UMass Medical School’s Center for Health Care Financing Receives $7.3 Million Contract to Aid California Department of Hea

Two-year contract to help improve access to care and maximize savings

WORCESTER, Mass.--(BUSINESS WIRE)-- The University of Massachusetts Medical School’s Center for Health Care Financing (CHCF), part of the school’s Commonwealth Medicine division, has entered a two-year, $7.3 million contract with the California Department of Health Services to improve health care access for millions of Californians and maximize savings for the state. Through an identification program seeking dual-eligible Medicare and Medicaid members and a quality control review of federal billing, CHCF officials expect they may be able to save California nearly $100 million over the course of the contract.

According to CHCF Director Marc Thibodeau, JD, California has 1.1 million dual-eligible individuals, the most in the country (five times the number in Massachusetts). Individuals who qualify for both Medicare and Medicaid may be entitled to receive more comprehensive coverage, and as a result, the state may save on expenditures for services administered. Enhancing benefits for members and maximizing savings for states often requires skillful coordination with the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS).

Having cultivated unique and extensive expertise in working with SSA and CMS on behalf of other states, CHCF will implement two techniques to increase Medicare coverage and savings in California: The first is an enhanced Medicare identification project that will work within current California processes to identify California Medicaid members who are also eligible for Medicare. The second is a quality control review project that will audit the federal bills issued to California for payment of Medicare premiums, known as Medicare Buy-In.

“Medicare identification will enable individuals to receive more comprehensive coverage, resulting in better access to better care in more extensive networks, and will afford the state opportunities to recover some of its past expenditures,” Thibodeau said, adding that the identification and quality control review programs will benefit both dual-eligible individuals in California and the state itself.

“CHCF is uniquely positioned to make sure that people are getting the proper level of health care benefits, and that states are able to more accurately monitor and control expenditures in support of those benefits,” said Thibodeau.

CHCF’s data analysis expertise is well known throughout the country. In 2009, a similar quality review project identified federal payment inaccuracies totaling more than $250 million, which were credited to 46 states and the District of Columbia. CHCF has also been providing enhanced Medicare identification and Medicare Buy-In billing analysis expertise to the Commonwealth of Pennsylvania since early 2009.

About Commonwealth Medicine

Commonwealth Medicine is the public, nonprofit health care consulting and service organization founded by UMass Medical School. Government agencies, nonprofits and managed care organizations benefit from Commonwealth Medicine’s expertise in clinical service delivery, health care financing strategies, policy management and quality improvement. Commonwealth Medicine programs have helped Massachusetts—and many other state, international and local health care agencies—to increase the value of health care expenditures while improving access and the delivery of care to at-risk and uninsured populations.

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