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.
UMass Medical School health policy experts have developed sustainable financing models for the state of Maine to support four community health worker (CHW) interventions that focus on patients with the greatest, and most costly, health care needs.
The steps to developing Complex Care Management Model Design for state Medicaid programs with a focus on one single point of entry.
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.
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. Work Without Limits 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.
How the Massachusetts Medicaid Pharmacy Program, which is managed by UMass Medical School, developed the Pediatric Behavioral Health Medication Initiative. The initiative was in response to studies and reports that found pediatric behavioral health medication polypharmacy regimes have been increasing.
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.
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.
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.
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.
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.
An examination of the choices that primary care physicians make in deciding to practice in a community health centers post health care reform. Researchers compared results of physician surveys conducted in 2008 and 2013.
This report describes the process of providing integrated care for patients with substance use disorders at three sites in central Massachusetts: Edward M. Kennedy Community Health Center, Family Health Center of Worcester, and Community Healthlink. It identifies common practices that improve care coordination and presents key findings.
Health insurance coverage data from state tax filings for 2011 and 2012 is used to address a gap in research that has focused on health insurance coverage in a given 12-month period and to provide a better understanding of the population in Massachusetts that is prone to remain uninsured over consecutive years.