Slide 1: One Care:  Implementation Council Meeting
Executive Office of Health & Human Services
MassHealth Demonstration to Integrate Care for Dual Eligibles
January 12, 2021, 10:00 AM – 12:00 PM
Virtual Meeting via Zoom
Slide 2: Topics to be discussed…
•	Integrated Care Team COVID Data Update 
o	COVID Positive Cases and Deaths 
o	Monthly COVID Positive Cases and Deaths
o	Morbidity and Mortality Rates 
o	Monthly Morbidity and Mortality Rates 
•	Department of Mental Health (DMH) 
o	DMH Engagement
o	The Role of the DMH Liaison 
o	Covered Services

Slide 3: Integrated Care Plan-reported COVID-Positive Cases and Deaths
For discussion purposes only – this data is self-reported, unofficial, and preliminary
Note: the following information is shown in bar chart.
Integrated Care Plans- COVID Positive Cases and Deaths
•	One Care (Ages 21-64)
o	12/1 Enrolled = 32,945
•	Positive Cases 893 (3.0%)
•	Deaths 70 (.02%)
•	PACE (Ages 55+) *
o	12/1 Enrolled = 4,760
•	Positive Cases 987 (21.0%)
•	Deaths 227 (5.0%)
•	SCO (Ages 65+)
o	12/1 Enrolled = 66,092
•	Positive Cases 4,887 (7.4%)
•	Deaths 808 (1.2%)
The above graph displays the cumulative number of positive cases and deaths of Enrollees in Integrated Care Plans through December 31, 2020. Percentages are cases divided by December 1, 2020 enrollments.

*All PACE participants are at a Nursing Facility Level of Care
Slide 4: Integrated Care Plans – Monthly COVID-Positive Cases and Deaths
For discussion purposes only – this data is self-reported, unofficial, and preliminary
Note: the following information is shown in line graph for the months of March 2020 – December 2020.
IC Plans - Monthly COVID Positive Cases and Deaths
Total Membership (n) as of December 1, 2020
	One Care – 32,945
	PACE – 4,760
	SCO – 66,092
One Care Positive
•	March: 53
•	April: 	382
•	May: 	225
•	June: 79
•	July: 39
•	August: 	17
•	September: 10
•	October: 23
•	November: 33
•	December: 32
One Care Deaths
•	March: 1
•	April: 18
•	May: 27
•	June: 9
•	July: 1
•	August: 7
•	September: 0
•	October: 6
•	November: 0
•	December: 1
PACE Positive
•	March: 41	
•	April: 527
•	May: 134	
•	June: 21
•	July: 13
•	August: 13
•	September: 10
•	October: 12
•	November: 81
•	December: 148
PACE Deaths
•	March: 33	
•	April: 95
•	May: 50	
•	June: 10	
•	July: 8
•	August: 3
•	September: 3
•	October: 7
•	November: 4
•	December: 14
SCO Positive
March: 107	
April: 2,159	
May 1,002	
June: 359
July: 77	
August: 56	
September: 71	
October: 174	
November: 310	
December: 550
SCO Deaths
•	March: 7	
•	April: 372	
•	May: 288	
•	June: 53	
•	July: 19	
•	August: 16	
•	September: 6	
•	October: 8	
•	November: 12	
•	December: 24
Slide 5: Morbidity and Mortality - What is the difference?
Morbidity is the proportion of a population that has a condition or illness. It can either be calculated at a specific point in time or over a specified period of time. It is often expressed as a percentage. Mortality rate is often expressed in population units, typically as “per 100,000 people.”

Mortality refers to the number of deaths that have occurred due to a specific illness or condition. Mortality is often expressed in the form of mortality rate. This is the number of deaths due to an illness divided by the total population at that time. As with morbidity, mortality rate is often expressed in population units, typically as “per 100,000 people.”
Sources:
•	What’s the Difference Between Morbidity and Mortality?
•	Morbidity and Mortality Weekly Report
Slide 6: Integrated Care Plans - Morbidity and Mortality Rates
For discussion purposes only – this data is self-reported, unofficial, and preliminary
Note: the following information is shown in a table.

Morbidity & Mortality Rate (per 100K pop.) for IC plans (n=Total members in each plan)
•	One Care: 2,711/212
•	PACE: 20,735/3,769
•	SCO: 7,394/1,223
Monthly Morbidity & Mortality Rate (per 100K pop.) for IC plans
One Care Morbidity
•	March: 161
•	April: 1,160
•	May: 683
•	June: 240
•	July: 118
•	August: 52
•	September: 30
•	October: 70
•	November: 100
•	December: 97
One Care Mortality
•	March: 3
•	April: 55
•	May: 82
•	June: 27
•	July: 3
•	August: 21
•	September: 0
•	October: 18
•	November: 0
•	December: 3
PACE Morbidity
•	March: 861
•	April: 11,071
•	May: 2,815
•	June: 441
•	July: 273
•	August: 273
•	September: 210
•	October: 252
•	November: 	1,702
•	December: 	3,109
PACE Mortality
•	March: 693
•	April: 1,996
•	May: 1,050
•	June: 210
•	July: 168
•	August: 63
•	September: 63
•	October: 147
•	November: 84
•	December: 294
SCO Morbidity
•	March: 162
•	April: 3,267
•	May: 1,516
•	June: 543
•	July: 117
•	August: 85
•	September: 107
•	October: 263
•	November: 469
•	December: 832
SCO Mortality
•	March: 11
•	April: 563
•	May: 436
•	June: 80
•	July: 29
•	August: 24
•	September: 9
•	October: 12
•	November: 18
•	December: 36
Slide 7: Integrated Care Plans - Morbidity and Mortality Rates (cont.)
Note: this slide displays the same data from Slide 6 in a line graph.
For discussion purposes only – this data is self-reported, unofficial, and preliminary.
IC Plans Monthly Morbidity & Mortality Rates (per 100K pop.)
Slide 8: One Care Contract Language for DMH Engagement
•	Care Delivery Model – Behavioral Health Section 5.2.3.3.1 indicates that; 
o	The Contractor must ensure that Enrollees with serious and persistent mental illness have access to services in keeping with the recovery principles, including ongoing medication review and monitoring, outpatient treatment, rehabilitation, recovery and support programs, Peer Support/Counseling/Navigation and other milieu alternatives to conventional therapy. The ICT must coordinate services with additional support services as appropriate. For such Enrollees, a qualified behavioral health clinician (see Section 2.5.2.2.2) must be part of the ICT. As necessary, care coordination with the DMH and its contracted programs that serve the Enrollee must be provided.
•	The Contractor shall ensure that services provided to Enrollees with DMH affiliation as follows (Section 2.5.8.2 – 2.5.8.2.5.2);
o	Ensure that Covered Services are delivered to all Enrollees;
o	Ensure that the ICT communicates with the DMH caseworker(s) assigned to Enrollees and informs them of the services provided through the Contractor's plan;
o	Ensure that for all DMH clients, a release of information is requested to be used to inform the agency of the Enrollee's current status; 
o	Ensure that for all DMH clients, the ICP specifies all Behavioral Health Services required during any acute Behavioral Health Inpatient Services stay, identifies discharge plans and, when appropriate, indicates the need for DMH Community-Based Services or continuing inpatient psychiatric care as part of the ICP; and 
o	Designate a DMH liaison to work with MassHealth and DMH 
Slide 9: DMH One Care Liaison Contract Language
•	One Care contract section 2.5.8.2.5.2.1. – 2.5.8.2.5.2.5. indicates that a DMH liaison shall; 
o	Establishing and maintaining contact with designated DMH case managers, as identified by DMH, and assisting MassHealth and DMH in resolving any problems or issues that may arise with a DMH-affiliate DMH-affiliated Enrollee;
o	Upon request of DMH, participating in regional informational and educational meeting meetings with DMH staff and, as directed by DMH , family members and peer support workers;
o	As requested by DMH, providing advice and assistance to regional directors or case managers on individual cases regarding Covered Services and coordinating non-Covered Services; 
o	If requested by DMH, working with providers of twenty-four (24) hour inpatient or diversionary services to coordinate discharge planning; and
o	As requested by MassHealth, actively participating in any joint meeting meetings or workgroups with MassHealth or other EOHHS agencies
•	The DMH liaison must have previous care management experience working with persons in need of significant Behavioral Health Services

Slide 10: DMH-Affiliated Covered Services -
•	Emergency Services Programs (Section 2.8.6.3)
o	Plans must contract with Emergency Service Providers (ESPs) located in their contracted service areas.
o	One Care Plans do not have to contract with DMH ESPs, but they must coordinate admissions and triage with DMH ESPs as they would with any contracted ESPs.
•	DMH operated hospitals (Section 2.8.6.5)
o	One Care Plans must contract with hospitals operated by DMH.
•	Two DMH services fall outside the One Care plan capitation and scope of covered services: 
o	DMH Targeted Case Management (TCM) services
o	DMH contracted Adult Community Clinical Services (ACCS) services (rehabilitative services provided by DMH)
For One Care enrollees receiving TCM or ACCS, the plan must coordinate with DMH as described above, and make an LTS Coordinator available to the enrollee (Section 2.5.3.6.9)
Slide 11: One Care MassHealth+Medicare
Bringing your care together

VISIT US ONLINE
www.mass.gov/one-care

EMAIL US 
OneCare@state.ma.us