Common use of Community Needs Clause in Contracts

Community Needs. Massachusetts as a state is more affluent, better-educated, and healthier than the nation as a whole. Massachusetts has an overall poverty rate of 15%, below the national rate of 21%, and a median income of $61,000, above the national median of $50,000. Of the Commonwealth’s approximately 6.6 million residents, 39% hold a bachelor’s or graduate degree, compared to 28% for the nation as a whole.5 In addition, Massachusetts has expanded health care coverage while maintaining above-average performance in key health indicators. Life expectancy in Massachusetts is 80.1 years, compared to a national figure of 78.6. The infant mortality rate is 5.6 per thousand, compared to a national rate of 6.8. Obesity and diabetes rates for both children and adults are lower than national rates.6 However, the communities that DSTI-eligible safety net providers serve are characterized by lower incomes, more severe socioeconomic challenges, and more adverse health status indicators than the state as a whole. For example, DSTI-eligible hospitals serve the state’s largest urban population (the Boston metropolitan area) as well as a rural county with the lowest per-capita income and worst health outcomes in the state (Hampden County).7 Populations in these communities have higher risk factors for asthma and diabetes and often face complex medical and behavioral health conditions. Linguistic, cultural, and socio-economic barriers require specialized resources and services to effectively coordinate care and promote health. Prevalence of chronic health care conditions such as diabetes, cardiovascular disease, COPD, and obesity, are higher than in other Massachusetts communities.8 These factors create specific challenges in designing effective interventions to coordinate and manage care for safety net populations and simultaneously make the need for delivery system transformation more urgent for safety net providers. Safety Net Health Care Challenges Safety net hospitals have been important participants in Massachusetts' health reform efforts. The newly insured have continued to rely on safety net hospitals for care, as well as outreach and enrollment, in large numbers. These organizations had long been the site of care for the uninsured; naturally, the newly insured continued to seek health services where they already had a connection. As a result, these hospitals experienced a 30% increase in Medicaid patient care volume during health care reform from 2006 to 2010.9 DSTI eligible safety net hospitals have a Medicaid payer mix that is, on average, nearly twice the statewide acute hospital average (27% vs. 14%). The DSTI hospitals’ commercial payer mix is, on average, 35% lower than the statewide average (24% vs. 37%). Despite the expansion in health coverage under Chapter 58 reforms, safety net hospitals continue to provide concentrated care to the residual uninsured population. These factors have limited the capacity of the eligible safety net providers to make investments that position them well for payment reforms. The transformation to new models of care delivery require hospitals and providers to make significant up-front investments in such areas as network development and management; care coordination, quality improvement and utilization 5 2010 American Communities Survey. 6 ▇▇▇▇▇▇ Family Foundation. State Health Facts: Massachusetts State Profile. < ▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇> 7 Massachusetts Community Health Information Profile (MassCHIP), available at <▇▇▇▇://▇▇▇.▇▇▇▇.▇▇▇/eohhs/researcher/community-health/masschip/welcome-to-masschip.html> 8 Ibid. 9 Aggregate increase in the annual number of Medicaid and Medicaid Managed Care patient care encounters 2006-2010 for seven safety net hospitals participating in DSTI, derived from Massachusetts Division of Health Care Finance and Policy FY2010 403 Cost Reports. management; clinical information systems; and data analytics to enhance performance measurement.10 Many of the eligible safety net hospitals have deferred capital investments (including IT) and operating investments (such as care coordination and management systems enabled by new clinical and financial reporting capabilities) in an effort to manage conservatively and live within their budgets. Choices like these, while necessary in the short term, threaten to undermine the ability of the Commonwealth’s safety net providers to transform their delivery systems to meet the Triple Aim goals that the hospitals share with CMS and EOHHS. Over the past three years, the DSTI program has provided a unique opportunity for the eligible safety net hospitals to begin to overcome these challenges and make meaningful initial progress toward delivery system transformation. Significant work remains to be done, the DSTI program will continue to enable safety net providers’ participation in delivery system reform initiatives as the Commonwealth shifts toward widespread adoption of value based payment models. DSTI Eligibility Criteria