Medicaid Cost Containment Solutions

Medicaid’s complex issues require special expertise.

 

The Commonwealth Medicine team of Medicaid clinical, policy and financial experts provides technical, operational, and strategic assistance to help Medicaid programs work more efficiently within the Medicaid ecosystem.

Tell us your most complex challenges. We’ll help you scale the cost containment summit, strengthening and extending your capacity to meet the needs of your state’s most vulnerable populations—today and tomorrow.

Commonwealth Medicine solutions for Medicaid’s most complex issues:

  • Long-term Services and Supports —We help Medicaid programs solve the LTSS challenge, protecting program integrity and controlling costs with clinical guidelines, network development, member engagement, and utilization management services.
  • Medicare-Medicaid Dual Eligibles — Our expertise in third party liability and coordination of benefits helps identify responsible third-parties, ensuring that Medicaid is the payer of last resort and saving or recovering millions of dollars.
  • Prescription Drugs — We help Medicaid programs address challenge of rising prices and increased demand with a multi-tiered pharmacy pipeline impact analysis that includes expert drug evaluation, formulary recommendations, and clinically-based guidance on improving prior-authorization operations and value-based purchasing programs.
  • Medicaid Financing — We integrate third party liability across program operations, implementing coverage, payment and recovery coordination to ensure that Medicaid is the payer of last resort, making revenue available to meet expanding program needs for today and tomorrow.
  • Eligibility Determination — Our proprietary data analysis tools, policy expertise, operational experience and understanding of all eligibility rules enable us to evaluate and synthesize state and federal data sets to deliver sound recommendations and determinations.
  • Policy Design & Implementation — We provide strategic consultation and support to states guiding them in the implementation of innovative flexibility authorized through waivers to ACA provisions.
  • Evaluation & Data Science — Our team employs program logic models, statistical techniques, and stakeholder input to evaluate health care programs, analyze data and deliver actionable recommendations and strategies to enhance the understanding of a program’s impact