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Commonwealth Medicine Publications

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Full-Text Articles in Health Law and Policy

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon Jun 2019

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon

Commonwealth Medicine Publications

Targeted strategies and sustained efforts at member outreach and engagement are helping Accountable Care Organizations (ACOs) and their Community Partners (CPs) achieve their shared goals for delivering patient-centered care. The most successful organizations focus on activities designed to create a stronger connection with their members, building trust and a better understanding of individuals’ characteristics and care needs. Positive results of these efforts include successful person-centered care planning, improved compliance with care plans and prescriptions, and implementation of recommended lifestyle changes — changes that help support independent living, reduce medical costs and complications, and drive improvements in member satisfaction.


University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish Jun 2019

University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish

Commonwealth Medicine Publications

On behalf of the Minnesota Department of Health Services, Health Law & Policy experts from our Public and Private Health Solutions group completed a literature review of successful efforts to improve the health of previously incarcerated individuals. In addition, our experts conducted five focus groups to obtain recommendations from experienced professionals who work directly with previously incarcerated individuals regarding interventions likely to improve the health of this unique population.

This study came about at the direction of Minnesota Legislature. They were interested in developing a methodology for paying higher rates to health care providers who provide services to high cost and ...


Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six, Robin E. Clark, Linda Weinreb, Julie M. Flahive, Robert W. Seifert May 2019

Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six, Robin E. Clark, Linda Weinreb, Julie M. Flahive, Robert W. Seifert

Commonwealth Medicine Publications

Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care ...


Will Ending Certain Drug Rebates Lower List Prices And Patient Out-Of-Pocket Costs?, Mckenzie Taylor, Stephanie Tran Apr 2019

Will Ending Certain Drug Rebates Lower List Prices And Patient Out-Of-Pocket Costs?, Mckenzie Taylor, Stephanie Tran

Commonwealth Medicine Publications

Earlier this year, the Department of Health and Human Services (HHS) proposed changes to the current pricing and contracting system for federal health care programs, Medicare Part D and Medicaid.This proposal aligns with the Trump Administration’s blueprint for lowering drug prices which we have written about previously.


The Expanding Role Of Pharmacists: A Positive Shift For Health Care, Ashley Chiara Mar 2019

The Expanding Role Of Pharmacists: A Positive Shift For Health Care, Ashley Chiara

Commonwealth Medicine Publications

When reflecting upon the impactful members of a patient’s healthcare team, much consideration is given to the patient’s nurses, primary care physician and specialists. However, with nearly nine in 10 Americans living within five miles of a community pharmacy, and four in five receiving prescription benefits through a pharmacy benefit manager (PBM), the role of the pharmacist in orchestrating a patient’s care on the front lines is often overlooked.


Payment Reform For Kids, Robert W. Seifert Feb 2019

Payment Reform For Kids, Robert W. Seifert

Commonwealth Medicine Publications

Comprehensive care for children – including greater attention to behavioral health, socio-emotional development, and strong family relationships – may hold the key to lifelong health and well-being. With this premise, a group in Connecticut has just published recommendations for improving pediatric primary care through payment reform.


Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price Jan 2019

Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price

Commonwealth Medicine Publications

Prohibiting gag clauses could help lower consumer out-of-pocket pharmacy costs - if Pharmacy Benefits Managers don't raise prices to make-up the difference. Mylissa Price closes our blog series on President Trump's Blueprint to Lower Drug Costs in this final entry.


Deciphering State Medicaid Programs, Rachel Gershon Jan 2019

Deciphering State Medicaid Programs, Rachel Gershon

Commonwealth Medicine Publications

State Medicaid programs vary substantially from one another. For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate.


Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran Dec 2018

Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran

Commonwealth Medicine Publications

The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs calls for incentives to lower drug list prices, including removing rebates. Our clinical consultant Stephanie Tran continues our pharmacy blog series with an assessment of this potential change & its impacts.


New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri Dec 2018

New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri

Commonwealth Medicine Publications

New Trump Administrations Section 1332 waiver guidance increases state ACA flexibility. Rachel Gershon & Catie Torri discuss what this could mean for health care policy.


Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor Nov 2018

Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor

Commonwealth Medicine Publications

Mckenzie Taylor continues our monthly conversation on the strategies presented in The Trump Administration Blueprint to Low Drug Prices and Reduce Out-of-Pocket Costs, discussing the ways new negotiations between payers and manufacturers are helping to reduce drug prices.


Why Retirement Systems Should Consider Vocational Review, Jody Simpson Nov 2018

Why Retirement Systems Should Consider Vocational Review, Jody Simpson

Commonwealth Medicine Publications

Whether the task is determining if a disability retirement applicant is prevented from performing their past public employment or whether they are able to adjust to other substantial work, administering disability benefit claims is a complex process that requires a sophisticated skill-set to ensure accurate and objective determinations. A critical component of that process is a comprehensive vocational assessment that determines a disability applicants vocational skills and abilities before a final recommendation is rendered.

Discover the value of vocational review and why it can be a critical part of the decision-making process.


How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih Oct 2018

How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih

Commonwealth Medicine Publications

In this installment of our blog series on "President Trump's Blueprint to Lower Drug Prices and Reduce Out-Of-Pocket Costs," our pharmacy expert Youkavet Samih discusses how creating drug competition drives down prices for consumers.


Hiring Workers With Disabilities Makes Sense Whether The Job Market Is Hot Or Cold, Kathleen A. Petkauskos Oct 2018

Hiring Workers With Disabilities Makes Sense Whether The Job Market Is Hot Or Cold, Kathleen A. Petkauskos

Commonwealth Medicine Publications

The U.S. Department of Labor released its latest report in September, and it was more of the same. Unemployment remained at 3.9 percent, where it has hovered for much of the year, but there was a shift for one key demographic.

After decades of struggle, workers with disabilities are beginning to move the needle, outpacing the employment gains of people without disabilities. In August 2018, the employment-to-population ratio for working-age people with disabilities jumped to 30.2 percent from 29.5 percent the year before. The labor force participation rate for working-age people with disabilities also increased, rising ...


Utilization Management Programs Are Critical For Effective Mltss Programs, Jessica Carpenter Oct 2018

Utilization Management Programs Are Critical For Effective Mltss Programs, Jessica Carpenter

Commonwealth Medicine Publications

When discussing an efficient managed long-term services and supports (LTSS) program, the importance of a utilization management program cannot be overlooked. It’s a way to not only ensure individuals receive the high-quality services they need, but also realize substantial cost savings for payers.


A View Of The Drug Pricing Blueprint, Bonnie C. Greenwood Sep 2018

A View Of The Drug Pricing Blueprint, Bonnie C. Greenwood

Commonwealth Medicine Publications

Drug spend is predicted to experience the fastest annual growth between 2017-2026 compared to other health care goods and services.Contributing factors include increasing unit prices of branded and generic medications, growth of the specialty drug market, and greater numbers of people with access to prescription drug coverage. A recent analysis estimates total drug expenditures in 2016 to be $480 billion when accounting for gross profits of intermediaries in the distribution chain, such as wholesalers, pharmacy benefit managers (PBMs), and pharmacies. Certainly, the complexity of the drug distribution and reimbursement system and lack of pricing transparency can be viewed both ...


Case Files Key To Comprehensive Medical Board Reviews, Jody Simpson Aug 2018

Case Files Key To Comprehensive Medical Board Reviews, Jody Simpson

Commonwealth Medicine Publications

There are many obstacles public retirement systems must overcome to ensure clinically sound medical board recommendations. Complex medical records that describe various conditions and ailmentsmust be compiled and analyzed to make accurate recommendations. There are key elements to inform a successful medical board review, and chief among them is compiling robust, well-documented case files. If you begin the process with incomplete documentation, you run the risk of getting a partial clinical picture of the member. Not having a full clinical picture could make it difficult to achieve a fully-informed decision.


Bringing Data Into Focus To Optimize Benefits And Savings For Medicare-Medicaid Members, Jenifer Hartman Aug 2018

Bringing Data Into Focus To Optimize Benefits And Savings For Medicare-Medicaid Members, Jenifer Hartman

Commonwealth Medicine Publications

Dual eligible recipients represent a critical population for state Medicaid programs. To get a better understanding of this unique demographic, MassHealth partnered with UMass Medical School to design data analytics programs around the objective of protecting Medicaid as the payer of last resort.

Over the last three years, these programs achieved over $68 million in new savings by optimizing benefits for dual eligible members. The program also identified and recovered over $21 million in Medicare premium overpayments for Medicaid members with discrepancies in Medicare entitlement and premium charges.

Jenifer Hartman of the Center for Healthcare Financing presented UMass Medical School ...


Managed Long-Term Services And Supports Program Framework: Best Practices, Jessica Carpenter Aug 2018

Managed Long-Term Services And Supports Program Framework: Best Practices, Jessica Carpenter

Commonwealth Medicine Publications

Health plans and accountable care organizations are working with Medicaid programs to transition fee-for-services long-term services and supports (LTSS) to a managed care model known as managed LTSS. With more individuals with disabilities seeking to living in their own homes or in community settings, payers must take proactive steps to ensure individuals receive the right service and in the right setting. This white paper details the actions health plan decision makers should consider while developing a comprehensive managed LTSS program.


Sne-Ptn Attends Cms Transforming Clinical Practice Initiative National Expert Panel 2018, Jay Flanagan Aug 2018

Sne-Ptn Attends Cms Transforming Clinical Practice Initiative National Expert Panel 2018, Jay Flanagan

Commonwealth Medicine Publications

Practice transformation networks from across the country are going public with their successful results on patients and clinical practices. UMass Medical School’s Southern New England Practice Transformation Network (SNE-PTN) was one of the networks sharing its positive outcomes.


The Role Of Health Care In Criminal Justice Reform, Julie White Jul 2018

The Role Of Health Care In Criminal Justice Reform, Julie White

Commonwealth Medicine Publications

Mass incarceration continues to be problem in United States with over 2.2 million people incarcerated, costing approximately $80 billion in taxes annually. As a result of the coalescence of social policy researchers, restorative justice policies, civil rights activists, and economists, there is recognition that incarceration is not a financially sustainable ‘solution’ to crime.


Public Retirement System Medical Board Reviews: Elements Of Success, Jody Simpson Jul 2018

Public Retirement System Medical Board Reviews: Elements Of Success, Jody Simpson

Commonwealth Medicine Publications

Comprehensive evaluations of disability benefit applications is a vital responsibility for public retirement systems. Incomplete or incorrect evaluations can lead to costly mistakes in both financial and human terms. The Disability Evaluation Services team shares an framework for success public retirement systems can use to ensure their Medical Boards receive disability determinations that are complete and clinically sound.


Advancing The Science And Practice Of Health Care For Justice-Involved Individuals, Dyana Nickl Jun 2018

Advancing The Science And Practice Of Health Care For Justice-Involved Individuals, Dyana Nickl

Commonwealth Medicine Publications

Our nation’s correctional population is about 6.6 million including those individuals supervised by probation and/or parole agencies, according to the latest figures from the U.S. Bureau of Justice Statistics. Over two million of those are incarcerated and in the custody of a state or federal prison or local jail. It has been reported time and time again that inmates have greater health needs than those living in the community, including higher rates of Hepatitis C, HIV/AIDS, mental health issues and substance use disorder. There is still much we can improve upon in the way we ...


The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton Jun 2018

The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton

Commonwealth Medicine Publications

This presentation describes the managed long-term services and supports (MLTSS) national landscape since 2012 as well as some LTSS utilization trends. A key part of the presentation is our MLTSS best practice framework and the role of LTSS clinical guidelines in that framework. The presentation includes a case study.

Experts from Disability Community Services and the Office of Clinical affairs gave the presentation during a webinar hosted by the Association for Community Affiliated Plans.


Massoptions Transforms The Way Elderly And People With Disabilities Get Much Needed Long-Term Services And Supports In Massachusetts, Jeff A. Auger, Kerrie Topi Jun 2018

Massoptions Transforms The Way Elderly And People With Disabilities Get Much Needed Long-Term Services And Supports In Massachusetts, Jeff A. Auger, Kerrie Topi

Commonwealth Medicine Publications

Some of the Commonwealth’s most underserved populations—the elderly, people with disabilities, and their caregivers— now have simplified access to the long-term services and supports (LTSS) they need, thanks to MassOptions, an innovative collaboration between UHealthSolutions, the nonprofit business affiliate of UMass Medical School, and the Massachusetts Executive Office of Elder Affairs.


Women’S Health Must Be A Criminal Justice Concern, Robert Delanders May 2018

Women’S Health Must Be A Criminal Justice Concern, Robert Delanders

Commonwealth Medicine Publications

One of the most compelling arguments for improvements to healthcare for individuals who are incarcerated is the fact that “[a]t least 95% of all state prisoners will be released…”1 Further, pursuant to a 2014 study by the Sentencing Project, more than 215,332 women and girls are now incarcerated in the U.S.2 This figure represents both a record percentage of the total prison population in the U.S. and an eight-fold rise in the incarceration of females since 1980.3 Critically, more than two thirds of these women are mothers and 60% of these women have ...


Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry May 2018

Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry

Commonwealth Medicine Publications

There is wide geographic variation in Social Security Disability Insurance and Supplementary Security Income participation across the United States. Some policymakers and members of the public may assume that interregional administrative inconsistencies are a major reason for the geographic variation. To test this assumption, and to reveal other potential explanations for the variation, we decompose the total variation into components by examining regional differences in disability prevalence and in program participation among persons with disabilities as well as the correlation between those two factors. We further decompose the variation in participation among persons with disabilities into socioeconomic components. Our findings ...


Justice Involvement Has A Profound Link To Social Determinants Of Health, Warren J. Ferguson Apr 2018

Justice Involvement Has A Profound Link To Social Determinants Of Health, Warren J. Ferguson

Commonwealth Medicine Publications

Social determinants are strong predictors of a person’s health, those being employment, income, housing, food security and social inclusion. What are the outcomes, then, when one characteristic has downstream impact on all the determinants?

I learned the answer at the 11th Academic and Health Policy Conference on Correctional Health in Houston on March 22, when leaders from the Association of American Medical Colleges (AAMC), the Academic Consortium on Criminal Justice Health(ACCJH) and JustLeadershipUSA discussed the impact of criminal justice involvement on the health of individuals and their families.


Pasrr: A Unique Gateway To Community Services, Jessica Carpenter Apr 2018

Pasrr: A Unique Gateway To Community Services, Jessica Carpenter

Commonwealth Medicine Publications

The Omnibus Budget Reconciliation Act of 1987 required state Medicaid programs to implement a Pre-Admission Screening and Resident Review (PASRR) process, which required every person entering or residing in a Medicaid funded or certified long-term care nursing facility be screened for evidence of serious mental illness, and/or intellectual disability, developmental disability or related conditions, such as autism and cerebral palsy. The PASRR review confirms those individuals with a PASRR-related diagnosis and determines the least restrictive environment to meet their needs, and identifies disability focused services to promote the individuals’ highest level of function and independence.


Skilled Nursing Facilities: Too Many Beds, Rebecca Laes-Kushner Mar 2018

Skilled Nursing Facilities: Too Many Beds, Rebecca Laes-Kushner

Commonwealth Medicine Publications

More than 15,500 skilled nursing facilities (SNFs) provide care to more than 1.35 million people in the United States who need assistance with their Activities of Daily Living (ADLs), including going to the toilet, getting out of bed, getting dressed, feeding themselves, and showering, or who have cognitive difficulties, such as from dementia. Nationally, SNF use has declined as people live longer and choose home and community-based services (HCBS) over institutional care. From 2004 to 2014, the percentage of people age 65 and older in nursing homes dropped from 3.6% to 2.5%, a decrease of 24 ...