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Full-Text Articles in Health Law and Policy

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.


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.


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 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.


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 ...


Impact Of A Pilot Outreach Program Upon Provider Awareness And Prescribing Of A Concerning Opioid Combination Regimen, Briana Santaniello, Thomas C. Pomfret, Mark A. Tesell, Nicole M. Trask, Caroline J. Alper, Karen M. Clements, Vincent Palumbo, Kimberly Lenz, Paul L. Jeffrey Feb 2018

Impact Of A Pilot Outreach Program Upon Provider Awareness And Prescribing Of A Concerning Opioid Combination Regimen, Briana Santaniello, Thomas C. Pomfret, Mark A. Tesell, Nicole M. Trask, Caroline J. Alper, Karen M. Clements, Vincent Palumbo, Kimberly Lenz, Paul L. Jeffrey

Commonwealth Medicine Publications

This pilot program was developed in response to a drug utilization review within a large Medicaid population that revealed some hazardous practices. Co-prescribing of opioids with benzodiazepines, gabapentin, and other stimulants occurred in more than 500 members, putting them at risk for additive central nervous system depression, misuse, abuse, and death from overdose.

The poster presentation outlines the objectives, methods, and results of a telephonic outreach program that addressed these safety concerns. It captures prescriber awareness of the presence and risks of potentially deadly medication combinations among members in their care, with some intriguing results.

Our experts provide health plans ...


A Medicaid Compromise Expanded Coverage For Hoosiers, But Important Questions Linger, Robert W. Seifert Feb 2018

A Medicaid Compromise Expanded Coverage For Hoosiers, But Important Questions Linger, Robert W. Seifert

Commonwealth Medicine Publications

In today’s polarized political environment, it is easy to forget that most policy decisions are not black or white, but rather some indeterminate shade of gray. A case in point is Indiana’s Medicaid waiver, which the federal government just approved for a three-year extension.


Integrating Third Party Liability (Tpl) Across Medicaid Operations And Enterprise Systems In Massachusetts, Jenifer Hartman Aug 2017

Integrating Third Party Liability (Tpl) Across Medicaid Operations And Enterprise Systems In Massachusetts, Jenifer Hartman

Commonwealth Medicine Publications

This poster highlights the results of a UMass Medical School partnership with MassHealth, the Massachusetts Medicaid program, to integrate third party liability (TPL) activities across all aspects of the Medicaid program. By embedding TPL at all stages of Medicaid operations and interfacing with all Medicaid systems, the partners optimized identification of and access to TPL sources for all Medicaid members.

The TPL activities include eligibility coordination, coverage coordination, payment coordination and recovery coordination. The partnership has achieved over $40 million in cost avoidance through the identification of missed Medicare benefits, over $64 million in cost avoidance over enhanced coordination of ...


Southern New England Practice Transformation Network: Thinking Outside The Box Solved Our Enrollment Challenges, David Polakoff Dec 2016

Southern New England Practice Transformation Network: Thinking Outside The Box Solved Our Enrollment Challenges, David Polakoff

Commonwealth Medicine Publications

The strategies used by the Southern New England Practice Transformation Network (SNE-PTN), a collaborative led by UMass Medical School and UConn Health, to enroll more than 5,000 clinicians from a variety of specialties by the end of October 2016. The strategies led SNE-PTN to achieve 186 percent of the year one enrollment target.

SNE-PTN is one of 29 practice transformation networks across the country chosen by the Centers for Medicare and Medicaid Services to be part of its Transforming Clinical Practices Initiative. This practice transformation program aims to bring together specialty and primary care clinicians to work individually and ...


Best Practices In Care Coordination & Transitions Of Care Communications, Jessica Carpenter Oct 2016

Best Practices In Care Coordination & Transitions Of Care Communications, Jessica Carpenter

Commonwealth Medicine Publications

Learn the strategies required to deliver patient-centric, quality care for individuals with complex care needs. Successful coordination and management requires networking with multiple care providers and linking each intervention to the individual’s overall care.


Complex Care Management Model Design, Jessica Carpenter Oct 2016

Complex Care Management Model Design, Jessica Carpenter

Commonwealth Medicine Publications

The steps to developing Complex Care Management Model Design for state Medicaid programs with a focus on one single point of entry. In this design, long term services and supports are provided in order for individuals to remain in the community.


Improving Population Healthcare Through Data Analytics, Visualization, And Reporting Tools, Rick Perro Aug 2016

Improving Population Healthcare Through Data Analytics, Visualization, And Reporting Tools, Rick Perro

Commonwealth Medicine Publications

Policy makers, program planners and health care providers must be able to identify at-risk populations and geographic areas of need, implement programs to effect change, and track and report the results to achieve success in today’s health care environment. Mapping and visualization tools can enhance the use of data to characterize a population’s health and social services needs, target interventions and compare outcomes across different population subgroups. In Massachusetts, visualization and analytic tools are used to manage 1915c Medicaid Waiver programs, track operations, improve efficiency, report quality measures, monitor program integrity and plan for expanded service needs.


A Pathway To Dual Eligible Data Integration: Maximizing Coordination Of Benefits, Services, And Payments Through The Massachusetts Mmis, Jenifer Hartman, Kathleen Melanson Aug 2016

A Pathway To Dual Eligible Data Integration: Maximizing Coordination Of Benefits, Services, And Payments Through The Massachusetts Mmis, Jenifer Hartman, Kathleen Melanson

Commonwealth Medicine Publications

We have partnered with MassHealth, Massachusetts’ Medicaid program, to develop and deploy precision data integration methodologies within the Massachusetts Medicaid Management Information System (MMMIS) to maximize coordination of benefits, services and payments for Medicaid recipients with current or potential dual eligibility for Medicare. Integration strategies and coordination benchmarks are used to ensure accurate Medicaid and Medicare enrollment; fully engage service delivery options (including managed care and integrated care programs); and effectively cost-avoid, reprice, or cost-share to ensure the state’s lowest payment liability.


Implementing Behavioral Health Integration In Primary Care, Joshua P. Twomey, Judith Steinberg, Joan D. Johnston, Amy Leary, Amy Norrman-Harmon, Jean Carlevale Jun 2016

Implementing Behavioral Health Integration In Primary Care, Joshua P. Twomey, Judith Steinberg, Joan D. Johnston, Amy Leary, Amy Norrman-Harmon, Jean Carlevale

Commonwealth Medicine Publications

A detailed review of the teaching assistance (TA) and shared learning (SL) in the area of behavioral health integration UMass Medical School provided to participants of the Primary Care Payment Reform program, an alternative payment pilot developed by the Massachusetts Medicaid program, MassHealth. PCPR was designed to improve access, patient experience, quality and efficiency. As a result of TA and SL, practices reported higher rates on behavioral health quality measures and milestones.


Paving The Way For Practice Success Under Value-Based Payments, Judith Steinberg, Anita Morris, Valerie Konar, Frederick (Rick) Perro, Pam Senesac, David Polakoff Jun 2016

Paving The Way For Practice Success Under Value-Based Payments, Judith Steinberg, Anita Morris, Valerie Konar, Frederick (Rick) Perro, Pam Senesac, David Polakoff

Commonwealth Medicine Publications

A comprehensive look at The Southern New England Practice Transformation Network (SNE-PTN), which supports implementation of person-centered, high quality, efficient, and coordinated care. SNE-PTN is funded under the Centers for Medicare & Medicaid Services’ Transforming Clinical Practices Initiative.

SNE-PTN is a complex, large-scale care transformation effort that requires a multi-faceted approach and alignment with state and national health care reform efforts. It is important to articulate the value proposition for clinicians.


Whole-Person Care: Implementing Behavioral Health Integration In The Patient-Centered Medical Home, Joshua P. Twomey, Joan Johnston, Judith L. Steinberg, Anita Morris Mar 2016

Whole-Person Care: Implementing Behavioral Health Integration In The Patient-Centered Medical Home, Joshua P. Twomey, Joan Johnston, Judith L. Steinberg, Anita Morris

Commonwealth Medicine Publications

Primary Care Payment Reform (PCPR) is an alternative payment pilot program of MassHealth, with learning collaborative support from UMass Medical School, that introduces the principles of accountable care, behavioral health integration and patient-centered medical homes in primary care practices. The pilot demonstrated that behavioral health integration is a necessary component of whole-person care and a complex, but highly accomplishable task; numerous transformation strategies can support the clinical, financial and cultural challenges to integration; and alternative payment models are essential to support sustainable, expandable and successful behavioral health services in primary care.


Stories From The Frontline: Patient-Centered Medical Home Care Transitions, Anita Morris, Joan Johnston, Sai Cherala, Ruth Aboagye, Pam Senesac, Judith L. Steinberg, Jaime Vallejos Mar 2016

Stories From The Frontline: Patient-Centered Medical Home Care Transitions, Anita Morris, Joan Johnston, Sai Cherala, Ruth Aboagye, Pam Senesac, Judith L. Steinberg, Jaime Vallejos

Commonwealth Medicine Publications

The Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI) was a three-year multi-payer demonstration designed to promote clinical model transformation in practices across the state and prepare the practices for PCMHI recognition. It was a partnership between MassHealth, the Massachusetts Medicaid program, and UMass Medical School. An analysis of the project at 46 participating practices finds that primary care practice transformation takes time; care transitions, including emergency room and post-discharge follow-up care, require the development of new clinical workflows; and the processes of care are more likely to improve before outcomes are affected. These lessons learned can aid provider organizations nationwide ...


Massachusetts Eligibility Data Platforms: Integrating State And Federal Data Sets To Maximize Benefits And Savings, Jenifer Hartman, Yuping Su Aug 2015

Massachusetts Eligibility Data Platforms: Integrating State And Federal Data Sets To Maximize Benefits And Savings, Jenifer Hartman, Yuping Su

Commonwealth Medicine Publications

This poster presentation shows how UMass Medical School works with state Medicaid programs to customize and implement business methodologies to maximize benefits for individuals and savings for states. The medical school’s collaboration with state and federal agencies has resulted in two national corrections of federal benefits systems in the past five years that led to increased benefits for individuals and increased Medicaid savings and revenue in all states.

Presented at the Medicaid Enterprise Systems Conference 2015.


State Differences In The Application Of Medical Frailty Under The Affordable Care Act, Peter Mosbach, Sherry Campanelli, A. E. Adams Jun 2015

State Differences In The Application Of Medical Frailty Under The Affordable Care Act, Peter Mosbach, Sherry Campanelli, A. E. Adams

Commonwealth Medicine Publications

This poster explains a study that examines how states undergoing Medicaid expansion differ in their treatment of the “medically frail” population. The medically frail are individuals who may need the extra benefits offered by traditional Medicaid.

The results provide needed information to policymakers that are interested in improving access among vulnerable populations in the 23 states that have not yet implemented Medicaid expansion, but may do so in the future. While regulations provide categories that qualify for medical frailty, each state is free to use their own method of determining who meets the definition. There is a need for ongoing ...


How Proposed Husky Cuts Will Harm Low-Income Families, Rachel Gershon, Katharine London, Robert W. Seifert Mar 2015

How Proposed Husky Cuts Will Harm Low-Income Families, Rachel Gershon, Katharine London, Robert W. Seifert

Commonwealth Medicine Publications

An analysis of proposed Medicaid changes in Connecticut was conducted by our health policy experts. Using research literature and the recent experience of other states, we estimated the number of persons who would be left uninsured if the proposal is implemented, and discussed effects on access to care for parents, pregnant women, and children.


One State's Perspective On The Management Of Hepatitis C Drugs, Pavel Lavitas Feb 2015

One State's Perspective On The Management Of Hepatitis C Drugs, Pavel Lavitas

Commonwealth Medicine Publications

This presentation provides an overview of the hepatitis C virus monitoring program implemented for state Medicaid to contain costs and to promote optimal member care. Key clinical and economic outcomes of the monitoring program are highlighted and formulary management strategies for novel hepatitis C virus agents identified.

Presented at the American Drug Utilization Review Society 2015 Conference.


New Payment Models For Asthma, Katharine London Oct 2014

New Payment Models For Asthma, Katharine London

Commonwealth Medicine Publications

This presentation discusses new payment models for asthma and provides an overview of the Massachusetts Children's High-risk Asthma Bundled Payment (CHABP) Demonstration Program. It also discusses opportunities and challenges of the new payment models.


Overview Of A Hepatitis C Medication Monitoring Program In A State Medicaid Program, Pavel Lavitas, Kimberly J. Lenz, Tasmina Hydery, Mark Tesell, J. Gagnon, Paul L. Jeffrey Oct 2014

Overview Of A Hepatitis C Medication Monitoring Program In A State Medicaid Program, Pavel Lavitas, Kimberly J. Lenz, Tasmina Hydery, Mark Tesell, J. Gagnon, Paul L. Jeffrey

Commonwealth Medicine Publications

This presentation outlines a successful hepatitis C medication monitoring program instituted by Clinical Pharmacy Services for MassHealth, the Massachusetts Medicaid program. The program used outreach and education strategies to communicate with prescribers about regimens that were the most effective in treating the virus and containing costs. Member adherence to the regimen was monitored and hepatitis C cure rates were tracked through the program.


Limiting The Duration Of Medication Assisted Treatment For Opioid Addiction: Will New State Policies Help Or Hurt?, Robin E. Clark, Jeffrey D. Baxter, Bruce A. Barton, Gideon Aweh, Elizabeth O'Connell, William H. Fisher Jun 2014

Limiting The Duration Of Medication Assisted Treatment For Opioid Addiction: Will New State Policies Help Or Hurt?, Robin E. Clark, Jeffrey D. Baxter, Bruce A. Barton, Gideon Aweh, Elizabeth O'Connell, William H. Fisher

Commonwealth Medicine Publications

This presentation details the impact of state Medicaid programs placing lifetime limits on buprenorphine therapy for individuals with opioid dependence. The research reveals that setting limits does not save money or help the patient.


Understanding And Analyzing The New Federal Reporting Requirements: Performance Indicators Of State Medicaid & Chip Programs, Michael Chin May 2014

Understanding And Analyzing The New Federal Reporting Requirements: Performance Indicators Of State Medicaid & Chip Programs, Michael Chin

Commonwealth Medicine Publications

This presentation describes Medicaid and CHIP requirements to report performance indicators, describes the marketplace federal reporting requirements, describes and analyzes initial results from the reporting requirements, and reviews the future of federal reporting for Medicaid and CHIP.


Implementing Integrated Clinical Care Management In The Patient-Centered Medical Home, Jeanne Z. Cohen, Christine Johnson, Judith Steinberg, Sai Cherala Mar 2014

Implementing Integrated Clinical Care Management In The Patient-Centered Medical Home, Jeanne Z. Cohen, Christine Johnson, Judith Steinberg, Sai Cherala

Commonwealth Medicine Publications

Clinical Care Management (CCM) of the highest risk, most complex and costly patients is a key element of the Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI), and is a new service for most primary care practices. There is much confusion about the role of the Care Manager (CM), and a lack of awareness of key foundational elements critical to successful implementation of CCM. This poster describes the shared approach to implementation of CCM in the MA PCMHI, use of care management and care coordination clinical quality measures to monitor implementation progress, and shared lessons learned in the implementation process.


Implementing Integrated, Interdisciplinary Clinical Care Management In The Patient-Centered Medical Home, Jeanne Z. Cohen, Christine Johnson, Judith Steinberg, Sai Cherala Nov 2013

Implementing Integrated, Interdisciplinary Clinical Care Management In The Patient-Centered Medical Home, Jeanne Z. Cohen, Christine Johnson, Judith Steinberg, Sai Cherala

Commonwealth Medicine Publications

Clinical care management (CCM) of the highest risk, most complex, and costly patients is an integral component of the patient-centered medical home (PCMH) but a new service for many primary care practices. The Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI) is a 3-year, multi-payer demonstration with 45 participating practices. Support for CCM implementation is provided through learning collaboratives and practice facilitation. Techniques for shared learning include developing a CCM interdisciplinary team workflow utilizing process mapping and modeling care plan development. MA PCMHI practices have found these techniques valuable for clarifying what a care plan is and visualizing existing workflows, so ...


The Impact Of Prior Authorization On Buprenorphine Dose, Relapse And Cost Of Opioid Addiction Treatment, Robin E. Clark, Jeffrey D. Baxter, Bruce A. Barton, Gideon Aweh, Elizabeth O'Connell, Bill Fisher Jul 2013

The Impact Of Prior Authorization On Buprenorphine Dose, Relapse And Cost Of Opioid Addiction Treatment, Robin E. Clark, Jeffrey D. Baxter, Bruce A. Barton, Gideon Aweh, Elizabeth O'Connell, Bill Fisher

Commonwealth Medicine Publications

This presentation discusses the impact of prior authorization on Buprenorphine dose, relapse, and cost for opioid addiction treatment for Massachusetts Medicaid members.

Presented at the AcademyHealth Annual Research Meeting 2013.