Analytics
We help state agencies, providers and payors take a detailed look at program and population specific performance.
Areas of focus for the analytics team include:
- Service utilization and cost of care analysis
- Consideration of costs and impact of addressing social determinants of health
- Population- and diagnoses-specific modeling and analyses of potential policy interventions
- Medicaid claims data analysis
- Review of nursing home admissions and census using MDS assessments
- Projections of health insurance enrollment across payers resulting from potential changes in policies and programs
Recent projects have included:
- Medicaid’s Financial Alignment Demonstration: Conducted a study of the Medicare-Medicaid dual eligibles program, assessing program performance, gaps, and opportunities for improvement
- Health Insurance Exchange and Medicaid Enrollment Trends: Forecasting enrollment trends across state Exchanges and Medicaid agencies through experience- and data-driven consideration of short- and long-term impact of cyclical events, including the COVID-19 PHE, economic indicators, and consideration of irregular shocks, such as implementation of Medicaid expansion and temporary moratoriums on redeterminations
- LTSS Population Analysis: Comprehensive analysis and modeling of home and community based LTSS populations and their utilization across providers and payers
- Medicaid Caseload Estimation: Providing a state Medicaid agency with reliable and timely estimates of the state’s overall caseload and fiscal position, including preparing bi-annual caseload estimation, reporting on annual state healthcare expenditures, defining investment and savings initiatives, testifying on behalf of the Medicaid agency, and maximizing federal participation
- Medicaid Rate Setting: Management of the rate setting process across state Medicaid agency, health plans, and certifying actuarial firm, including pre-contracting population assessment and benchmarking; design and implementation of risk mitigation strategies; defining relevant performance targets; ROI estimation; and health plan financial reporting and oversight
- Medicaid Expenditure Reporting: Developed an annual report to the legislature on Medicaid expenditures across providers, populations and services. Updated and re-issued report for eight years
- ACO Benchmarks:Development of benchmarks and targets for a set of cost and utilization metrics related to MassHealth ACO implementation, both for an overall population and incorporating sub-targets using a race ethnicity lens
- Person Centered Options Counseling: Assessed and defined the likely users of Person Centered Options Counseling for purposes of establishing program scope and staffing needs
- Housing Profiles of ACO Members: Create profile of the characteristics of Medicaid ACO beneficiaries identified as homeless or housing unstable based on a combination of claims data, demographics data, and risk profiles in order to inform intervention design. Profile included most prevalent diagnoses, service utilization and patterns, and costs relative to housed beneficiaries.