Mathematica | Health

Regional Partnership Grants Cross-Site Evaluation Annual Report October 2024-September 2025

Fri, 30 Jan 2026 21:27:00 Z

The annual report describes the major activities and accomplishments from October 2024 through September 2025 for Mathematica’s contract to conduct the cross-site evaluation and provide technical assistance (TA) for the seventh cohort of the Regional Partnership Grants (RPG).

How to keep competition alive in Medicaid managed care markets

Tue, 27 Jan 2026 23:50:00 Z

Medicaid managed care markets have been consolidating, which can increase costs, limit coverage options, and decrease access to specialized plans. This article in Health Affairs explores strategies states can use to strengthen competition among managed care plans.

Analysis of the Colorado Option, pursuant to § 10-16-1310, C.R.S

Fri, 16 Jan 2026 00:00:00 Z

Mathematica’s evaluation of the Colorado Option shows growing enrollment, lower premiums and out-of-pocket costs, and simpler plan choices in the individual and small-group insurance markets.

Latest Medicaid and CHIP Scorecard Strengthens Data-Driven Oversight and Transparency

Tue, 06 Jan 2026 00:00:00 Z

The Centers for Medicare & Medicaid Services just released the 2025 Medicaid and Children’s Health Insurance Program Scorecard to strengthen oversight of these two programs and increase transparency about their administration and health outcomes across federal and state partners.

The rise of Medicare Advantage payviders

Thu, 18 Dec 2025 14:18:07 Z

This brief combines information from published literature with diverse public data sources to describe trends in Medicare Advantage (MA) payviders—financial integration between MA plans and provider organizations. We describe patterns in health system ownership of MA plans and MA plan affiliation with primary care providers. We also use analyses from the Medicare Payment Advisory Commission and others to show how growing MA payvider control of primary care settings might reflect organizational strategies to use payvider arrangements to maximize MA payments.

Working with Medicare - State Contracting with D-SNPs, Part 2: Contracting Strategies and Considerations for States

Mon, 01 Dec 2025 19:41:00 Z

This webinar explains contracting strategies for states developing integrated care models for dually eligible individuals; Medicaid regulations states should keep in mind when leveraging D-SNPs to cover Medicaid benefits; and procurement and timeline considerations.

Meeting the Moment: Using Data to Drive Medicaid Community Engagement Implementation

Mon, 10 Nov 2025 16:34:48 Z

This white paper explores how states can use data to help them implement Medicaid’s community engagement requirements. By designing solutions with compliance reporting and monitoring in mind, states can anticipate future needs and set themselves up for success.

Working with Medicare - State Contracting with D-SNPs: Introduction to D-SNPs and D-SNP Contracting Basics

Sat, 01 Nov 2025 19:41:00 Z

This webinar provides an introduction to D-SNP contracting for state Medicaid agencies, including (1) a description of D-SNPs and the ways D-SNPs differ from other Medicare Advantage plans; (2) a summary of new federal rules for D-SNPs that take effect in 2027 and 2030.

Medical Loss Ratio Plan-to-State Reporting Template

Mon, 22 Sep 2025 00:00:00 Z

This reporting template supports states in improving the MLR data collection and validation processes from managed care plans.

Using AI to Eliminate Information Silos and Accelerate Government Efficiency

Thu, 18 Sep 2025 00:00:00 Z

Federal agencies face a significant challenge in overcoming information silos, which can hinder their efficiency, accountability, and effective use of taxpayer dollars. Mathematica proposes using advanced data linkage and AI-driven analysis to break these silos, improve coordination, and strengthen service delivery.

Denise Hoffman Testifies at House Ways and Means Hearing on Barriers to Work for People with Disabilities

Wed, 10 Sep 2025 18:16:48 Z

Mathematica Principal Researcher and disability policy expert Denise Hoffman testified at a joint House Ways and Means Social Security and Work and Welfare Subcommittee hearing on removing barriers to work and supporting opportunity for people with disabilities.

Principles and Promising Practices for Hiring and Retaining Young Autistic Workers

Fri, 29 Aug 2025 17:41:42 Z

This brief describes benefits, practical tips, and effective strategies for employers to attract and retain the growing share of the workforce that is on the autism spectrum. It highlights small adjustments to business practices that can improve employment experiences for autistic workers.

Payers and Providers Align on Value-Based Care Tech But Struggle to Deliver It

Tue, 19 Aug 2025 17:54:00 Z

A new report shows that although healthcare leaders across payer and provider organizations align on the goals of value-based care and feel optimistic about technology’s potential, critical execution gaps could stall progress in reducing costs and improving outcomes.

The Tipping Point: The State of Technology in Value Based Care 2025

Mon, 18 Aug 2025 14:47:00 Z

Mathematica partnered with Reveleer, a pioneering value-based care tech company, to explore how payers and providers are managing data, AI, and cybersecurity in an evolving healthcare landscape. The report finds strong alignment on the goals of value-based care and the role of technology, but identifies critical execution gaps that threaten progress. As value-based care contracts grow and investments in data and AI expand, the real test will be whether organizations can build the technology and data foundations needed to deliver results at scale.

Mathematica Launches PricePrism™: Advanced Price Transparency Intelligence Platform

Thu, 07 Aug 2025 13:27:00 Z

Mathematica, a leading provider of data analytics, research, operations services, and digital solutions, today announced the launch of PricePrism, a comprehensive suite of price intelligence tools, analysis, and data intelligence services for professionals and organizations in healthcare, including providers, physician practices, and medical associations, colleges and societies.

Enhance Medicaid Data Quality with Mathematica at MESC 2025

Fri, 01 Aug 2025 20:54:00 Z

Mathematica data and health policy experts will share insights into using and improving Medicaid data at the upcoming Medicaid Enterprise System Conference (MESC) in Milwaukee, Wisconsin from August 11-14.

Glossary of Terms Related to Integrated Care for Dually Eligible Individuals

Fri, 01 Aug 2025 19:41:00 Z

This glossary defines key terms related to dually eligible individuals, including different types of dual eligibility, Medicare and Medicaid coverage, and programs designed to coordinate or integrate Medicare and Medicaid benefits.

How CMS Can Improve Hospital Price Transparency and Strengthen Enforcement Through Data

Fri, 25 Jul 2025 14:29:22 Z

Mathematica provided recommendations to the Centers for Medicare & Medicaid Services for improving hospital price transparency compliance and enforcement processes to ensure that the pricing information publicly disclosed by hospitals is accurate and complete.

REYAAS Case Study: Life Management Assistance Program (LifeMAP)

Thu, 24 Jul 2025 19:58:19 Z

LifeMAP is a one-to-one coaching program that helps people on the autism spectrum identify and work toward goals. This case study describes the model’s services, clients who may benefit from coaching, funding sources, lessons learned from the program, and research on employment outcomes.

The Retaining Employment and Talent After Injury/Illness Network (RETAIN) Demonstration: Impacts Two Months After Enrollment

Fri, 11 Jul 2025 12:36:00 Z

This report presents early impacts of the RETAIN demonstration, a federal initiative to help workers with recent injuries or illnesses remain the labor force. Findings are based on a follow-up survey of enrollees conducted about two months after enrollment.

Modernizing and Strengthening the Digital Health Ecosystem

Mon, 07 Jul 2025 19:52:00 Z

Mathematica provided recommendations to the Centers for Medicare & Medicaid Services and the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology for modernizing and strengthening the digital health ecosystem for Medicare beneficiaries.

Mathematica and Tuva Health Partner to Transform Data Analytics for Government and Public Health

Thu, 12 Jun 2025 12:41:00 Z

Mathematica and Tuva Health are teaming up to help healthcare organizations and agencies more easily generate insights from data so they can improve efficiency and health outcomes.

Working with Medicare: An Introduction to Dual Eligibility

Sun, 01 Jun 2025 19:41:00 Z

This webinar explains Medicare-Medicaid dual eligibility, including the differences between full- and partial-benefit dual eligibility; Medicare Savings Program categories, eligibility criteria and covered benefits; and Medicare and Medicaid coverage options for dually eligible individuals.

Regional Partnership Grants Cross-Site Evaluation: Annual Report, October 2023–September 2024

Wed, 21 May 2025 15:47:24 Z

The annual report describes the major activities and accomplishments from October 2023 through September 2024 for Mathematica’s contract to conduct the cross-site evaluation and provide technical assistance (TA) for the sixth and seventh cohorts of the Regional Partnership Grants (RPG).

Unlocking the Power of Price Transparency in Healthcare

Tue, 20 May 2025 13:49:00 Z

Discover how federal rules on price transparency can revolutionize healthcare. Mathematica's data from over 1.1 million health plans empowers medical societies, associations, and colleges to better advocate for physicians. Learn how this data can enhance negotiations and pricing strategies for practices.

Cross-State Analysis of Section 1115 Serious Mental Illness and Serious Emotional Disturbance Demonstration Monitoring Data

Fri, 16 May 2025 19:15:00 Z

This report examines the performance of Medicaid section 1115 waiver demonstrations for adults with serious mental illness and children with serious emotional disturbance. CMS and states can use this to monitor progress, explore strategies for meeting goals and milestones, and inform policy decisions.

Primary Care First Model Evaluation of the First Three Model Years (2021–2023): Findings at a Glance

Fri, 09 May 2025 20:59:00 Z

This is a summary of the third annual report of the evaluation of the Centers for Medicare & Medicaid Services’ Primary Care First Model. This model tests the impact of financial risk incentives and performance-based payments on advanced primary care practices, costs, and patient health outcomes.

Evaluation of the Primary Care First Model: Third Annual Report

Thu, 08 May 2025 20:36:00 Z

This is the third annual report of the evaluation of the Centers for Medicare & Medicaid Services’ Primary Care First Model. This model tests the impact of financial risk incentives and performance-based payments on advanced primary care practices, costs, and patient health outcomes.

Streamlining Performance Measures for More Effective Value-Based Care

Thu, 08 May 2025 17:05:00 Z

In a new Health Affairs Forefront article, Mathematica experts share how healthcare payers can build a cohesive measure set that fosters more effective, efficient, and accountable value-based care programs.

Using Default Enrollment to Align Coverage for Dually Eligible Medicare-Medicaid Beneficiaries

Thu, 01 May 2025 19:41:00 Z

This tool explains default enrollment into Medicare Advantage dual eligible special needs plans (D-SNPs), including D-SNP and enrollee eligibility, state roles in default enrollment, steps that D-SNPs must take to obtain CMS approval for default enrollment, enrollee rights, and resources.

Working with Medicare: Medicare 101

Tue, 01 Apr 2025 19:41:00 Z

This webinar provides an overview of the Medicare program—including Medicare eligibility, benefits, and coverage options—and discusses how Medicare and Medicaid benefits overlap and interact for dually eligible individuals.

How States Can Improve the Value Provided by Medicare Advantage Plans

Mon, 10 Mar 2025 14:11:00 Z

In a new Health Affairs Forefront article, Mathematica experts share recommendations on how state Medicaid agencies can increase financial transparency and improve the value of Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs).

New Dashboards Help State Officials Assess Key Healthcare Cost Drivers

Thu, 27 Feb 2025 00:00:00 Z

Connecticut is seeking to lower growth in its healthcare spending to make care more affordable for its residents. To help the state meet this goal, Mathematica developed new interactive online dashboards that give state officials a better view into the factors driving growth in healthcare costs.

Electronic Clinical Quality Measures for Prosthetic Joint Infection Diagnosis: Pitfalls and Potential

Wed, 26 Feb 2025 13:38:00 Z

Prosthetic joint infection after total hip and knee arthroplasty is a major cause of morbidity in orthopedics. We specified and evaluated electronic clinical quality measures across different healthcare institutions to improve diagnosis.

How Do Hospitals Exert Market Power? Evidence From Health Systems and Commercial Health Plan Prices

Tue, 18 Feb 2025 17:49:20 Z

Higher hospital concentration is associated with higher prices, while higher insurer concentration is associated with lower prices. Large insurers are less effective in reducing prices in extremely concentrated hospital markets.

California Medi-Cal Home and Community-Based Services Gap Analysis Report

Fri, 14 Feb 2025 16:57:00 Z

This report identifies gaps in the availability of programs and services to meet member needs for home and community-based services and long-term services and supports now and in the next decade, limitations in provider capacity to meet member needs and coordinate care, barriers impeding members’ ability to find and obtain high-quality person-centered care, and problems stemming from inefficient program administration and operations.

Referrals to Peer Support for Families in Pediatric Subspecialty Practices: A Qualitative Study

Wed, 29 Jan 2025 14:58:00 Z

The is study explores healthcare providers' perspectives on referring families of children with special health care needs to peer support services. It identifies barriers and facilitators to such referrals, aiming to enhance support mechanisms.

Leveraging the Power of AI in Healthcare: A Comprehensive Guide to Data Governance and Interoperability

Tue, 21 Jan 2025 17:04:00 Z

Healthcare organizations need to be cognizant of how they gather, access, leverage and ultimately share data. This valuable whitepaper provides valuable guidance with insights from top thought leaders.

Understanding Economic Risk for Low-Income Families: Economic Security, Program Benefits, and Decisions About Work

Tue, 07 Jan 2025 16:53:00 Z

Mathematica conducted a survey of means-tested benefit recipients to understand what they consider when deciding whether to take a new job opportunity. Respondents evaluated fictional opportunities which varied in pay increase, benefit loss, job stability, and the ease of regaining lost benefits.

Regional Partnership Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children Affected by Substance Abuse: Eighth Report to Congress

Tue, 07 Jan 2025 13:24:00 Z

The Report to Congress discusses three cohorts of RPG projects. It shares the final findings for the fourth cohort, including characteristics of enrolled families, services received, and changes in outcomes over time. The report also includes interim information for the fifth and sixth cohorts.

The RETAIN Demonstration: A Case Study of Medical Providers Experiences in Ohio

Mon, 06 Jan 2025 15:58:00 Z

The Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration is a federal initiative to help workers with recent injuries or illnesses remain in the labor force. In this brief, we describe the experiences of medical providers in Ohio RETAIN.

Medicaid Behavioral Health Providers Delivering Most Behavioral Health Services via Telehealth Before and During the COVID-19 Pandemic

Mon, 30 Dec 2024 14:35:00 Z

This study examined the extent to which Medicaid providers who deliver behavioral health services shifted their practices to mostly tele-behavioral health services during the COVID-19 pandemic.

Reducing Consumption of Sugar-Sweetened Beverages in Oakland

Thu, 26 Dec 2024 00:00:00 Z

Revenues from Oakland’s sugar-sweetened beverage (SSB) tax have been used to support programs and services to promote community health and address the health impacts of SSBs. This report describes findings across these investments and how grantees adapted in the wake of the COVID-19 pandemic.

Building Skills and Peer Connections to Improve Mothers’ Mental Wellness: Implementation of Western Mass MOMS

Tue, 17 Dec 2024 18:06:00 Z

This report shares findings from a descriptive and cost study of Western Mass Mental Health Outreach for MotherS PartnershipSM (Western Mass MOMS). It explores the design, implementation, and cost, based on the MOMS Partnership model to improve the emotional well-being of mothers and help them reach education and employment goals.

More Group Practices and Doctors Join Health Systems, New Data Finds

Mon, 16 Dec 2024 19:21:00 Z

Updated Compendium of U.S. Health Systems shows a 5-percentage point increase in number of doctors affiliated with vertically integrated health systems between 2018 and 2022.

Innovative 988 Crisis Service Systems for Children, Youth, and People with Disabilities

Mon, 16 Dec 2024 15:37:00 Z

This brief describes innovative state approaches to providing crisis, stabilization, and recovery-oriented supports and services for children, youth, and people with disabilities through the integration and partnership of crisis services systems with other service systems. The brief describes partnerships and strategies of five states (Connecticut, Georgia, New Jersey, Pennsylvania, and Virginia) that have focused on developing crisis services for these populations.

CMS' Scorecard Measures Medicaid and CHIP Performance at Federal and State Levels

Mon, 16 Dec 2024 14:42:00 Z

The 2024 Medicaid and CHIP (MAC) Scorecard includes state-by-state information showing state’s performance for the year, including all-time high spending devoted to HCBS.

State Public Health Data Reporting Policies and Practices Vary Widely

Thu, 12 Dec 2024 20:16:00 Z

This report provides a first-of-its-kind analysis of the policies and practices across all 50 states and the District of Columbia that govern how clinical data flows to state public health agencies via case reports, lab reports, syndromic surveillance, and immunization information systems.

Participants’ Characteristics and Experiences from the First Two Years of the Vermont Career Advancement Project

Wed, 11 Dec 2024 18:04:00 Z

The five-year Vermont Career Advancement Project (VCAP) helps people with disabilities find career pathways so that they can secure high-wage, high-quality jobs in fields that interest them. This brief describes VCAP participants’ characteristics and experiences from the first two years of the project.

Helping a Health System Cut Costs and Improve Quality with a Customized Hospital Value Dashboard

Wed, 11 Dec 2024 00:00:00 Z

MaineHealth needed a tool that would help them gauge how their revenue, expenses, and quality compared to similar U.S. health systems. Learn how they partnered with Mathematica to build and customize a Hospital Value Dashboard that helps them identify cost-saving and quality improvement strategies.