February 21, 2014
National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) report, “Strengthening the Value and Performance of Health Insurance Market Conduct Examination Programs: Consumer Recommendations for Regulators and Lawmakers” was created to serve as a resource that could offer guidance to lawmakers, regulators, the NAIC and others in light of the Affordable Care Act’s new consumer protections.
HMA Principal Dianne Longley conducted the research and authored this report for the NAIC. The report takes a look at market conduct examinations and highlights best practices.
February 6, 2014
Terry Conway, MD | Managing Principal | Contributor
Pat Terrell | Managing Principal | Contributor
Accountable Care has emerged as a critical delivery system redesign companion to expanded coverage within federal health reform. Accountable Care calls for providers to organize to provide a full continuum of care to patients and populations, to commit to improving quality while controlling cost, and to be rewarded as they succeed. However, the principles of Accountable Care are based upon demonstrations and lessons learned primarily in Medicare populations served by highly organized and integrated health systems.
The Safety Net differs in the patient populations it serves, the structures and relationships between its providers, and its funding, which is mainly concentrated in Medicaid and local government reimbursement. Thus, the federal emphasis on the development of Accountable Care will need to be tailored differently for the Safety Net. Further, California’s Safety Net will face the challenges of building collaborative delivery models earlier than the rest of the nation as the renewal of the State’s 1115 Medicaid Waiver is implemented during the next year. These State and national moves toward integrated care offer both opportunity and challenge to the Safety Net and progress toward Accountable Care will be made only after embarking on an honest and thorough examination of necessary changes in relationships and organization, delivery system design, infrastructure, and revenue distribution.
Taking leadership now to create Accountable Care is a strategy that is most likely to secure the ongoing existence of Safety Net providers, assure access for the patients they have historically served, and improve the health status of their communities. It is also a strategy that is likely to gain the support of the federal government as new models are sought to efficiently and effectively deliver care for a population that will soon represent the single largest publically‐funded health coverage program.
December 16, 2013
Michealle Gady, JD | Senior Consultant | Contributor
Stephanie P. Denning, MPA | Senior Consultant | Contributor
Lynn Dierker | Principal | Contributor
Joan Henneberry, MS | Managing Principal | Contributor
Susan Mathieu, MPP | Senior Consultant | Contributor
Mike Nardone | Managing Principal | Contributor
Janet Olszewski, MSW | Principal | Contributor
Tony D. Rodgers | Principal | Contributor
Catherine Rudd, J.D. | Senior Consultant | Contributor
November 22, 2013
Stewards of Affordable Housing for the Future
Mike Nardone | Managing Principal | Contributor
Matt Roan | Senior Consultant | Contributor
November 22, 2013
The Commonwealth Fund
Sharon Silow-Carroll, MSW, MBA | Managing Principal | Contributor
Barbara Markham Smith, JD | Principal | Contributor
The market for health applications, or apps, on mobile devices is growing rapidly, with over 40,000 currently in use. One type of app technology—clinical management apps—enable patients and providers to work together to manage chronic conditions, particularly diabetes and asthma. These apps are mostly used by health plans and large health care organizations with an interest in improving outcomes and controlling costs. Challenges to broader adoption of apps include the lack of objective research to evaluate outcomes, uncertainty about how to pay for and encourage the use of cost-effective apps, and the absence of a regulatory framework that standardizes development to ensure performance. If this infrastructure is developed, apps may serve as a catalyst to stimulate the transformation of health care generally and target low-income populations to expand access to care and help reduce health disparities.
October 28, 2013
The Kaiser Commission on Medicaid and the Uninsured
Vern K. Smith, PhD | Managing Principal | Contributor
Eileen Ellis, MS | Managing Principal | Contributor
Kathy D. Gifford, JD | Managing Principal | Contributor
The Kaiser Commission on Medicaid and the Uninsured recently released "Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014." HMA Managing Principals Vernon K. Smith, Kathleen Gifford, and Eileen Ellis authored the report outlining the survey findings in conjunction with Robin Rudowitz and Laura Snyder of the Kaiser Commission on Medicaid and the Uninsured.
The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state. At this time, the intensity of fiscal pressures and the focus on cost Medicaid containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program.
The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington.
Key findings from the survey include the following:
- Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013. In FY 2014, national enrollment and spending growth are expected to rise. States moving forward with the Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds.
- The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states whether they are implementing the ACA Medicaid expansion or not.
- Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs and better balance the delivery of long-term services and supports across institutional and community-based settings.
- Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity.
- Looking ahead, FY 2014 will be a transformative year for Medicaid.