Slide 1: One Care Implementation Council’s
Recommendations to MassHealth
One Care Contract 2.0
March 10, 2020
Slide 2: Outline
•	Background
•	Context (One Care enrollee experiences)
•	Past recommendations
•	Priorities in focus
•	Next steps 
Slide 3: IC MOU/3-way contract recommendations
•	Health and Wellness Equity: eliminate disparities in health care quality and access, so that all One Care enrollees can achieve their highest level of health and wellness.
o	Require plans to participate in health equity pilot projects
o	Initial focus on women’s health and wellness
•	Adherence to Independent Living (IL) and Recovery Models: 
o	Require plans to demonstrate care planning, goal setting and authorization processes that align with IL and recovery models
o	Integrate LTS Coordinator, CPS and CRC enrollee engagement in onboarding and care planning
Slide 4: IC MOU/3-way contract recommendations
•	Sustainability: 
o	Reduce preventable ED visits and hospitalizations
o	Reduce isolation
o	Reduce health and wellness disparities
•	Provide evidence of strategy to promote sustainability:
o	Increase investment in person-centered LTSS, behavioral health and social needs
o	Rebalance spending
o	Alternative payment models
o	Evidence-based growth and sustainability  
Slide 5: Ongoing areas of focus
•	Person centered care:
o	Role of the care coordinator
o	Care planning - include the member and their goals beyond medical and include wellness (ex: nonmedical transportation and isolation prevention)
o	Address medical necessity and administrative prior authorization processes that act as barriers to enrollee attainment of identified care goals
o	Care coordination - high touch consistent coordination, education and advocacy to support enrollee goals
•	Quality measures and transparency:
o	Increase reporting requirement by plans on percentage of enrollees accessing services, and duration and frequency of those services.
Slide 6: Next steps
•	In collaboration with MassHealth hold public meeting to discuss the MOU for DD 2.0
•	Continue drilling down contract recommendations by IC to advance increased oversight of plans by MassHealth and CMS
•	Advocate for increased plan oversight using best practices from other states
•	Respectfully request MassHealth to provide monthly updates to the Council on status of specific contract recommendations by the Council and other advocates, e.g., DEAF communication access and food is medicine