration to be bold and to challenge all of us – providers, payers, advocates, and others – on how we can address these issues together. We know that access, quality, and affordability will all be front-and-center, and it’s significant that workforce – the single biggest priority today for every provider – will be front-and-center for the Healey-Driscoll Administration.”

AG Addresses Boarding Crisis as She Leaves for Governorship

In one of her last acts as Attorney General before becoming Governor, Maura Healey last Wednesday announced $2.9 million in grants to non-profits that can appropriately divert patients in need of urgent mental healthcare to treatment sites without needing to go through a hospital’s emergency department.

“The demand for urgent mental healthcare services across the state has placed unprecedented pressure on our hospital emergency departments and overall capacity,” then-AG Healey said. “This innovative new grant program will help address existing shortfalls and help ensure that residents in need of mental health care services receive appropriate support.”

In a media release announcing the grants, the AG’s Office cited MHA’s weekly reporting (see below) that tracks patients boarding in a hospital as they await a behavioral health evaluation or an available psychiatric inpatient bed.

Among the recipients of funding are: a partnership between Boston Children’s Hospital and Youth Villages that will allow home-based mental health interventions for youth; the Franciscan Children’s/Children’s Wellness Initiative to bolster home-based phone and video after-care support; Lawrence General Hospital, which will hire a bilingual (Spanish/English) Behavioral Health Coordinator to provide intensive case management; Lowell General Hospital to fund a Behavioral Health Support Specialist within its ED Diversionary Services program; and Aspire Health Alliance – Enhanced Mobile Respite Services that will provide diversionary care for patients seeking behavioral health care at South Shore Hospital’s emergency department.

FOCUS ON WORKFORCE:
An Effort to Ease the Burden on EDs

Lori Cunningham, VP of Talent Acquisition, has a motto: “BILH would like you to start your career and have you retire here. BILH wants to provide all opportunities for career growth within our own system.” BILH has developed a program that aims to keep its workers in their system, but not necessarily tied to a specific role or organization within it.

As Assistant Vice President, Workforce Planning and Development at Beth Israel Lahey Health, Joanne Pokaski, describes it, “A young nurse might want to live in the city and work at an academic medical center. And then they might have a family, move to the suburbs, and suddenly that city focus doesn’t feel as fun. Maybe they want a different pace, an easier parking situation, and easier commute. We want to accommodate people where they are and whatever they want to do, and that changes in people’s lives. We have a lot of different settings to work in, so we can do that.”

With an expansive system of community hospitals, academic medical centers, and primary care offices across the eastern part of the state, both clinical and non-clinical staff can easily transfer from one location to another with support and assistance from their current managers and the organization.

Read the rest of the story about BILH’s flexible workforce strategy, as well as workplace stories from other providers throughout the state, by visiting MHA’s Workforce Toolkit.

DOI Reminds Insurance Companies of State’s Abortion Law

The state’s Division of Insurance issued a bulletin last week reminding health insurance companies that they have an obligation under the law to cover abortion services in the state without “unreasonable restrictions.”

Former Governor Charlie Baker, on July 29, 2022, signed Chapter 127, “An Act Expanding Protections for Reproductive and Gender Affirming Care.” Among other things, the law asserts that “Access to reproductive healthcare services and gender-affirming healthcare services is a right secured by the constitution and the laws of the commonwealth. Interference with this right, whether or not under color of law, is against the public policy of the commonwealth.”

DOI’s bulletin last week reminds health insurers that effective January 1, 2023, they are required to cover all abortion and abortion-related care to people covered under a health plan, including spouses and dependents. “Abortion-related” services are defined as pre-operative exams and counseling, lab services, post-operative care, and advice on contraception or family planning, among other services. Insurers can require network and utilization review for abortion services as for other procedures but they cannot impose “any unreasonable restrictions or delays” and they can’t impose deductibles, coinsurance, co-payments, or other cost-sharing requirements (except if the plan is a “High-Deductible Health Plan,” which would normally impose cost sharing).

A health plan that is offered to an employer that is a church or is “church-controlled” is exempt from the above requirements.

In a related story, the Food and Drug Administration last Tuesday allowed drugstores for the first time to dispense the abortion pill Mifepristone to people with a prescription, either in stores or through mail order. Previously the drug could only be dispensed by certified doctors or clinics. Mifepristone is used in a regimen with the prescription drug misoprostol, which has not been as tightly restricted, to terminate pregnancies.

Workforce Crisis Also Affecting School Nurses

In addition to the estimated 19,000 vacancies afflicting Massachusetts hospitals, a report last week showed that there are nearly 300 job postings for school nurses – which is more than 10% of available positions.

In an interview with WBUR, which first reported the story, Massachusetts School Nurse Organization President Cathryn Hampson said, “There’s nobody to fill the positions. I’ve been a school nurse for 26 years now, and this is the worst I’ve ever seen as far as open positions goes.”

The nursing shortage in hospitals, post-acute care facilities, and now schools demonstrates that there is indeed a widespread shortage of personnel as opposed to the argument that a minority of interests have made that vacancies are a symptom of financial decision making. In fact, the opposite is true as healthcare organizations spent an estimated $1 billion on traveler nurses in 2021, and take unprecedented steps – including high hourly wages and signing bonuses – to fill posts.

What Are You Waiting For? Loan Repayments Available

Since the state announced in early December the availability of $130 million in loan repayments for behavioral health and primary care workers, the application rate has been less than expected.

There are three separate loan repayment initiatives, offering awards that range between $12,500 and $300,000 per individual depending on their occupation, job setting, academic degree level, and whether the individual works part-time or full-time. The deadline for applying is January 30.

Last week, the Massachusetts League of Community Health Centers, which is administering the program, noted a lag in applications from employees of psychiatric units, particularly employees with bachelor and associate-level degrees. While generally the loan forgiveness program is available for already accrued educational debt, two categories of applicants are eligible for both current and future qualifying debt. This notice from Mass League contains links to the application form and contact information to learn more about the program.

CBHCs & Behavioral Health Help Line Launched (With FAQ Documents)

The state last week rolled out two components of its Roadmap for Behavioral Health Reform. Twenty-five Community Behavioral Health Centers (CBHCs) launched across the commonwealth that provide community-based crisis intervention for behavioral health needs as well as urgent visits and routine appointments. Additional information on the CBHCs, including locations and communities served, is available here.

Also launching last week is the 24/7 clinical Behavioral Health Help Line. The help line offers a single point of contact for residents to receive real-time support, initial clinical assessment, and connection to the right mental health and substance use disorder evaluation and treatment, regardless of insurance status or ability to pay. The phone and chat line offer real-time clinical triage and service navigation in more than 200 languages to help individuals and families access the range of treatment for mental health and addiction offered in the commonwealth, including outpatient, urgent, and immediate crisis intervention. Every call, text, or chat conversation will include clinical follow up. The help line is available through phone or text at (833) 773-BHHL (2445), as well as by chat online at masshelpline.com.

The Department of Mental Health has created two FAQs on the help line, one geared toward providers and advocates and another geared toward the public.

Transitions

Governor Maura Healey has appointed Mary Beckman as acting secretary of the Executive Office of Health and Human Services (EOHHS). Beckman is well known and respected in the healthcare arena, most recently serving as chief of the Health Care and Fair Competition Bureau in the Attorney General’s Office under Healey. She previously worked as compliance officer and legal counsel at Children’s Hospital Boston. The new administration said that once a permanent secretary is chosen, Beckman will become a senior advisor at EOHHS. In the interim, Marylou Sudders, the EOHHS secretary throughout former Governor Charlie Baker’s eight-year term of office, will serve as an advisor to Beckman to ease the transition.

Last Wednesday, just before her term ended, EOHHS Secretary and Board Chair of the Massachusetts Health Connector Sudders, appointed Audrey Morse Gasteier as Acting Executive Director of the Massachusetts Health Connector. Gasteier comes to the interim directorship from her role as deputy executive director and chief of policy and strategy at the Connector. She succeeds Louis Gutierrez, who recently retired after leading the Connector since 2015.

The Massachusetts Biotechnology Council’s Board of Directors last week named Kendalle Burlin O’Connell as the organization’s new CEO and president. She previously served as MassBio’s president and COO, and she replaces Joe Boncore, who stepped down as CEO at the end of 2022.

John LoDico, Editor