UMass Medical School Supports MassHealth Effort to Integrate Care for ‘Dual Eligibles’

$1 million federal grant will fund a design plan for improving quality, coordination and cost-effectiveness of care for individuals eligible for both Medicare and Medicaid

WORCESTER, Mass.--(BUSINESS WIRE)-- The University of Massachusetts Medical School (UMMS) is partnering with the Massachusetts Office of Medicaid (MassHealth) in an effort to develop a model that will fully integrate the delivery and financing of care for all 21- to 64-year-old “dual eligibles,” those who qualify for both Medicare and Medicaid services.

“By combining the funding streams of these two federal health care programs, the state will be able to offer a broader menu of services for people eligible for both Medicare and Medicaid. Making sure they have the care they need can lead to better health for this population, as well as reductions in long-term expenses and unnecessary hospitalizations,” said Stephanie Anthony, JD, MPH. As principle associate at UMMS’s Center for Health Law and Economics, Ms. Anthony will provide senior-level leadership on the project. “We believe this approach will provide high quality, cost-effective care for this population.”

With $1 million in funding from the Innovation Center at the Centers for Medicare and Medicaid, the state will oversee the project, which will demonstrate how this care and financing model would work. UMMS will provide MassHealth with support in four main areas of the project:

  • Document development support (e.g., drafting of demonstration proposal, requests for information/proposals, and internal and external briefings; analyzing of RFI and RFP responses)
  • Population-based data analytics using linked Medicare and Medicaid data
  • Evaluation plan design
  • Stakeholder engagement, including member focus groups and stakeholder meetings

UMMS also will coordinate with the MassHealth Quality Office on its development of quality metrics for the demonstration project.

The demonstration project will test and evaluate a model of care delivery for approximately 115,000 Massachusetts residents with dual eligibility, 75 percent of whom have chronic medical conditions, such as asthma or chronic obstructive pulmonary disease. Sixty-four percent have been diagnosed with a mental illness or substance abuse issue.

The objectives of the integrated care model include the following:

  • Ensuring access to appropriate services
  • Integrating comprehensive services (acute, behavioral health, and long-term services and supports) at the person level
  • Improving care coordination
  • Creating payment systems that hold providers accountable for the care they deliver

“We anticipate that this project will significantly improve health outcomes for the dual-eligible population and enable the Commonwealth to better align financial incentives and provider accountability,” said Massachusetts Medicaid Director Terry Dougherty. “We are pleased to be working with UMass Medical School to promote cost-effective, coordinated care for this dual-eligible population.”

About the University of Massachusetts Medical School

The University of Massachusetts Medical School, one of the fastest growing academic health centers in the country, has built a reputation as a world-class research institution, consistently producing noteworthy advances in clinical and basic research. The Medical School attracts more than $255 million in research funding annually, 80 percent of which comes from federal funding sources. The mission of the Medical School is to advance the health and well-being of the people of the commonwealth and the world, through pioneering education, research, public service and health care delivery. The Center for Health Law and Economics is part of UMass Medical School’s health care consulting division, Commonwealth Medicine. For more information, visit


University of Massachusetts Medical School
Jim Fessenden, 508-856-2000
[email protected]

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