Our approach to dual eligible data analytics led to MassHealth, the Massachusetts Medicaid program, saving over $68 million through benefits optimization and recovering over $21 million in Medicare premium overpayments.
Amid a nationwide opioid addiction crisis, providers and payers must look well beyond simply containing costs and work closely with doctors who are prescribing these powerful pain medications.
Integration strategies and coordination benchmarks within the Massachusetts Medicaid Management Information System (MMMIS) 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.
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 MassHealth Hospice Program: Overview and Analysis study employed mixed methods to conduct a descriptive analysis of primary and secondary data, using document review, key informant interviews, and MassHealth claims and enrollment data. This report explains the structure and implementation of the hospice benefit, examines the increase in hospice benefit utilization and expenditures, assesses member and family satisfaction with the benefit, and describes end of life services provided by Medicaid programs in five states.
Primary Care Payment Reform (PCPR), an alternative payment pilot program of MassHealth with learning collaborative support from UMass Medical School, demonstrated that behavioral health integration is a necessary component of whole-person care and a complex, but highly accomplishable task.
An analysis of the Massachusetts Patient-Centered Medical Home (MA PCMHI) 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.
This article highlights a buprenorphine dose-based prior authorization policy developed by MassHealth, the Massachusetts Medicaid program, in consultation with UMass Medical School. The policy may be a model for other states that are concerned about diversion of buprenorphine among individuals with opioid dependence.