Enhanced Coordination of Benefits

The Center for Health Care Financing’s Enhanced Coordination of Benefits (ECOB) Program is the first of its kind in the nation.  Adopted by Massachusetts Medicaid to perform targeted third party liability identification and benefit coordination, ECOB is a potential model for other state Medicaid programs.  Developed in 1999, the program reduces a state’s financial burden by working with high-cost, medically complex Medicaid members to identify, access and coordinate their private health insurance benefits ensuring that Medicaid is the payor of last resort. 

Comprised of a multidisciplinary staff with expertise in the financing and administration of health care services, the team provides one-on-one counseling to oncology, organ transplant, trauma, neonatal intensive care, cardiac and other acutely and chronically ill patients.  ECOB coordinators follow patients through the course of their treatment to assist them in understanding the complexities of health insurance while simultaneously maximizing Medicaid savings.

Our health benefit coordinators work onsite at acute care facilities with clinical and non-clinical staff to:

• Identify high-cost patients who may have access to both commercial health insurance and Medicaid 
• Advise on benefits they are entitled to and advocate with insurers on their behalf
• Perform a variety of benefit coordination activities and ongoing claims review to ensure that Medicaid remains the secondary payor.

In addition to working at facilities, the ECOB team also performs in-depth analysis of Medicaid claims data to identify and outreach to high cost chronically ill Medicaid members. The team can provide states beyond Massachusetts with an analysis to determine whether and how to establish a program.

 

Results

Since its inception, the program has cost avoided approximately $250 million for the Commonwealth of Massachusetts and now saves the state more than $50 million annually.  In 2005, the program was honored with an Innovation in Government award from the Pioneer Institute.