Slide 1: One Care: Implementation Council Meeting
MassHealth Demonstration to
Integrate Care for Dual Eligibles
January 14, 2025 10:00AM – 12:00PM
Virtual Meeting via Zoom

Note: an image of the One Care motto appears in the upper right corner of this slide. It includes the following text:
One Care
MassHealth+Medicare
Bringing your care together
Slide 2: MassHealth Agenda
•	Background – CMFI Shared Learning Workstream
•	CMFI Shared Learning Modules 
•	Shared Learning Taskforce
•	CMFI Module Training Completion Data
Slide 3: Background
The Care Model Focus Initiative (CMFI) identified challenges in defining the Care Coordinator role, promoting person-centered relationships, encouraging ICT representation, and facilitating “navigation” on Enrollees’ behalf.
Objectives
•	Establish principles guiding Care Coordinators in executing their roles; connect principles with expected outcomes to drive a goal-oriented approach to the Care Coordinator role
•	Develop options to drive person-centeredness in executing the Care Coordinator role
Scope
•	Align on and develop principles to which Care Coordinators can refer to successfully execute their roles
•	Brainstorm potential materials, programs, and/or exercises to standardize elements of Care Coordinator training across health plans 
•	Explore and document best practices for Care Coordinator relating to Enrollees, navigating to advance Enrollee goals within the health plan, and engaging with Care Teams
CMFI Deliverable
•	Training modules oriented on Care Model Focus Initiative (CMFI) recommendations to enhance care coordination by guiding Care Coordinators in best practices for person-centered care, Enrollee advocacy, conducting clinical trainings, executing comprehensive assessments and care planning, and collaborating with care team including the Long-term Supports Coordinators (LTS-Cs).
Slide 4: CMFI Shared Learning Module Roadmap
MassHealth and ForHealth Consulting co-led the Care Coordinator Shared Learning Workgroup in defining their approach to delivering training modules oriented on CMFI recommendations for enhancing care coordination.

Note: the following information is shown in a table on this slide.

Module 1 – Best Practices in Person Centered Engagement
•	Training Topics
o	Introduction to Shared Learning
o	CMFI Core Team Introduction	
o	Introduction to Module 1
o	Engagement Practices	
•	Target Month
o	January 2023 Complete (live/online)

Module 2 – Best Practices as Enrollee Internal Advocate 	
•	Training Topics
o	Introduction to Module 2
o	People Management 
o	Health Plans’ Procedures, Policies, Staff	
o	Covered Services and Flexible Benefits 
o	LTSS Denial Process Training	
•	Target Month
o	March 2023 Complete (live/online)

Module 3 – Clinical Training 	
•	Training Topics
o	Introduction to Module 3
o	Disabilities
o	Substance Use, Misuse, and Dependency 	
o	Mental Health Conditions
o	Medical Conditions
o	Key Preventative Care	
•	Target Month
o	June 2023 Complete (live/online)

Module 4 – Care Coordinator/ LTS-C Joint Training
•	Training Topics
o	Role of LTS-C
o	Care Team Convening and Facilitation	
o	Care Coordinator/LTS-C Collaboration and Communication	
•	Target Month
o	Oct/Nov 2023 Complete (live/online)

Module 5 – Housing Search Guidance and Resources Training
•	Training Topics
o	Introduction to Module 5
o	One Care Plan Internal Housing Resources	
o	EOHHS Housing Search ‘Tips & Tricks’
o	DMH Housing Services & Supports 	
•	Target Month
o	July 2024 Complete (live/online)
Slide 5: Shared Learning Taskforce Input
MassHealth and ForHealth Consulting supported the establishment of a multidisciplinary Taskforce to provide input on module content; Taskforce members relayed knowledge of One Care’s history, priorities, and Enrollees via monthly meetings.

Note: the following information is shown in a table on this slide. The table has a color-coded key below it which indicates that Lisa Fulchino is an optional participant, Tony Dodek was a kick-off meeting only participant and that all the others are permanent participants.

Name/ Affiliation/ Email Address
•	Henri McGill
o	MassHealth Integrated Care Team
o	henri.m.mcgill@state.ma.us
•	Jean Carlevale
o	MassHealth Integrated Care Team
o	jean.carlevale@state.ma.us
•	Lisa Fleming
o	Commonwealth Care Alliance
o	lfleming@commonwealthcare.org
•	Kelli Barrieau
o	Commonwealth Care Alliance
o	kbarrieau@commonwealthcare.org
•	Mariuca Tuxbury
o	Commonwealth Care Alliance
o	mtuxbury@commonwealthcare.org
•	Lisa Fulchino
o	Tufts Health Unify
o	lisa.fulchino@point32health.org
•	Sarah Gauss
o	Tufts Health Unify
o	sarah.gauss@point32health.org
•	Jess Colangelo
o	Cityblock Health
o	jessica.colangelo@cityblock.com
•	Tony Dodek
o	UnitedHealthcare
o	anton_dodek@uhc.com
•	Cori Leech
o	UnitedHealthcare
o	cori_leech@uhc.com
•	Keyla Williams
o	UnitedHealthcare
o	keyla.williams@uhc.com
•	Lisa McGlinchy
o	ForHealth Consulting
o	lisa.mcglinchy@umassmed.edu
•	Abby Velazco
o	ForHealth Consulting
o	abimelech.velazco2@umassmed.edu
•	Jeffrey Keilson
o	Implementation Council
o	jkeilso@advocates.org
Slide 6: Modules 1-5 Training Completion Data
Completion data for Modules 1 through 5, as of 07/31/2024

Note: the following data is shown in bar graphs on this slide.

CCA
Module 1
Online	247
Live	130
Module 2
Online	223
Live	135
Module 3
Online	191
Live	166
Module 4
Online	125
Live	272
Module 5
Online
Live	38

Tufts
Module 1
Online	57
Live	38
Module 2
Online	43
Live	38
Module 3
Online	51
Live	32
Module 4
Online	2
Live	45
Module 5
Online
Live	25

UHC
Module 1
Online	38
Live	53
Module 2
Online	13
Live	71
Module 3
Online	18
Live	63
Module 4
Online	16
Live	57
Module 5
Online
Live	37
Slide 7: Appendix: Care Coordinator Training – Topics
Initial and ongoing training is critical to supporting the role the Care Coordinator plays in delivering person-centered care.

•	Techniques in establishing trust in the relationship and communication approaches, including active listening
•	Establishing understanding with the Enrollee on how best to communicate with one another -- expectations about type and frequency of contact; best way to contact if problems or questions arise; Enrollee needs from Care Coordinator and Care Coordinator needs from Enrollee for optimal results
•	Care team convening and facilitation 
•	Role of the LTSS-C and how to fully utilize that role in the care team
•	How to develop person-centered care plans based on Enrollee, assessment, and care team input
•	Health plan functional organization, with focus on exposing the organization to the Care Coordinator role and explaining to both the Care Coordinator and other functional units how to interact successfully (medical, LTSS, BH, dental, pharmacy, transportation, community-based, vendors)
•	Health plan utilization management and prior authorization processes – making sure the Enrollee interests are well-presented in submitting service requests and understanding administrative and clinical requirements
•	Health plan processes for internal escalation of Care Coordinator concerns about Enrollee care
Slide 8: Appendix: Care Coordinator Training – Topics (continued)
Initial and ongoing training is critical to supporting the role the Care Coordinator plays in delivering person-centered care.

•	Covered services and flexible benefits: ensure Care Coordinators are versed in these and know specific processes for accessing, including how to prepare requests; ensure Care Coordinators can effectively communicate these to Enrollees; and ensure Care Coordinators understand how MassHealth and Medicare services interface for maximum coverage
•	How to use and refer to community-based services and supports: understanding the role and value of community health workers, peer supports, and other non-medical, community-based resources – especially to address recovery, social determinants of health and health equity issues
•	How to interface with government and non-profit human service providers (e.g., DMH, DDS, BSAS, ILCs, ASAPs, RLCs, community action entities, etc.)
•	ADA requirements and interfacing with the accessibility enforcement structure within the health plan