Health Care Reform Committee

Neuropsychologists in-the-know      

With the changes in healthcare priorities and in payment and healthcare delivery systems that came with the 2010 federal Affordable Care Act (ACA) and the 2012 Massachusetts healthcare law Chapter 224, neuropsychologists realized that we need to be aware of the healthcare environment in which we practice.  Both laws seek to improve each person’s experience of care by delivering patient-centered care (better care), reduce healthcare costs (better value), and improve the health of populations (better health outcomes). In response to the COVID-19 pandemic's spotlight on health disparities in the US, public and private healthcare policy makers now include reducing health disparities as a fourth priority for healthcare systems.  Coordination of care with other clinicians and expanding access to our services for traditionally underserved groups are critical priorities for our profession.

Five past MNS Presidents and Board members have chapters in a 2019 book designed to educate clinicians regarding the role that neuropsychology plays in integrated healthcare.  According to the publisher, Springer, “This unique volume teaches those in the medical fields about the scientific value of neuropsychology in assessing cognition, the 6th vital sign, as part of well integrated collaborative care.  It offers physicians a comprehensive tour of the many dimensions neuropsychology can add to primary and specialized medical care across the lifespan.….The Physician’s Field Guide to Neuropsychology (Karen Sanders, Editor) is both a rigorous and an accessible reference for clinicians in diverse disciplines including general practice, family medicine, neuropsychology, pediatrics, gerontology, and sports medicine. …”

MNS Past Presidents Maggie Lanca, PhD and Karen Postal, PhD, current MNS Board member Flannery Geier, PsyD,  and former MNS Board members Emily Wilner, PsyD, and Jen Queally, PhD contributed chapters.  Dr. Lanca’s chapters include  A Model of Collaboration between Primary Care and Neuropsychology;  Neuropsychological Assessment of Adult Attention-Deficit/Hyperactivity Disorder – co-authored with Dr. Geier,  and Neuropsychology in the Twenty-First Century: The Rise of Multicultural Assessments -- co-authored with Dr. Wilner.  Dr. Queally’s chapter is entitled, The Integration of Neuropsychology in Pediatric Care Teams .  Dr. Postal writes on the topic of Effective Feedback Conversations.  Be sure to add this to your reading list --- and request it for or gift it to your hospital, clinic, or office library!

To learn the basic terms, trends, practice issues and solutions, and other information related to Patient Protection and Affordable Care Act (ACA for short), visit the IOPC Toolkit website: https://iopc.online/healthcare-reform-101

At the State Level
                                             
Massachusetts had a head start in implementing healthcare reforms. The federal Affordable Care Act (ACA) is modeled on the 2006 MA healthcare reform law, which required all citizens in the Commonwealth to have health insurance and established insurance exchanges. Furthermore, in 2012, MA Chapter 224 became law: An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. The schedule for implementing specific elements of this act, focused on healthcare delivery systems and payment reform, is at the end of the law.

Chapter 224 established the Health Policy Commission, which is charged with advancing “ a more transparent, accountable, and innovative health care system through independent policy leadership and programs.  Our goal is better health and better care at a lower cost across the Commonwealth.” The HPC monitors healthcare cost trends and sets annual goals for keeping cost increases low.  The Commission also solicits input from healthcare stakeholders in developing new models of care, such as Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO).  The HPC then sets the standards and certifies health care organizations as PCMHs or ACOs.  ACO certification standards are being updated for 2022-2023 certification.  In 2017, Massachusetts became the first state to have statewide, all-payer standards of care for care delivery.  PCMH certification stresses the importance of integrating behavioral health care in primary care settings.  

Electronic health records (EHR) are central to providing integrated care, according to state and federal laws. The Mass HIway is the Massachusetts Health Information Exchange (HIE) allows all healthcare clinicians to “push” (send) and “pull” (access and receive) patient information via this secure electronic communication network (with patient consent). An EHR system is not required to connect. For information on how to enroll and/or sign up to receive newsletter, go to: http://www.masshiway.net/HPP/index.htm

 

Although MA Chapter 224 states that all healthcare providers will connect through the Mass HIway, as of April 2022, no plans to require this for solo and small-group behavioral health clinicians have been announced.  Connection requirements have been phased in over a 4-year period that extends into 2022 and affect only these health care facilities: acute care hospitals, community health centers, and medium/large medical ambulatory care practice.  Individual clinicians are not required to connect -- only the organizations. The Mass HIway team will keep the healthcare community updated of any additional phase-in requirements. The regulations (101 CMR 20.08(1b)) specify that future guidance will provide at least one year notice for affected provider organizations to connect to the Mass HIway.  Any additional requirements related to neuropsychologists will be posted here and on the MNS list serv, but no such plans are on the horizon as of April 2022.

 

Medical practitioners governed by the Board of Medicine have generally been further along in adopting EHR's relative to behavioral health clinicians, although behavioral health clinicians and practices are increasingly moving from paper to electronic records.  Various task forces analyzed the unique privacy concerns in behavioral health.  As of April 2022, requirements to adopt EHR’s in Massachusetts behavioral health practices is off the table. Should this change, any announcement regarding EHR requirements will be posted here and on the MNS list serv.

At the Federal Level       

The ACA has survived numerous political and court challenges and remains the law governing healthcare in the US.  The transition from fee-for-service to quality or value-based delivery and payment systems has gone more slowly for Medicare than CMS had anticipated.  Medicaid programs have embraced innovation more quickly than Medicare.  Nonetheless, changes in payments and healthcare delivery systems continue to be implemented, tracked, and incentivized. The Health Care Transformation Task Force and another national stakeholder group, the Health Care Payment and Learning Action Network, monitor and educate health care organizations on how new care delivery and payment methods are working or not working.  They have a new focus on how these methods can reduce health disparities.

 

The Biden-Harris administration is working to strengthen the ACA by directing all federal agencies involved in administering the ACA, Medicare, and Medicaid to review all policies and procedures related to expanding access to high-quality health care and healthcare coverage, with goals of lowering coverage costs in the ACA marketplace exchanges, expansion of Medicaid in states that have not yet expanded coverage, requiring high quality coverage,  and improve connections between healthcare systems and other stakeholders to address social determinants of health.

 

The COVID-19 pandemic re-focused the spotlight on health disparities.  CMS has created an ACO initiative focused on health equity with models to launch in 2023. This is called the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.   From the Centers for Medicare & Medicaid Services: “CMS has redesigned the Global and Professional Direct Contracting Model (GPDC) Model in response to {Biden-Harris} Administration priorities, including our commitment to advancing health equity, stakeholder feedback, and participant experience. CMS is renaming the model the ACO REACH Model to better align the name with the purpose of the model: to improve the quality of care for people with Medicare through better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved, a priority of the Biden-Harris Administration.”

 

You can read about this model here.

 

Questions? Or if you’d like to join the HRC, please contact the HRC Chair