This issue brief describes the key elements of the most recent MassHealth 1115 waiver extension, including the shift to a delivery system centered on Accountable Care Organizations and Community Partners, a Delivery System Reform Incentive Program, the redesigned Safety Net Care Pool, and the expansion of services for treatment of substance use disorders. It concludes with a discussion of implications of the new system for major stakeholder groups.
How managed care organizations can better address the opioid addiction crisis, including improving access to naloxone and Medication Assisted Therapies (MAT) as well as ensuring benefit design will support alternative pain management methods.
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.
The Academy of Managed Care Pharmacy (AMCP) Partnership Forum, Navigating Innovations in Diabetes Care, brought together AMCP members, industry experts, and other key healthcare stakeholders together to discuss the impact of advances in diabetes treatments related to a range of new drugs, technology solutions and care management models.
Pipeline Trends is produced by the Clinical Pharmacy Services division and is distributed at least once a year. It provides an overview of promising new agents, investigational indications, projected generic entry, FDA updates and industry trends.
Hospitals face financial challenges when providing access to medical interpreters. A new study shows that access to interpreters lowers readmission rates, a key quality indicator. Greater access to medical interpreters may help hospitals facing new payment incentives to reduce readmissions.
A summary of efficacy data for high-impact specialty pipeline drugs expected to reach the market, including their place in therapy and budgetary impact. Also featured are strategies to mitigate costs of these cutting-edge medications and compare them to current therapy options.
An overview of waivers made possible by Section 1115 of the Social Security Act and Section 1332 of the Affordable Care Act. It explains spending and waiver authority and the legal considerations that may arise, the ways that states have used waiver authority, and reviews the limitations and new responsibilities that come with waivers.
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.
The steps to developing Complex Care Management Model Design for state Medicaid programs with a focus on one single point of entry.
Even with health insurance gains, access may still be an issue. State Innovation Waivers offer an opportunity to build on the Affordable Care Act and increase health insurance affordability. States can ask the federal government for authority to change parts of the ACA to achieve their goals.
A comprehensive overview of why policymakers should include language access elements in Medicaid ACO design and a description of how such a design can be implemented. Access to language services is crucial to providing quality care and reducing health disparities among patients who are deaf or Limited English Proficient.
The Care Transformation Collaborative of Rhode Island (CTC), a patient-centered medical home initiative managed by UMass Medical School, explains how primary care practices can build a medical neighborhood by creating a community health team to provide behavioral health and social support services to patients with high-cost, complex care needs.
Breakthrough direct-acting antivirals set a new standard in the management of hepatitis C virus (HCV) with regard to cure rates and improved tolerability, but cost is a challenge. We designed and implemented a comprehensive HCV medication management program that helped one state Medicaid program avoid nearly $3.8 million in costs while ensuring members have access to clinically appropriate regimens.
Many individuals with disabilities are interested in working, but don’t know how doing so will affect their ability to receive public benefits like Social Security and Medicare. BenePLAN was established in 2000 to provide Massachusetts residents who receive public benefits with information to help them make informed decisions about going to work.
This annual report outlines the 2015 accomplishments of Care Transformation Collaborative (CTC) Rhode Island, a primary care initiative managed by UMass Medical School. CTC includes more than 80 primary care practices across the state
Our customized, results-oriented high-risk medication program dramatically reduced refills for this Medicare Part D client with targeted prescriber outreach. This indicates discontinuation of the prescription or change to a safer medication.
More than 150 adults with acquired brain injury in Massachusetts transitioned from long-term care settings to the community from November 2010 to August 2013. Some individuals transitioned with an increase in risk incidents. A registered nurse care manager was engaged to address the needs of those at high risk. The results show there was a decrease in hospitalizations and emergency room visits.
Women with disabilities are at risk for poor birth outcomes. Little is known about specific potentially disabling health conditions and their effects on pregnancies. We found that disability risk identified through hospital claims is associated with poor infant and maternal outcomes.
How 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 population subgroups. These tools are used to manage Massachusetts 1915c Medicaid Waiver programs, track operations, improve efficiency, report quality measures, monitor program integrity and plan for service needs.
An assessesment of the impact of the MassHealth, the Massachusetts Medicaid program, Children's Behavioral Health Initiative implemented in 2007. The initiative, requires behavioral health screening at well-child appointments, substantially increased the percentage of children receiving behavioral health screenings.