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Health Policy Commission certifies Southcoast Health System’s ACOs under Learning, Equity, and Patient-Centeredness (LEAP) standards

Southcoast Health announced today that the not-for-profit community health system’s accountable care organizations (ACOs) – Southcoast Accountable Care Organization (SACO) and Southcoast Community Alliance (Medicaid ACO) – received ACO Certification under the Health Policy Commission’s (HPC) new certification standards known as ACO LEAP 2022-2023. The standards reflect HPC’s focus on learning, equity, and patient-centeredness.

Southcoast Health’s ACOs first became HPC-certified in 2017, with SACO – its Medicare ACO – launching in 2013. Southcoast Health was in the first cohort of Medicaid ACOs in Massachusetts launching in 2018, which is operated in partnership with Boston Medical Center Health System. Southcoast Health’s two ACOs are responsible for over 40,000 covered lives in the South Coast region.

“The new certification standards required us to show that we’ve integrated health equity and behavioral health into our care management systems,” said Jay Lawrence, MD, Southcoast Health Senior Vice President, Chief Transformation and Innovation Officer and Physician-in-Chief for Primary Care. “Both are integral to meeting the care needs of patients with MassHealth insurance. Southcoast Health will always be committed to ensuring that every single patient, regardless of socioeconomic status, has access to high-quality health care and that we attend to both the behavioral and physical health needs of patients.”

“The ACO Certification program, in alignment with other state agencies including MassHealth, is designed to accelerate care delivery transformation in Massachusetts and promote a high quality, efficient health system. ACOs participating in the program have met a set of objective criteria focused on core ACO capabilities demonstrating dedication to patient-centered care, use of evidence-based and data-driven strategies to improve care delivery, and commitment to addressing long-standing health inequities,” according to the letter received from the Health Policy Commission confirming the certification.

This certification is for the period of January 1, 2022, through December 31, 2023.

ACOs are comprised of groups of doctors, hospitals, and other healthcare providers that organize themselves to provide coordinated high-quality care to patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. ACOs are successful when they are able to deliver high-quality care and spend healthcare dollars wisely.

The HPC Accountable Care Organization Certification Program is designed to accelerate care delivery transformation in Massachusetts and promote a high-quality, efficient health system. The program complements existing local and national care transformation and payment reform efforts, encourages value-based care delivery, and promotes investments by payers in high-quality and cost-effective care across the continuum. As of 2021, the Health Policy Commission has certified 16 ACOs that collectively represent 2.9 million attributed commercial, Medicare, and MassHealth patients in the Commonwealth.

The HPC ACO LEAP 2022-2023 standards are designed to allow for a variety of ACO approaches to meeting core principles consistent with the “Learning Health System” framework developed by the National Academy of Medicine (formerly the Institute of Medicine). This approach is intended to focus on the ACO model as a catalyst for learning and improvement, recognizing that ACO structures, processes, and approaches are conducive to learning and improvement over time.




Southcoast Health’s Dr. Daniel Sousa Honored as 2022 Community Clinician of the Year by Mass. Medical Society

The Massachusetts Medical Society (MMS) announced Southcoast Health pulmonologist and critical care physician Daniel Sousa, MD, has been selected as the Bristol South District Medical Society’s 2022 Community Clinician of the Year. This award recognizes his professionalism and contributions as a physician.

Dr. Sousa has been on the frontlines of the pandemic during the past few years. In 2020, he was profiled in the Fall River Herald News about his work caring for patients with COVID-19.

“It is a great honor to be recognized by the Massachusetts Medical Society. There are so many deserving physicians at Southcoast Health and in Bristol County, especially with the work that’s been done to fight the pandemic in the last two years,” Sousa said. “I am very grateful to receive this award and to the dedicated team I work with at Southcoast Health. When you work with great people they make you shine. This award is as much theirs as it is mine.”

Southcoast Health President and CEO Rayford Kruger, MD, congratulated Sousa for his achievement.

“Dr. Sousa is an outstanding physician highly deserving of this recognition. His work in critical care medicine and with pulmonary patients and those with COVID-19 is greatly respected,” Kruger said. “We are proud that he is a part of Southcoast Physicians Group and pleased that he has earned this recognition from the MMS, an esteemed physician organization.”

Dr. Sousa has practiced in the Fall River area since 2004 and is board certified in internal medicine, pulmonary medicine and critical care medicine. He is a fellow in the College of Chest Physicians. Dr. Sousa received his Doctor of Medicine degree from the University of Vermont College of Medicine. He completed his internal medicine residency program at Brown University School of Medicine/Rhode Island Hospital and Miriam Hospital and his training in pulmonary/critical care medicine at Rhode Island Hospital, Roger Williams Hospital, Memorial Hospital, and Veterans Affairs Medical Center in Providence. Dr. Sousa also served on the Fall River Board of Health for ten years from 2010-2019.

The Massachusetts Medical Society (MMS) is the statewide professional association for physicians and medical students. Last year, the MMS named Dr. Holly Alexandre as the Bristol South District’s Community Clinician of the Year.

To learn more about the providers at Southcoast Health, please visit https://www.southcoast.org/doctors/.




St. Luke’s Women & Children’s unit gets Massachusetts Department of Public Health nod on innovative new model

The Massachusetts Department of Public Health has approved a new room model at the Robert F. Stoico/FIRSTFED Women and Children’s Pavilion at St. Luke’s, making the hospital among the first in Massachusetts and Rhode Island to offer Level II Couplet Care to mothers and newborns, Southcoast Health officials announced.

Starting in the summer of 2022, infants with acute conditions after delivery will be able to bond with their mothers in a private room equipped with centralized monitoring and located in close proximity to the on-call neonatologist’s office, rather than be restricted to a clinical nursery housing multiple newborns, as has historically been the case for most hospitals.

“During this most recent round of major renovations at the Stoico/FIRSTFED Women and Children’s Pavilion at St. Luke’s, our entire team has been looking forward to moments like these as we strengthen what is, along with Charlton Memorial, already the best possible starting point for the mom and child journey,” said Dr. Ray Kruger, Southcoast Health President and CEO. “The nurses, providers, and staff have earned a place on Newsweek’s Best Maternity Care Hospitals list for consecutive years, and we continue to invest in their efforts, on behalf of both our patients and the employees who serve them.”

The new Neonatal Couplet Care Room will be part of the St. Luke’s 5,866-square-foot Level II Special Care Nursery, with additional rooms planned in subsequent phases of the renovation, designed by Lavallee Brensinger Architects. The new Level II Special Care Nursery will also include seven bassinet rooms, as well as an Airborne Infection Isolation Couplet Room, for a total of eight rooms.

The St. Luke’s Level II Special Care Nursery is licensed for the following:

· Providing neonatal resuscitation at required deliveries
· Stabilizing and caring for infants born 32 to 37 weeks
· Stabilizing newborn infants who are ill and require a higher level of care
· Stabilizing infants born before 32 weeks of gestation and weighing less than 3.3 pounds until transfer to a neonatal intensive care facility (NICU)

“When it comes to couplet care in a Level II Special Care setting, with mom and baby being able to stay together, we’ll see newborns heal more quickly, better breastfeeding rates, and improved neurodevelopmental outcomes,” said Kim Pina, RN, Executive Director of the Stoico/FIRSTFED Women and Children’s Pavilion at St. Luke’s.

“Parents will be better prepared for discharge, and the overall patient experience will be sustainable at the highest possible level, with our skilled nurses having everything they need, including top-tier technology, in one place, to provide exceptional care in a private setting,” Pina added. “We are thrilled to be an early adopter of this model, and to be able to offer it to the moms and babies who need it most. Receiving design approval from the Massachusetts Department of Public Health so close to Mother’s Day makes it even more exciting, and we are so grateful.”

Philip Oliveira, Southcoast Health Vice President of Support Services, agreed.

“All of our postpartum rooms at St. Luke’s will now be equipped for couplet care, and our plan is to add additional Level II Special Care couplet care rooms as we continue to provide world-class care, close to home,” Oliveira said. “This has allowed us to be one of the first hospitals to offer this service to our patients. Southcoast’s design and construction teams were happy to collaborate with Lavallee Brensinger and the Massachusetts Department of Public Health to create this beautiful space for our community.”




FDA Approves First COVID-19 Treatment for Young Children

The U.S. Food and Drug Administration expanded the approval of the COVID-19 treatment Veklury (remdesivir) to include pediatric patients 28 days of age and older weighing at least 3 kilograms (about 7 pounds) with positive results of direct SARS-CoV-2 viral testing, who are:

– Hospitalized, or
– Not hospitalized and have mild-to-moderate COVID-19 and are at high risk for progression to severe COVID-19, including hospitalization or death.

This action makes Veklury the first approved COVID-19 treatment for children less than 12 years of age. As a result of today’s approval action, the agency also revoked the emergency use authorization for Veklury that previously covered this pediatric population.

Before now, Veklury was only approved to treat certain adults and pediatric patients (12 years of age and older who weigh at least 40 kilograms, which is about 88 pounds) with COVID-19.

“As COVID-19 can cause severe illness in children, some of whom do not currently have a vaccination option, there continues to be a need for safe and effective COVID-19 treatment options for this population,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “Today’s approval of the first COVID-19 therapeutic for this population demonstrates the agency’s commitment to that need.”

Veklury is not a substitute for vaccination in individuals for whom COVID-19 vaccination and booster doses are recommended. The FDA has approved two vaccines, and three vaccines are available for emergency use, to prevent COVID-19 and the serious clinical outcomes associated with COVID-19, including hospitalization and death. The FDA urges the public to get vaccinated and receive a booster when eligible. Learn more about FDA-approved and authorized COVID-19 vaccines.

Given the similar course of COVID-19 disease in adults and pediatric patients, today’s approval of Veklury in certain pediatric patients is supported by efficacy results from phase 3 clinical trials in adults. Information on the trials in adults can be found in the FDA-approved drug labeling for Veklury. This approval is also supported by a phase 2/3, single-arm, open-label clinical study of 53 pediatric patients at least 28 days of age and weighing at least 3 kilograms (about 7 pounds) with confirmed SARS-CoV-2 infection and mild, moderate or severe COVID-19. Patients in this pediatric phase 2/3 trial received Veklury for up to 10 days. The safety and pharmacokinetic results from the phase 2/3 study in pediatric subjects were similar to those in adults.

The only approved dosage form is Veklury for injection.

Possible side effects of using Veklury include increased levels of liver enzymes, which may be a sign of liver injury; and allergic reactions, which may include changes in blood pressure and heart rate, low blood oxygen level, fever, shortness of breath, wheezing, swelling (e.g., lips, around eyes, under the skin), rash, nausea, sweating or shivering.

The FDA granted approval to Gilead Sciences Inc.




Governor Baker Awards Additional $4.5 Million for COVID-19 Vaccine Equity Efforts

The Baker-Polito Administration today announced an additional $4.5 million in grants to organizations working in communities hardest hit by the COVID-19 pandemic. This funding is a component of the Massachusetts Vaccine Equity Initiative to increase awareness and access to the COVID-19 vaccine and mitigate the impacts of the pandemic. The latest grants are part of the Administration’s investments of over $51 million to promote vaccine access and confidence, primarily in communities of color.

The grants are the result of a major funding award from the US Centers for Disease Control and Prevention (CDC) to the Commonwealth, building on the state’s investment to increase vaccine awareness and acceptance. These funds support community organizations and community health centers to continue the work of reducing barriers to vaccine access and promoting vaccines and boosters for communities and populations most disproportionately impacted by COVID-19.

“These trusted community-based organizations know their communities best,” said Public Health Commissioner Margret Cooke. “They use their knowledge and relationships to expand the efforts of our Vaccine Equity Initiative by helping address the unique health equity needs of the communities and populations they serve – needs that have been exacerbated by COVID-19.”

This additional $4.5 million includes:

$1.1 million in new grants to 26 community- and faith-based organizations, including Tribal and Indigenous People-serving organizations, in partnership with Health Resources in Action (HRiA). Along with 50 other community organizations currently funded, these organizations will provide culturally appropriate outreach and education on COVID-19 vaccination and mitigation as well as host and promote vaccine clinics for priority populations most impacted by COVID-19. Funded organizations will engage families and children for pediatric vaccinations and boosters.
$3.1 million for the Massachusetts League of Community Health Centers to support 42 community health centers for critical workforce and equipment needs and outreach, education, and navigation support towards COVID-19 vaccination. This funding is in addition to $5 million being distributed to community health centers for walk-in vaccination services.
$300,000 to three community organizations to expand the COVID-19 vaccine equity work in rural communities, in partnership with the New England Rural Health Association. With the addition of these grants, the program now funds vaccine equity work serving 143 rural towns.

Award Recipients:

Community Outreach and Education (HRiA) ($1.1 million)
Grant size: $15,000 – $50,000 per organization

African Cultural Services, Inc.
BRIDGE (Berkshire Resources for the Integration of Diverse Groups through Education)
Centro de Apoyo Familiar (CAF)
Chappaquiddick Tribe of the Wampanoag Indian Nation Corporation
Chinese Culture Connection, Inc.
Coalition for a Better Acre
DEAF, Inc.
Dwelling House of Hope, Inc.
Extreme Kid, Inc.
Haitian Community Partners
Haitian Health Institute
Leaving the Streets Ministries, Inc
Love Your Menses
Massachusetts Coalition for Occupational Safety & Health (MassCOSH)
Metrowest Worker Center (Casa do Trabalhador/Casa del Trabajador)
MOCHA
Next Leadership Development Corporation
Nigerian American Multi-Service Association (NAMSA)
People Affecting Community Change (PACC Global)
Pioneer Valley Workers Center
South Asian Workers’ Center
Springfield Boys and Girls Club
The Black Literacy and Arts Collaborative Project, Inc.
UHAI for Health Inc.
Women Encouraging Empowerment Inc.
YMCA of Greater Boston

Community Health Centers ($3.1 million)

Boston Health Care for the Homeless Program
Bowdoin Street Health Center
Brockton Neighborhood Health Center
Brookside Community Health Center
Cambridge Health Alliance
Caring Health Center, Inc.
Charles River Community Health Center
Codman Square Health Center
Community Health Center of Cape Cod
Community Health Center of Franklin County
Community Health Connections Family Health Center
Community Health Programs
The Dimock Center
DotHouse Health
Duffy Health Center
East Boston Neighborhood Health Center
Edward M. Kennedy Community Health Center (Framingham)
Family Health Center of Worcester
Fenway Community Health Center
Greater Lawrence Family Health Center
Greater New Bedford Community Health Center
Greater Roslindale Medical and Dental Center
Harbor Health Services Incorporated
Harvard Street Neighborhood Health Center
HealthFirst Family Care Center
Hilltown Community Health Center
Holyoke Health Center, Inc.
Island Health Care
Lowell Community Health Center
Lynn Community Health Center
Manet Community Health Center
Mattapan Community Health Center
North End Waterfront Health
North Shore Community Health Center
Outer Cape Health Services
South Boston Community Health Center
South Cove Community Health Center
Southern Jamaica Plain Health Center
Springfield Health Services for the Homeless
SSTAR Family Healthcare Center
Upham’s Corner Health Center
Whittier Street Health Center

Rural Vaccine Program ($300,000)

Hilltown CDC
Franklin Regional Council of Governments
Nantucket Board of Health/ Health Imperatives/ Community Foundation for Nantucket




Governor Baker Announces Availability of Second COVID-19 Booster Dose for Residents 50 and Older, Immunocompromised Individuals

Following updated recommendations from the federal government, the Baker-Polito Administration today announced that all residents aged 50 and older or individuals who are younger with certain medical conditions may now access a second COVID-19 booster. The U.S. Centers for Disease Control and Prevention (CDC) on Tuesday recommended that certain immunocompromised individuals and all individuals over the age of 50 get an additional booster dose of COVID-19 vaccines. The decision follows authorization by the U.S. Food and Drug Administration (FDA) for a second booster dose for these groups four months after receiving a first booster of the Pfizer or Moderna vaccines. Those eligible include:

– Individuals 50 years of age and older at least 4 months after getting a first booster
– Individuals 18 and older with certain medical conditions may get a second Moderna booster at least 4 months after first booster
– Individuals 12 and older with certain medical conditions may get a second Pfizer booster at least 4 months after the first booster.
– Separately and in addition, per the CDC, individuals 18 and older who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago may now receive a second booster dose using an mRNA COVID-19 vaccine.

Residents may access booster doses from more than 1,000 locations, with appointments readily available for booking across the Commonwealth. The Commonwealth has capacity to administer over 150,000 boosters weekly across the state.

“Vaccines including boosters are the most effective and widely available tool we have to prevent COVID infection, severe disease, and death,’’ said Dr. Larry Madoff, Medical Director of DPH’s Bureau of Infectious Disease and Laboratory Sciences. “It is important that everyone stay up to date on their vaccines. If residents have questions about whether they are eligible to get an additional booster dose, DPH encourages you to talk with your doctor.”

If you are eligible, here are the steps to find a convenient location for getting a second COVID-19 Booster:

– Visit the Vaxfinder tool at vaxfinder.mass.gov for a full list of hundreds of locations to receive a booster and to book an appointment.
– For individuals who are unable to use Vaxfinder, or have difficulty accessing the internet, the COVID-19 Vaccine Resource Line (Monday through Friday, 8:30 a.m. to 6:00 p.m., Saturday and Sunday 9 a.m. to 2 p.m.) is available for assistance by calling 2-1-1 and following the prompts. This service is available in English and Spanish and has translators available in approximately 100 additional languages.
– Individuals with questions about the booster or their eligibility should contact their healthcare provider.
– Vaccines are widely available across the Commonwealth. Getting vaccinated remains the most important thing individuals can do to protect themselves, their families, and their community. Fully vaccinated residents should receive a COVID-19 booster shot when they are eligible to increase their protection against COVID-19 and its variants.

The COVID-19 booster is safe, effective, and free. Additional information on the COVID-19 booster, including FAQs, can be found at mass.gov/COVID19booster.

Massachusetts leads the nation in vaccine administration, over 80% of the eligible population (5+) is fully vaccinated, and more than half are boosted. According to Bloomberg, the Commonwealth currently ranks 5th in the nation for percent of population with a booster dose.




Southcoast Behavioral Hospital to open two child and adolescent units

Southcoast Behavioral Health (“ScBH”) today reinforced its strong commitment to the communities it serves through the addition of a dedicated child and adolescent behavioral health program, expanding the service line from 24 to 48 beds. This is the second bed expansion since the hospital’s opening in 2015. The first expansion of 24 beds occurred in 2019, providing a Dual Diagnosis (substance use disorder) unit. The expected completion of this expansion is the first half of 2023. ScBH is operated through a joint venture partnership between Southcoast Health and Acadia Healthcare.

Located in Dartmouth, Massachusetts, Southcoast Behavioral Health is one of New England’s leading providers of inpatient behavioral health treatment. Readily accessible from Cape Cod, Boston, and Rhode Island, ScBH delivers compassionate care and hope to children, adolescents, adults, and seniors of all identified genders. The hospital treats a wide array of behavioral health diagnoses.

“We are very pleased to expand our facility to help meet the growing behavioral health needs of our communities,” said Felicia Risick, Chief Executive Officer of Southcoast Behavioral Health. “We are increasing our bed capacity to 192 beds, which will make us the second-largest behavioral health hospital in the State. With the addition of a pediatric service line, we can now serve patients through the lifespan, thus aiming to broadly extend healing throughout our communities. I want to thank the entire hospital staff and our partners for their commitment and hard work. This milestone would not be possible without you.”

“Since partnering with Southcoast Behavioral Health seven years ago, they have provided life-saving services to thousands of residents in our area,” said Renee Clark, Executive Vice President and Chief Operating Officer of Southcoast Health. “The hospital, in collaboration with the Southcoast Health system, has provided services that treat the whole patient. This expansion – the second in the hospital’s history – is an exciting moment for our partnership, as together we continue to invest in the future of our communities.”

“We take great pride in the ongoing success and growth of this hospital,” said Dwight Willingham, Operations Group President of Acadia Healthcare. “Every day we must work to eliminate the stigma around mental illness, overcome fear and misunderstanding, and make sure all those coping with a behavioral health issue know they are not alone. Unfortunately, too many who grapple with mental health illnesses are still suffering in silence. This hospital is a beacon to those in need and provides exceptional quality of care in a safe and welcoming environment to all ages.”




Massachusetts Gov. Baker’s administration files legislation aimed at expanding access to health care

The Baker-Polito Administration today filed comprehensive health care legislation to strengthen the Commonwealth’s health care system by increasing access to care and controlling costs for Massachusetts families. The bill would increase investments in behavioral health and primary care through a new spending target for health care providers and payers. It would also control health care costs for residents and families by addressing systemic factors that drive increased spending. The legislation also takes several steps to improve access to high-quality care.

“An Act Investing in the Future of Our Health” includes several components initially filed by the Administration in 2019 and incorporates lessons learned from the COVID-19 pandemic. Governor Charlie Baker announced the filing of the bill today at a visit to Codman Square Health Center alongside officials from Codman and Boston Medical Center. The Administration’s visit to Codman highlighted the legislation’s focus on increasing access to behavioral health services, especially given the impacts of the pandemic.

“Over the past two years, the Commonwealth’s health care workers stepped up to the plate and demonstrated the strengths of our health care system. But the pandemic also shed light on structural, underlying challenges, many of which we proposed addressing with our 2019 legislation,” said Governor Charlie Baker. “The bill we are filing today would increase access to behavioral care and other services that keep people healthier in the long-term by increasing investment in these areas. It would also control the factors that increase costs for residents and families, and improve access to high-quality, coordinated care. We know our partners in the Legislature agree on the need to address these challenges and look forward to working with them to enact these meaningful reforms.”

“We are pleased to file this bill which would make comprehensive changes that improve access to care and control costs for residents and small businesses,” said Lieutenant Governor Karyn Polito. “Our legislation would provide our small business owners with more affordable coverage options for their employees. It will ensure that high-value, affordable plans are easily accessible to small employers and their employees as well as for individuals and families.”

“The delay in preventative and behavioral health services resulting from the COVID-19 pandemic, coupled with the significant workforce challenges within our healthcare systems, require deliberate action to meet the needs of our residents,” said Health and Human Services Secretary Marylou Sudders. “For far too long, primary and behavioral health care have not been at the forefront of our health care system. This legislation is patient-focused, with proposed policies that prioritize the physical and mental health care of all of our residents for years to come.”

The bill includes reforms across three major areas:

• Prioritizing Primary Care and Behavioral Health

• Managing Factors that Increase Costs for Families

• Improving Access to High-Quality Care

Prioritizing Investments in Primary Care and Behavioral Health

This legislation increases investment in primary care and behavioral health care through setting a statewide target to address historic underinvestment in these services, particularly for individuals who have been historically underserved. The proposal sets a system-wide primary care and behavioral health spending target, requiring health care providers and payers to increase expenditures on primary care and behavioral health by 30% over 3 years, with the initial performance period ending in calendar year 2024. This will result in a substantial rebalancing of funds equal to a system-wide investment of approximately $1.4 billion into primary care and behavioral health, and improve front door access to services.

• Calendar year 2019 serves as the baseline year that calendar year 2024 spending will be measured against.

• Providers and payers must achieve the target while remaining under the health care cost growth benchmark.

• Recognizing systems have varying baselines and tools to achieve the target, the legislation does not prescribe how payers and providers achieve the target. Payers and providers can achieve the target through strategies such as increased rates to primary care (PC) and behavioral health (BH) providers, expanding PC/BH networks, increasing access to PC/BH through extended hours and additional telehealth services.

In addition to increasing behavioral health and primary care investments, this legislation reinforces behavioral health coverage parity requirements, supports workforce development and sustainability, and promotes timely access to emergency behavioral health care.

The legislation builds on recent investments in community health centers and establishes a Primary Care and Behavioral Health Equity Trust Fund to provide enhanced funding to primary care and behavioral health providers serving Medicaid members. Approximately 20% of the funds will be earmarked for grants to high public-payer providers in target equity communities. This fund will help increase access to these critical services and level the inequities in our health care system.

Managing Factors that Increase Costs for Families

The legislation addresses health care costs through a multi-faceted approach that targets systemic cost drivers and increases affordability for individuals and small businesses.

• Surprise billing protections for certain Out of Network (OON) services: This bill establishes a default payment rate of reimbursement that carriers must pay to out-of-network providers for unforeseen OON services, effectively removing the patient from the payment dispute.

• Increased accountability for drug manufacturers: To address year-over-year increases in pharmacy cost and spending growth, this proposal will: 1) hold high-cost drug manufacturers accountable through similar measures used for high-cost payers and providers; 2) impose penalties on excessive drug price increases; and 3) establish new oversight authority for pharmacy benefit managers (PBMs).

• Merged Market Reforms: To ensure individuals and small business owners have access to more affordable insurance coverage options, this legislation implements small group rate review reforms, as well as recommendations from the Merged Market Advisory Council Report to promote adoption and access to high-value, lower-cost health plans.

• Improved Access to High-Quality, Coordinated Care

This legislation modernizes licensure and scope of practice standards and promotes access to high-quality, coordinated care.

• Scope of Practice and licensure standards: Improvements to scope of practice standards and other licensure requirements will strengthen the health care workforce and expand capacity through measures that allow providers to practice at the top of their license and remove barriers to licensure.

• Multistate licensure compact: This legislation authorizes Massachusetts entry into the Interstate Medical Licensure Compact (ICLM). The ICLM is an agreement among participating U.S. states to work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify.

• Health Care workforce: This bill directs the Center for Health Information Analysis (CHIA) to study the health care workforce in the Commonwealth, including how it is changing over time, the supply of and demand for workers, demographic characteristics of the workforce including race, ethnicity, language, and age, geographic variations, job satisfaction, retention, and turnover, and other issues affecting the Commonwealth’s healthcare workforce.

• Urgent Care: This legislation defines “urgent care services” and requires entities providing urgent care services to be licensed as a clinic and accept MassHealth members.

• Telehealth: To reduce barriers and advance adoption of telehealth, this bill provides increased flexibility for providers delivering telehealth services. Specifically, this legislation clarifies BORIM policy authorizing providers to render telehealth services without limitation to location or setting, so long as the provider is compliant with federal and state licensing requirements of the state in which the patient is physically located.

Modernizing data standards and health information exchange: Proposals within this legislation will improve the ability for providers and the health care delivery system more broadly to exchange necessary information to improve patient access and care coordination.




Massachusetts Department of Public Health Updates COVID-19 Death Definition

Beginning Monday, March 14, the Massachusetts Department of Public Health (DPH) will update the criteria used for identifying COVID-19 deaths to align with guidance from the Council of State and Territorial Epidemiologists. Currently, the COVID death definition includes anyone who has COVID listed as a cause of death on their death certificate, and any individual who has had a COVID-19 diagnosis within 60 days but does not have COVID listed as a cause of death on their death certificate. The updated definition reduces this timeframe from 60 days to 30 days for individuals without a COVID diagnosis on their death certificate.

The revision follows the recommendation of the Council of State and Territorial Epidemiologists (CSTE), in collaboration with the US Centers for Disease Control and Prevention (CDC), to create a standardized approach for states to use for counting COVID-19 deaths. Several other states are adopting this definition.

Massachusetts has applied this new definition retroactively to the start of the pandemic in March 2020. As a result, 4,081 deaths in Massachusetts that were previously counted as associated with COVID will be removed. In addition, approximately 400 deaths not previously counted but identified through a manual process of matching death certificates with medical records will be added to the COVID-19 death count. The state’s overall COVID death count, therefore, will decline by 3,700.

“We are adopting the new definition because we support the need to standardize the way COVID-19-associated deaths are counted,” said DPH State Epidemiologist Dr. Catherine Brown. “Prior to the CSTE definition, states did not have a nationally recommended definition for COVID-19 deaths and, as such, have been using a variety of processes and definitions to count their deaths. In Massachusetts, our definition has consistently been broader than most other states. After a deep dive into our data and reviewing thousands of death certificates we recognize that this updated definition gives us a truer picture of mortality associated with COVID-19.”

“It is important to understand that we cannot identify all COVID-19 deaths with 100 percent accuracy,” said Nicolas Menzies, Associate Professor of Global Health at the Harvard T.H. Chan School of Public Health. “The revised definition for COVID-19 deaths is a reasonable balance between sensitivity and specificity and will make it easier to compare Massachusetts death data with data from other jurisdictions.”

“Updating this important metric is a necessary step to help us better gauge the current severity of the pandemic and its impact on our health system and society as a whole,” said Dr. Helen Boucher, Interim Dean of Tufts University School of Medicine, Chief Academic Officer at Tufts Medicine and infectious disease physician at Tufts Medical Center and member of the Governor’s Medical Advisory Board. “The ability to be nimble and quickly adapt to changing circumstances demonstrates Massachusetts’ continued leadership in COVID-19 data reporting and analysis.”

Early in the pandemic, and absent clear national guidance, DPH matched COVID-19 surveillance case information with death certificates to identify deaths in people who tested positive for the virus but did not have COVID listed as a cause of death. To avoid the possibility of missing any COVID-associated death, anyone who tested positive for COVID and died was counted as a COVID-associated death regardless of the length of time between their diagnosis and their death or whether COVID was listed as the cause on their death certificate. This approach was overly broad and led to an overcounting of COVID-19-associated deaths.

Beginning in April 2021, based on the growing knowledge about COVID-19 and an analysis of deaths in Massachusetts up to that point, DPH updated the way it counted deaths. COVID-19-associated deaths still included anyone with COVID-19 listed as a cause of death on the death certificate but DPH also applied a 60-day timeframe from diagnosis to death for anyone diagnosed with COVID-19 but who did not have COVID-19 on the death certificate.

This latest update further reduces the timeframe between diagnosis and death from 60 days to 30 days for individuals without COVID listed on the death certificate. The new definition will be reflected in the COVID-19 interactive dashboard data on Monday, March 14.

Beginning Monday, all calculations involving deaths posted in the COVID-19 dashboard and the raw data file will contain the updated data. Previous raw data files will still be available on the website and will not be updated.

Deaths in long-term care facilities (LTCF) will continue to be reported directly from those facilities, but the updated definition will align surveillance deaths more closely with the LTCF-reported counts.

Several new data points and some changes in functionality and visualizations are also being added to the COVID-19 dashboard, beginning Monday. No data are being eliminated and the changes are designed to enhance the interactive experience for dashboard users and to ensure compliance with Americans with Disabilities Act requirements.




Massachusetts Public Health Reports “Significant Overcount” of COVID Deaths

By Chris Lisinski
State House News Service

When state public health officials publish Monday’s report about the latest COVID-19 impacts on Massachusetts, the cumulative death toll through two years of the pandemic will suddenly stand about 15 percent lower.

The Baker administration will start using a new public health surveillance definition next week, narrowing the window of time between a confirmed COVID-19 diagnosis and death required for the fatality to get attributed to the highly infectious virus.

Saying the Bay State’s earlier methodology led to a “significant overcount of deaths,” officials said Thursday they will adopt a new system recommended by the Council of State and Territorial Epidemiologists.

And in a step that could reshape understanding of the pandemic’s impact on Massachusetts, the administration will apply the new method retroactively, resulting in 4,081 deaths once linked to the virus being recategorized as stemming from other causes and roughly 400 others newly being labeled as COVID-19 deaths.

“We think this is an absolutely critical step in improving our understanding of who COVID has impacted most significantly during the pandemic,” said state epidemiologist Dr. Catherine Brown. “We believe that this will provide us a much more accurate picture of who has died associated with a COVID infection in Massachusetts, and it will also improve our ability to compare our data with data from other jurisdictions.”

For the duration of the pandemic, state officials have deemed a fatality COVID-related if it met at least one of three criteria: if a case investigation determined the virus “caused” or “contributed” to the death, if the death certificate listed COVID-19 or an “equivalent term” as the cause, or if state public health surveillance linked a confirmed COVID-19 diagnosis to a Bay Stater’s death.

The first two measures remain unchanged since the earliest days of the crisis, but the third has already been updated once and is set to evolve again on Monday.

From March 2020 to March 2021, DPH counted the death of any person who had previously tested positive for COVID-19 as a COVID-related death, regardless of how much time elapsed between those two events.

Even if someone contracted the virus in March and died in a car crash in July, they were added to the ongoing tally of pandemic deaths for that first year.

“This strategy worked well at the beginning of the pandemic, and in fact, a paper was published last summer in the Journal of the American Medical Association, which lauded our efforts here in Massachusetts in counting deaths that occurred during the first wave of the pandemic as opposed to several other jurisdictions,” said Public Health Commissioner Margret Cooke. “But over time, our approach proved to be too expansive and led to a significant overcount of deaths in Massachusetts. People who had gotten COVID earlier in 2020 and died for other reasons ended up still being included in COVID-associated death counts.”

The department updated its approach for the third criterion in April 2021, officials said Thursday, keeping the death investigation and death certificate triggers in place. Under that method, officials counted only those who died within 60 days of a COVID diagnosis as deaths related to the virus, unless their death was clearly linked to another cause such as trauma.

That system remained in place for most of 2021 and will be replaced in Monday’s daily report by the new definition, recommended in December by the national consortium of state public health leaders after months of study.

The new method suggested by the Council of State and Territorial Epidemiologists calls for counting deaths within 30 days of a COVID-19 diagnosis where “natural causes” is labeled on a death certificate as attributable to the virus, half as long a timeframe as under the most recent definition in Massachusetts.

Brown said the update will “make sure that what we are capturing is the acute impact of COVID.”

“People who are seriously ill and hospitalized for longer and end up dying after that 30 days have almost invariably had COVID listed on their death certificate, so they end up being counted under another method,” Brown said.

As has been the case throughout the pandemic, if an official death investigation determined the virus caused or contributed or if a death certificate lists COVID-19 or an equivalent term, that fatality will add to the pandemic death toll.

Brown said the vast majority of the 4,081 deaths that will no longer be deemed COVID-related, about 95 percent, occurred between May 2020 and May 2021, covering the tail end of the state’s first surge and its second surge that winter. Most of the roughly 400 deaths that will acquire a COVID label also happened in that span, Brown said.

Taken together, the removals and additions net out to a reduction in the cumulative COVID-19 death toll of about 3,700 people, more than the entire population of Provincetown.

DPH does not expect to have a new tally for the number of COVID-19 deaths in Massachusetts until it publishes new data on its COVID-19 dashboard around 5 p.m. on Monday. Back-end work to merge datasets will take place over the weekend, according to Brown.

It also remains unclear if the change in Massachusetts will send out ripple effects across the country.

Asked if other states planned to adopt the national council’s recommended methodology as well, Brown said that the new definition planned for rollout in Massachusetts is “actually much more consistent with what many other jurisdictions are already using.”

“This is a recommended guidance definition, and it is designed to help improve comparability across jurisdictions, across states. But we have also heard from a few jurisdictions that they are not planning on updating the way they count deaths,” she said. “What’s really important is that this change to the definition will actually increase the ability to compare the counts in Massachusetts with other jurisdictions because it will be more similar to what most other jurisdictions are using.”

The U.S. Center and Disease Control’s online tracker on Thursday listed 959,533 total COVID-19 deaths across the country since Jan. 21, 2020. Massachusetts had the 13th-most total deaths among states and the 11th-highest rate of deaths per 100,000 residents, both of which will likely change when the updated death toll is published next week.

As of 5 p.m. Wednesday, Massachusetts health officials had recorded 23,708 confirmed and probable COVID-19 deaths since the outbreak first began, so that figure is likely to drop to around 20,000 on Monday.

The new methodology will also apply to weekly reporting about COVID-19 cases in vaccinated individuals, the next version of which is set for publication on Tuesday.

Brown added that preliminary analysis did not show any significant changes to the distribution of deaths by age group, sex and race or ethnicity once the new definition was applied.

“While we absolutely acknowledge that we’re moving to a more accurate and appropriate way to count deaths, it doesn’t change our understanding, it does not alter our understanding, of who has died from COVID and where the most disproportionate impacts have been,” Brown said.

The Baker administration appears not to have made as public an announcement about the first change to its statewide COVID-19 death definition as the latest update. Officials said in April 2021 that they would change how deaths were counted specifically in long-term care facilities to align with the CDC’s national definition, but made no mention in that press release of the broader change imposing a 60-day limit on the span between an infection and death to count in some cases.

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