Exploring the Future of Medicaid

Delivering Third-Party Liability Results, Mile After Mile

UMass Experts Talk About Where Medicaid Might Be Headed

How We Solve Medicaid Challenges

UMass Medical School helps states navigate their high-priority challenges, by offering specialized services and expertise to contain costs and improve outcomes. Our offerings address the following:

An increased focus on developing new service delivery and financing models
The importance of federal waivers in securing programmatic funding
Long-term services and supports challenges for Medicaid enrollees with complex needs
Supporting Medicaid as the Payer of Last Resort

Medicaid Consulting and Operations

Financing and claiming initiatives
Helping states recover significant costs and save millions

Policy design and development
Developing, evaluating, and implementing targeted health care policies

Drug management strategies for high-cost medications
Curbing medication costs while improving treatment outcomes

Delivery System and Payment Reform

Federal approval for waivers
Navigating the waiver process from start to finish

Alternative payment systems
Helping develop shared savings arrangements, bundled payments, and global payments

Payment method modeling
Evaluating how reimbursement and purchasing reforms affect financing and service delivery

Long-Term Services and Supports

Data analytics
Providing a complete picture of a complex population

Complex clinical case consultation
Ensuring Medicaid members receive the most appropriate and highest quality care

Disability determinations
Providing medical and vocational reviews of disability cases

Medication therapy management
Optimizing medication use and enhancing CMS star ratings

Medicare Eligibility Enhancement

Medicare and disability entitlement correction
Resolving federal errors to increase individual benefits and state savings

Medicare outreach and enrollment
Increasing Medicare enrollment for eligible Medicaid recipients

Medicare Premium Payment Review
Integrating state and federal data to ensure accurate state Medicare buy-in expenditures

Related Information

Data Analytics

Our data management and analytics solutions allow government agencies, health plans, and providers to make evidence-based health care decisions for the populations they serve.

Dual Eligibles

Individuals who qualify for both Medicare and Medicaid may be entitled to receive more comprehensive coverage and care than they currently receive through one program alone. We can help states develop and implement demonstration projects that support this population — eliminating barriers to care while also containing costs.

Financing

Our financing expertise and services include payment model development, third-party liability, insurance reform, Medicaid and Medicare savings initiatives, revenue recovery, federal claiming, program integrity, benefit coordination, and more.

Health Care Reform

Our team has decades of success in legislative reform, including drafting new health care laws and amending existing ones, developing vehicles to contain costs, working with policymakers and stakeholders, and supporting care improvement.

Hepatitis C Medication Management

We can help states, pharmacy benefit management programs, health plans, and other organizations develop comprehensive medication management strategies for Hepatitis C treatment, which promote optimal therapeutic outcomes and contain costs.

Long-Term Services and Supports

Our long-term services and support (LTSS) offerings integrate expertise in health law, policy, clinical and program operations to provide our public and private clients the robust solutions, recommendations, and program development services needed for successful LTSS solutions in a complex health care environment.

Managed Care

We work with managed care organizations to ensure members with multiple, complex health issues receive the high-quality, cost effective care required to qualify for federal incentives.

Medicaid

Our work encompasses all facets of Medicaid consulting and administration, including financing, policy and program development, care coordination, medication management, data analytics, evaluation, and more.

Payment Reform

Our experts help states develop innovative financing strategies, such as bundled and global payments, pay-for-performance, and shared savings arrangements. We analyze financial, legal and policy implications, including federal compliance requirements.

Star Ratings

We have developed Star Rating enhancement services that focus on key criteria used to measure Medicare plan performance.

Care Coordination

We provide care coordination services for medically fragile individuals, and design and deliver training to providers and practices to enhance their ability to manage and deliver patient care.

Data Management

Our data management solutions ensure state agencies and health care organizations have access to quality data for analysis and policy development.

Drug Utilization Review

Ongoing reviews of new drugs and new drug classes are key components of effective drug management decisions. We use evidence-based methods to determine which pharmaceutical products and treatments are both clinically and economically sound, helping public and private health care organizations balance positive clinical outcomes with fiscal responsibility.

Medicare Eligibility Enhancement

We utilize our knowledge of SSA and CMS eligibility policies and procedures, as well as our technical expertise in federal data sets, to evaluate the accuracy of Medicare benefit determinations, and identify federal discrepancies and errors potentially impacting state cost savings and recovery efforts.

Medication Therapy Management

Our patient-centered Medication Therapy Management (MTM) services improve medication adherence, detect adverse events or medication misuse, provide education, and assist the patient in developing personal strategies to achieve the health outcomes they are striving to reach.

Policy Development

Crafting health policy requires a multifaceted approach, including data analytics, legal analysis, finance, and economics. We offer policy consulting by a team of seasoned health care experts.

State and Federal Claiming

Unraveling the complexities of Medicare, Medicaid, and other agencies and programs is not easy. We work with states across the country to maximize federal reimbursement and reclaim revenue owed to state agencies and localities.

Third Party Liability

The core of third-party liability is ensuring that Medicaid is the payer of last resort. By pursuing payment from other entities for services to Medicaid recipients, states can recover significant costs and save millions.

Waiver Development

We have particular expertise in guiding states through the process of obtaining and implementing section 1115, 1915(c) and other waivers. We are well equipped to assist in developing ACA section 1332 state innovation waivers.

Commonwealth Medicine

Exploring the Future of Medicaid

Delivering Third-Party Liability Results, Mile After Mile

UMass Experts Talk About Where Medicaid Might Be Headed

How We Solve Medicaid Challenges

Medicaid Consulting and Operations

Delivery System and Payment Reform

Long-Term Services and Supports

Medicare Eligibility Enhancement

Contact Us

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Exploring the Future of Medicaid

Delivering Third-Party Liability Results, Mile After Mile

UMass Experts Talk About Where Medicaid Might Be Headed

How We Solve Medicaid Challenges

Medicaid Consulting and Operations

Delivery System and Payment Reform

Long-Term Services and Supports

Medicare Eligibility Enhancement

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Related Information

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