MassHealth Technical Assistance Program

Integration Sciences is an approved Technical Assistance Vendor for the MassHealth 1115 Waiver

Our role is to help your organization build upon its strengths and stretch to improve patient care with a wider lens. Our specialty is boundary crossing and we’ll help you reach out to and work with partners that share in the care of your patients. We bring evidence-based practices and practical know-how to help you integrate care among primary care, emergency departments, mental health providers, substance use disorder treatment, community based social services, schools, and justice organizations.

Model TA Projects

We have found the following projects to be most valuable for our partners. All Projects may be customized or created new to meet your organization’s most pressing needs.

Strategies for Value-Based Payment (Domain 1)

Strategy Under Accountable Care – Dreaming big - Aligning care and payment
Clinical Quality Improvement – Shoring up the foundation for payment reform
Justifying new high value roles and services under Accountable Care
Value Based Purchasing for Community Partners (Based upon the Pathways Community Hub evidence)

Care Coordination & Integration (Domain 2)

Comprehensive Screening – Casting a wide net for safety, physical health, mental health, substance misuse, and basic human needs
Follow up to discovered needs – Roles and workflow for Behavioral Health Clinicians and Community Health Workers
Shared Care Planning across organizations and boundaries and the Multi-Disciplinary Care Team
Patient Centered Medical Home – Practice transformation, compliance, and NCQA annual reporting for PCMH recognition
Advancing through the SAMHSA 6 Levels of Integration – Training and progress assessment
Substance misuse – No Wrong Door to recovery
Patient Privacy in integrated care

Community-Based Care and Social Determinants of Health (Domain 3)

Screening and follow up for Behavioral Health and SDOH needs
Shared Care Planning
Pathways Community Hub – An evidence based model for community support referral, measurement, and payment
Critical Time Intervention – An evidence based 30/60/90 day model for reintegrating from hospital or incarceration back to community
SUD Treatment Integration

Consumer Engagement (Domain 4)

Patient-centric goals and the Shared Care Plan
Patient Centered Medical Home
Engaging Consumer representatives in governance, planning, and policy
Facilitation support for consumer workgroups
OpenNotes implementation
Optimizing technology to engage Consumers

Flexible Services (Domain 5)

Setting up programs in line with the flexible services program guidance
Screening for need, risk, and flexible spending eligibility
Connecting the Safety Net – Flexible services network building
Flexible Services under COVID-19 conditions
Pathways Community Hub – An evidence based model for community support referral, measurement, and payment

HIT and Health Information Exchange (Domain 6)

HIT and HIE strategic planning
From RFP to Implementation - Technology procurement assistance
Technology adoption, use and optimization
Foundational Technology for Accountable Care
Patient Privacy when crossing boundaries between healthcare, SUD treatment, education, justice, and community organizations

Performance Improvement (Domain 7)

Strategic Planning
Dashboards that align action - Key Performance Indicators and data reporting
Change Management Coaching
Performance Improvement – Team skill building and toolkit
Quality Improvement – Implementing actionable PDSA Cycles
Performance and payment optimization
Program Evaluation

Population Health (Domain 8)

Intervention-oriented risk stratification and registry development
Event Notification – Workflow for action
Comprehensive Screening – Casting a wide net for safety, physical health, mental health, substance misuse, and basic human needs
Follow up to discovered needs – Roles and workflow for Behavioral Health Clinicians and Community Health Workers
Shared Care Planning across organizations and boundaries and the Multi-Disciplinary Care Team

Workforce (Domain 9)

Workforce gap assessment and planning
Optimized workforce under Value Based Purchasing
Hiring, deploying, managing, and training ‘Bridge Roles:’ Behavioral Health Clinicians, Community Health Workers, and Care Team Coordinators
Patient Centered Medical Home – Practice transformation, compliance, and NCQA annual reporting for PCMH recognition
Peer Support Workers – Engaging the sober workforce
Building bench - Workforce sustainability planning

Telehealth (Domain 10)

Workflow planning for a seamless virtual visit
Planning to address access and equity barriers
Preparing Patients for the virtual visit
Behavioral Health Integration in the virtual World – planning warm handoffs
Telehealth Implementation - Technology (re)Procurement Assistance
Telehealth Policy – Current day and Post-COVID
Patient Privacy and Telemedicine
Workflow planning for virtual SUD Treatment