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.

We are eager to learn more about your analytics needs and how we can work together.