Slide 1: One Care:  Implementation Council Meeting
Executive Office of Health & Human Services
MassHealth Demonstration to Integrate Care for Dual Eligibles
February 8, 2021, 10:00 AM – 12:00 PM
Virtual Meeting via Zoom
Slide 2: Topics to be discussed…
•	One Care Enrollment and DMH Affiliation
•	Rating Category One Care Contract Language
•	Readiness Review Update
•	Audit Tool update 
•	Quality Measures
Slide 3: January 2021 One Care Enrollment
Note: the following information was shown in tables on this slide.
•	Effective January 1, 2021, total number of enrollees:  31,372
Total Enrollment by Plan
Commonwealth Care Alliance (CCA)	28,186
Tufts Health Plan 	3,186
Total	31,372

Total Enrollment by Rating Category
Rating Category	Enrollees		% of Enrollees
F1	228	0.7%
C3B	275	0.9%
C3A	15,278	48.7%
C2B	1,431	4.6%
C2A	8,788	28.0%
C1	5,361	17.1%
Unavailable*	11	0.0%
Total	31,372	100.0%

*The rating categories for 11 enrollments were unavailable at the time of this report.
One Care Enrollees with DMH Affiliation (January 2021): 2,996
•	CCA: 2,789
•	Tufts Unify: 207
Slide 4: One Care Rating Category Definitions

•	F1 – Facility-based Care. Individuals identified as having a long-term facility stay of more than 90 days
•	C3 – Community Tier 3 – High Community Need. Individuals who have a daily skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations
o	In CY2014, C3 split into two subsets:
•	C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3
•	C3A: for remaining C3 individuals
•	C2 – Community Tier 2 – Community High Behavioral Health. Individuals who have a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need
o	In CY2014, C2 split into two subsets
•	C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness 
•	C2A: for remaining C2 individuals 
•	C1 – Community Tier 1 Community Other. Individuals in the community who do not meet F1, C2 or C3 criteria
Slide 5: One Care Contract Negotiations/Readiness Reviews
•	MassHealth is engaged in contract negotiations with three selected entities
•	MassHealth and UMass Medical School have shared the first set of deliverable requests with the selected entities, and are preparing additional requests
•	The first part of the review process focuses on:
o	Enrollee Services – emphasizing on training polices and access
o	Network Adequacy and Accessibility
o	Organizational Structure - Sufficient Staffing and Staff Training
o	Care Coordination Capabilities
o	Assessment and Care Planning
o	Information Systems
•	CMS will also conduct Readiness Reviews for entities with which they do not currently contract, and annual reviews for all entities expected to offer One Care products in 2022
Slide 6: One Care Plan Clinical Audit Update
•	Clinical Audit Tool Review
o	Feedback from the Implementation Council will be incorporated into the Clinical Audit Tool before distribution to current One Care Plans.
•	Scope of documented providers was expanded;
•	Expanded scope of “refusal of services” definition; and 
•	Increased awareness how goals and needs of the Enrollees should be captured in assessment and care planning process. 
o	The Clinical Audit Tool is designed to evaluate One Care Plans ability to incorporate person-centered treatment and evaluation from pre-engagement and outreach of their members, through the assessment and care planning processes, and transition and discharge planning from inpatient hospital settings. 
Slide 7: One Care Current Quality Withhold Metrics
Quality Withhold Measure		Measure Steward/Data Source	
Plan all-cause readmissions		NCQA/HEDIS	
Annual flu vaccine		AHRQ/CAHPS	
Follow-up after hospitalization for mental illness		NCQA/HEDIS	
Controlling blood pressure		NCQA/HEDIS	
Part D medication adherence for diabetes medications		CMS/PDE Data	
Initiation and engagement of alcohol and other drug 
dependence treatment		NCQA/HEDIS	
Adults’ access to preventive/ambulatory health services		NCQA/HEDIS	
Encounter data		CMS defined process measure	
Slide 8: Additional One Care Quality Areas
Additional Quality and Contract Reporting
•	In addition to our Quality Withhold Measures, our One Care Plans are required to submit monitoring and performance data to CMS and MassHealth on a monthly/quarterly basis. 
•	Core reporting requirements can be found here: CMS Medicare-Medicaid Plan Reporting Requirements 
•	Plans also must conduct and submit CAHPS, HEDIS, and other surveys

Collaborating on Quality, Disparities Measurement
•	RFR Section 5.8.B.3. requires One Care plans to collect, analyze, and submit data to support identification and measurement of disparities, including in:
o	Mental health
o	Substance Use Disorder (SUD)
o	Women’s health
o	Individuals who are Deaf or hard of hearing
o	Race, ethnicity, and language
o	Sexual orientation and gender identity
o	Other areas identified by EOHHS, CMS, or the One Care plan
•	MassHealth will connect the Council to our internal quality experts to begin organizing how to approach this work
Slide 9: One Care MassHealth+Medicare
Bringing your care together
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www.mass.gov/one-care

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OneCare@mass.gov