Improving Care Coordination between Accountable Care Organizations and Community Partners: Early Findings from the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Program

Research Objective: The Massachusetts’ Medicaid and Children’s Health Insurance Program (MassHealth/MH) initiated the Delivery System Reform Incentive Payment (DSRIP) program in 2017, as part of its section 1115 Demonstration, to coordinate care for Medicaid members, reduce healthcare costs and improve patient outcomes. Central to this program was a requirement that Accountable Care Organizations (ACOs) develop relationships with all behavioral health and at least 2 long-term care service MH contracted Community Partner agencies (CPs) operating in their service areas to be responsible for coordinating care and developing care plans for members. This presentation will describe barriers and facilitators to developing ACO-CP relationships identified in the first 1.5 years of program implementation. Study Design: This paper focuses on ways in which ACOs and CPs are responding to new contracting requirements and programmatic expectations related to the MA 1115 DSRIP. Semi-structured interviews were conducted with individuals in leadership positions at all 17 ACOs and 27 CPs by pairs of trained interviewers, in person, or via video or teleconference. Interview data were analyzed qualitatively, using a framework approach informed by the literature, the program logic model, and the evaluation design. Population Studied: ACOs/CPs nominated 2 to 3 individuals best positioned to speak to implementation topics including governance and organizational structure, workforce development, ACO-CP relationships, provider engagement, care coordination, quality improvement, and environmental factors including the role of MassHealth. Ninety-four interviews were conducted with 99 interviewees across the 44 organizations. The majority of interviewees were female and typically held managerial roles, ranging from program managers to executives. A majority were with their organizations prior to or at the time of DSRIP inception. Principal Findings: Communication and information sharing were identified as key ingredients to coordinating member health care between ACOs and CPs; the absence of effective means to communicate and share information were identified as major barriers. Strategies for enhancing communication included scheduling regular meetings to discuss shared patients (i.e., within and between organizations), designating points of contact (e.g., staff liaisons), and clarifying roles regarding member-facing activities. Information sharing was found to be most effective when organizations agreed on processes, particularly around the use of electronic medical records or other information exchange technologies. ACO and CP interviewees indicated that successful communication and information sharing led to the development of stronger and more positive partner relationships (e.g., between an ACO and the CPs with which they share information and coordinate care well). Participants also described ways in which MassHealth has actively responded to challenges within the original design of the ACO-CP relationship to improve coordination and member experience. Conclusions: Designated points of contact, well-conceived and executed communication strategies, and effective information exchange are essential for developing relationships and coordinating care between ACOs and community-based organizations. Implications for Policy or Practice: States need to consider the complexity of coordinating care with multiple community-based agencies and the importance of standardized processes for effective information sharing when promoting care coordination between health care and human service entities. States should also incorporate means of ongoing technical support and rapid cycle feedback to allow for continuous policy improvement in Medicaid delivery systems

Re-defining journalism education: Using systems thinking and design to revolutionize the future of storytelling

The problem Journalism education has not kept pace with the growing complexity of the professional practice. The first crisis in journalism had to do with transitioning to a vastly more complex digital environment. Now, journalism is struggling to sustain itself amidst outdated business models, fractured audiences, declining trust, and a White House bent on undermining the whole operation. At stake is a vital part of the checks and balances system of a functioning democracy. Journalism + Design is a forward-looking, iterative education program preparing students and professionals alike to function in the complex ecosystem of contemporary journalism. We use systems thinking and design practices to help journalists better understand the interconnected nature of the problems they face, both as journalists having to operate within a complex adaptive system as well as practitioners and future practitioners expected to report on and explain the most important stories of our times – climate change, the effects of unfettered global capitalism, income inequality, racism, crumbling democracies. These are all stories of complex adaptive systems, or what Rittel and Webber called, wicked problems – impossible to even name, let alone solve, and with boundaries that blur into other wicked problems (Rittel and Webber, 1973). Design and systems journalism initiative This abstract seeks to outline the theory and practice behind our efforts to bring design practices and systems thinking into journalism education for both students and professionals. As mentioned above, the problem for journalists is two-fold: First, how do we build a sustainable system by which news is gathered, verified, synthesized, and distributed in a way that is independent from powerful interests? Many people talk about “saving the newspapers” or in other ways propping up existing entities. French economist, Julia Cagé, in her book, Saving the Media, argues that what will fix the news is a new, not-for-profit business model (Cagé, 2016). There’s Victor Pickard who, in his piece for The Guardian, recognizes that traditional ways of thinking about the news is not helping the industry, but still recommends a new, non-commercial business model (Pickard, 2009). Our analysis is that what is at stake is not so much the longevity of existing manifestations, but rather ensuring that some system for doing the above-mentioned work itself exists in the future – whatever that might look like. Second, how do we prepare journalists to tell the most important stories of our times – those of complex adaptive systems, or, wicked problems? This does not require merely digital skills, which is the strategy of most news organizations. Rather, it requires the ability to understand the forces behind events in the news, the interconnections between those forces, the non-linear natures of how events occur and multiply, and how to identify feedback loops and leverage points. A systems approach to redesigning journalism education and professional development is necessary to address these problems. The Journalism + Design initiative involves identifying leverage points for interventions in the education and professional spheres as well as opportunities for inspiring public discourse, such as publishing papers and popular articles, launching a podcast, and convening open workshops with community partners. The additional challenge is how to foster a change in attitude among the future of journalism community from one of trying to solve the problem of the crisis in journalism to one seeking to sustain a healthy system of journalism. Re-designing journalism education and professional development A significant part of the work of this initiative has been the development of an undergraduate journalism major at The New School in New York that marries fundamental journalistic practices and ethics with a systems and design practice. Our definition of design is a set of flexible processes for navigating unknown environments. We define systems thinking as the practice of studying wholes rather than parts in isolation, studying patterns of change overtime and identifying driving forces. This work has been primarily done through the Journalism + Design program at The New School. The program started four years ago with seven classes and 30 majors. Today, we offer 27 classes, have nearly 100 majors and see 406 students taking our classes. It has already become the second biggest major in the school. The excitement generated by the program among professionals led to the development of workshops and events outside the college, such as systems thinking for beat reporters, basic design process workshops, and systems and design support for projects around complex topics like homelessness, gentrification, and gerrymandering. In addition, the initiative has also begun work fostering systems and design approaches to journalism among community leaders in underserved urban neighborhoods in order to help build informal information networks to serve needs unmet by professional news organizations or the closing of local professional news outlets. The aim is to equip journalists with the ability to surface and diversify story ideas and sources, explore complex relationships, be more resilient in the face of uncertainty, identify how the structure of complex systems dictate outputs and consequences, and develop and maintain participatory and collaborative partnerships with non-media organizations and community members. Presenting In this presentation, we will provide an overview of the theories and intellectual work behind this initiative as well as surface learning to be gleaned from the work itself. This presentation will provide the audience with years of innovative research, curriculum, and insights, and, since playful experimentation is a key tenant of how our program was designed, our presentation will incorporate how our initiative actually operates in the field. More specifically, it will look at how systems thinking and design cooperate, how our program has integrated them into fast-paced, overworked newsrooms, and what this initiative means for sustainable journalism and democracy at large

SHAP Enrollment and Eligibility Activities: Implications for Process and System Modernization Under National Health Reform

Shares five states' experiences and best practices in using State Health Access Program grants to expand public health coverage through community-based outreach and improved eligibility and enrollment processes, as well as implications for federal reform

Solomon Islands: Malaita Hub scoping report

The CGIAR Research Program (CRP) Aquatic Agricultural Systems (AAS) will target five countries, including Solomon Islands. The proposed hubs for Solomon Islands were to cover most provinces, referencing the Western, Central and Eastern regions. Scoping of the initial ‘Central’ hub was undertaken in Guadalcanal, Malaita and Central Islands provinces and this report details findings from all three. As scoping progressed however, it was agreed that, based on the AAS context and priority needs of each province and the Program’s capacity for full implementation, the Central Hub would be restricted to Malaita Province only and renamed “Malaita Hub”. Consistent in each AAS country, there are four steps in the program rollout: planning, scoping, diagnosis and design. Rollout of the Program in Solomon Islands began with a five month planning phase between August and December 2011, and scoping of the first hub began in January 2012. This report, the second to be produced during rollout, describes the findings from the scoping process between January and June 2012. This report marks the transition from the scoping phase to the diagnosis phase in which output from scoping was used to develop a hub level theory of change for identifying research opportunities. Subsequent reports detail in-depth analyses of gender, governance, nutrition and partner activities and discuss Program engagement with community members to identify grass-roots demand for research

Changing Stakeholder Needs and Changing Evaluator Roles: The Central Valley Partnership of the James Irvine Foundation

This case study describes the evolution of the evaluator's role as the program evolved and developed, and as the needs of the client and intended users changed over time. The initiative aimed to assist immigrants in California's Central Valley. The case illustrates important tensions among accountability, learning and capacity building purposes of evaluation

Boston University Bulletin. School of Management; Graduate Programs, 1980-1981

Each year Boston University publishes a bulletin for all undergraduate programs and separate bulletins for each School and College, Summer Term, and Overseas Programs. Requests for the undergraduat e bulle tin should be addressed to the Admissions Office and those for other bulletins to the individual School or College. This bulletin contains current information regarding the calendar, admissions, degree requirements, fees, regulations, and course offerings. The policy of the University is to give advance notice of change, when ever possible, to permit adjustment. The University reserves the right in its sole judgment to make changes of any nature in its program, calendar, or academic schedule whenever it is deemed necessary or desirable, including changes in course content, the rescheduling of classes with or without extending the academic term, canceling of scheduled classes and other academic activities, and requiring or affording alternatives for schedul ed classes or other academic activities, in any such case giving such notice thereof as is reasonably practicable under the circumstances. Boston University Bulletins (USPS 061-540) are published twenty times a year: one in January, one in March, four in May, four in June, six in July, one in August, and three in September

Building Citywide Systems for Quality: A Guide and Case Studies for Afterschool Leaders

This guide is intended to help cities strengthen and sustain quality afterschool programs by using an emerging practice known as a quality improvement system (QIS). The guide explains how to start building a QIS or how to further develop existing efforts and features case studies of six communities' QIS

Community Partnerships for Cultural Participation: Concepts, Prospects, and Challenges

Evaluates the first year of the Wallace Foundation's Community Partnerships for Cultural Participation Initiative, which funded nine community foundations working to increase participation in the arts and culture in their communities