In this presentation, Stephanie Tran, PharmD, clinical consultant pharmacist, explains how a retrospective compounding monitoring program demonstrated a reduction in per member per year spend through the placement of select high-cost compounding ingredients on prior authorization.
Nonalcoholic steatohepatitis (NASH) is an advanced form of nonalcoholic fatty liver disease (NAFLD) that is estimated to affect 5 - 21 million people in the United States. In this report, Pavel Lavitas, PharmD, BCPS, discusses findings from the Clinical Pharmacy Services pipeline monitoring team which was observing the results of a trail for a new treatment for the disease.
Director of Child and Family Policy Audrey Smolkin discusses interventions to promote children's resilience to minimize the long-term effects of trauma.
The federal “public charge” rule is causing many non-citizens to avoid treatment for potentially serious health issues—including COVID-19. This report, co-authored by CWM Health Law and Policy experts, examines the rule’s impact on non-citizens and the Mass. health care system.
Karen Clements, senior project director, Research and Evaluation, co-authored this poster on providing Medicaid populations with access to advanced hep C treatments which was nominated for best poster at the recent Academy Health 2020 Annual Research Meeting.
This poster by Judy Savageau, MPH, research consultant, informs MassHealth policies and programs for medical and behavioral health services with the goal of reducing opioid overdoses. Savageau presented her poster at the Academy Health 2020 Annual Research Meeting.
For children of color, early-life traumas increase the risk for long-term physical and mental health issues. Audrey Smolkin, director of Child and Family Policy at the UMass Med School, discusses the need for training on the link between race, trauma, and resilience.
There are many systems and services that contribute to children’s health, development, and well-being. However, many of our health systems are complicated, difficult to use, and have strict eligibility requirements; and many health services exist in silos and are not well coordinated. As a result, access for families is difficult. Many children who are not given a chance to thrive and get a healthy start in life grow up to be unhealthy adults with chronic and costly health conditions.
Reviewing applications for disability retirement benefits is a complex and time-sensitive process. Getting it right protects plan members and the financial soundness of the plan itself. Commonwealth Medicine empowers its team of licensed and credentialed case reviewers with secure, cloud-based technology to maintain operational continuity—even during a pandemic. The result is accurate, fair and timely disability recommendations.
A study, led by Soumya Vishwanath and other policy experts, from Commonwealth Medicine, assessed the effectiveness of a three-part, proactive intervention in prompting new prior authorization (PA) submissions and/or provider response prior to PA expiration in a Medicaid population.The intervention group had PAs submitted an average of 2.7 days before the expiration date vs.13 days after expiration in the comparison group.
Pharmacy experts from the University of Massachusetts Medical School and Commonwealth Medicine completed a study on whether the overall benefit of sacubitril/valsartan outweighed the cost of the drug within a Medicaid population. Previous studies have shown that patients treated with sacubitril/valsartan had lower rates of hospitalizations, but before now, the data on the economic impact of the drug on a Medicaid population was limited.
A policy brief co-authored by Commonwealth Medicine’s Robert Seifert, MPA, & Hilary Deignan, JD, MEd, and the Child Health and Development Institute of Connecticut, Inc's Lisa Honigfeld, PhD & Eminet Garganus, MPH explains why having all insurers involved in pediatric primary care redesign is vital for creating more positive health outcomes for children in families in communities at large
The Director of the Charitable Trusts Unit, within the New Hampshire Attorney General’s office, is charged with reviewing transactions involving health care charitable trusts, including non-profit hospitals, to determine whether these transactions are in the best interest of the community. The Charitable Trusts Unit retained the Health Law & Policy team at Commonwealth Medicine, UMass Medical School, to perform a thorough, impartial review of the Hospital Corporation of America’s (HCA) proposed acquisition of Frisbie Memorial Hospital.
Commonwealth Medicine’s Health Law & Policy expert Carol Gyurina explains why the federal parity law, which requires health plans to apply the same coverage limits to both behavioral health and medical benefits, is a good first step but not enough on its own to guarantee substance abuse services for Medicaid enrollees
Discover the comprehensive and customized approach Commonwealth Medicine's Disability Evaluations Team takes toward reviewing the 40,000+ disability evaluations it screens every year.
Our Health Law & Policy expert Katharine London joined several other policy and program experts to explore the role, impact, and system supports for community health workers in the United States, and Navajo Nation.
Find keys to success, policy recommendations, and implementation tools for starting a Recovery Coach program in your community. Commonwealth Medicine’s Health Law & Policy experts Katharine London, MS, and Jeremy Tourish, MPH, share research on the impact Recovery Coaches had in the battle against opioid use disorder in six states.
Check out our Health Law & Policy team’s brief updating information on the MassHealth Accountable Care Organization program as it enters its second year. Released by Blue Cross Blue Shield, the primer explores enhancements including the expanded Community Partners Program and the new Flexible Services Program. Learn more on our website about the way nearly 900,000 residents of The Commonwealth are receiving health care services
Take a look at results from The Massachusetts Medicare Enrollment Support Initiative, coordinated with guidance from our third party liability expert Jenifer Hartman of Health Care Finance Solutions.
Learn how cost avoidance activities made possible by our Health Care Finance Solution's Enhanced Coordination of Benefits led to a savings of $66.4 million for MassHealth in 2019.
Our Medicare Buy-In Quality Review Initiative, which our TPL expert Jenifer Hartman presented on during the 2019 Medicaid Enterprise Systems Conference, digs deep to find gaps in quality control and has returned $25 million in Part A premium overpayments since 2009 for MassHealth.