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Seeing results: 2019 will show whether opioid, ACO and staffing initiatives are on the right path

BY Grant Welker

12/24/2018
Photo/Courtesy/Flickr-Cindy Shelby
Photo/Courtesy/Flickr-Cindy Shelby
The state's opioid death rate has been flat despite broad efforts. The coming year could show whether those initiatives are making headway.

Opioid deaths in Massachusetts surpassed 2,000 in 2016 and nearly as many in 2017. In 2018, they were roughly on the same pace, with more than 1,500 deaths in the first nine months of the year.

That data from the state Department of Public Health could be seen as either promising – the epidemic may not be getting worse – or discouraging, as efforts by so many at the state, federal and local levels have yet to curb deaths by any significant amount.

Either way, 2019 may offer a good clue for whether efforts are working. And those efforts have been many.

Among initiatives cited by the Department of Public Health, the state has put in place first-in-the-nation limits on opioid prescribing, created a prescription monitoring program and mandated addiction education curriculum in medical, dental and social work schools.

When a November ballot question that would have put in place nurse staffing mandates failed, hospital leaders said they'd nonetheless work with unions to make changes to improve patient care.

In the aftermath of the ballot question's failure – which the Massachusetts Health & Hospital Association spent $25 million to help defeat – the association's president and CEO, Steve Walsh, said the question was only the start of a conversation on patient care.

“Question 1 forced some difficult and necessary discussions about the future of health care and the future of our workforce going forward,” Walsh said. “These are conversations we owe to the voters. Most importantly, these are conversations we owe to our patients.”

The Massachusetts Nurses Association, which fought for the new standards, said it will continue fighting for better patient care.

Donna Kelly-Williams, the association president, said hospitals admitted there was a problem with patient care but didn't want to be held accountable with set staffing limits.

“We'll wait, along with those patients in harm's way, to see what their proposed solution is,” Kelly-Williams said.

Early in 2018, the state began a new system of care for Medicaid patients in hopes of having better-coordinated patient care and a way to keep costs down.

In Central Massachusetts, Fallon Health and Reliant Medical Group combined to form one of 17 such Massachusetts accountable care organizations, or ACOs.

Fallon has partnered with Health Collaborative of the Berkshires in Western Massachusetts and Wellforce in Eastern Massachusetts, while Worcester's Kennedy Community Health Center is one of 13 federally qualified health centers to combine under another ACO.

Each of these teams, with insurers paired with providers, are given incentives to keep costs down, while in some cases, such as with Fallon and Reliant, they already work together in similar ways.

Meanwhile, under another new MassHealth feature, a network called the Central Community Health Partnership has been assembled for behavioral health needs consisting of Central Mass. nonprofits Open Sky Community Services, AdCare, LUK Inc., and Venture Community Services. There's also a long-term services and supports team to help those with physical or intellectual disabilities to include Elder Services of Worcester Area and the Center for Living & Working.

Many of those agencies already work together, too. The coming year will give ample evidence of whether the ACO system will improve care and rein in costs.