Competency Area #1: Respect, understand, and engage MassHealth members
The key elements that comprise Competency Area #1 are outlined below. These can be used as touchpoints in determining whether your TA project helps advance your ACO or CP in this competency.
Member characteristics, preferences, and needs: ACOs and CPs understand the social, cultural, linguistic, and access characteristics, as well as the overall preferences and needs, of the unique population(s) of MassHealth members they serve in order to ensure that they are capable of engaging every MassHealth member enrolled in their ACO or CP using a person-centered approach that is responsive to the member’s individual circumstances, accommodation needs, and complexity of care.
Responsive models of member engagement and care: ACOs and CPs design and implement models of member engagement and care that are responsive to the social, cultural, linguistic and access characteristics, as well as the overall preferences and needs, of the unique population(s) of MassHealth members they serve in order to ensure that all members gain the maximum benefit from the services available to them, regardless of their individual circumstances or the complexity of their care.
Responsive models of organizational governance: ACOs and CPs design and implement models of organizational governance that enable MassHealth members to inform the decision-making of ACOs and CPs.
Risk stratification: ACOs and CPs apply member data and qualitative insights into member characteristics, preferences, and needs to design, implement, evaluate, and refine risk stratification models that enable them to better understand, engage, and care for the unique population(s) of MassHealth members they serve.
External partnerships, including clinical-community linkages: ACOs and CPs develop and maintain partnerships with a broad range of external organizations, including hospitals, specialist providers, oral health providers, state agencies, social services agencies, and community-based organizations of all sizes, in order to maximize their capacity to address the care coordination, complex care management, health needs, and health-related social needs of every MassHealth member enrolled in the ACO or CP.
ACO/CP Integration: ACOs and CPs develop and maintain shared values, incentives, data, and workflows across ACO-CP partnerships in order to ensure that MassHealth members with the most complex behavioral health, long-term services and support, and health-related social needs benefit from comprehensive and seamless systems of care while leveraging the unique expertise and competencies of both entities.
Next: Competency Area #2