Lisa Tomai, M.S., is a senior researcher at L&M. She has over 25 years of experience in healthcare analytics and research in both public and private settings. Ms. Tomai has worked extensively with large healthcare claims and administrative databases from sources including Medicare, Medicaid, Worker’s Compensation, and commercial carriers.
Her recent contributions involve database development and analytics for the evaluation of various federal and state programs related to innovative care delivery and alternative payment models. Specific projects include analysis of health equity for Medicare Advantage and Prescription Drug Plan Monitoring, exploration of beneficiary potential access, realized access, and out-of-pocket costs under Health Plan Innovation Models and Direct Contracting Part D Senior Savings Model, examination of the effects of the 340B Drug Pricing Program on MS-DRG relative weights affecting IPPS payments to hospitals, Medicare Advantage relative risk analysis, and examination of Medicaid claims and encounter data to assess population healthcare cost disparities for CMS’s Office of Minority Health. Ms. Tomai is proficient in SAS programming, and has extensive experience working in the Chronic Condition Warehouse databases within the CMS Virtual Research Data Center as well as other programming environments.
Prior to joining L&M Policy Research, Ms. Tomai worked in a number of diverse settings including commercial insurance, managed care organizations, and independent business consulting. During her career, Ms. Tomai has developed and tested algorithms for various payment models involving beneficiary-ACO attribution, primary care medical homes, and value-based payment systems for private insurers. Additional areas of focus have included Medicare fraud and abuse, provider profiling design, clinical outcomes monitoring, and development of pharmaceutical opioid diversion detection and monitoring methods.
Ms. Tomai holds an M.S. in Public Policy Analysis from the University of Rochester.