UMass Medical School supports MassHealth effort to integrate care for "dual eligibles"

June 15, 2011

UMass Medical School is partnering with the Massachusetts Medicaid program, MassHealth, in an effort to develop a model that will fully integrate the delivery and financing of care for all 21- to 64-year-old “dual eligibles,” those who qualify for both Medicare and Medicaid services.

With $1 million in funding from the Innovation Center at the Centers for Medicare and Medicaid, the state will oversee the project, which will demonstrate how this care and financing model would work. UMass Medical School will provide MassHealth with support in four main areas of the project:

  • Document development support (e.g., drafting of demonstration proposal, requests for information/proposals, and internal and external briefings; analyzing of RFI and RFP responses)
  • Population-based data analytics using linked Medicare and Medicaid data Evaluation plan design
  • Stakeholder engagement, including member focus groups and stakeholder meetings

UMass Medical School also will coordinate with the MassHealth Quality Office on its development of quality metrics for the demonstration project.

The demonstration project will test and evaluate a model of care delivery for approximately 115,000 Massachusetts residents with dual eligibility, 75 percent of whom have chronic medical conditions, such as asthma or chronic obstructive pulmonary disease. Sixty-four percent have been diagnosed with a mental illness or substance abuse issue.

The objectives of the integrated care model include the following:

  • Ensuring access to appropriate services
  • Integrating comprehensive services (acute, behavioral health, and long-term services and supports) at the person level
  • Improving care coordination
  • Creating payment systems that hold providers accountable for the care they deliver