Behavioral Health

Behavioral Health

HMA experts in data integrity and data governance presenting at NATCON24 in St. Louis, April 15-17

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At the upcoming NATCON24 convention, HMA principals Robin Trush and Jodi Pekkala will present “Achieving Data Integrity and Staff Satisfaction through Technology Data Governance.” Health equity, alternative payments, and social determinants of health are all healthcare “North Stars” in healthcare grounded in data collection. To achieve standard metrics and address patient care coordination, EHRs, population-health platforms and other technology innovations must be used accurately, consistently and be configured properly. Cross-department database governance is grounded in standards to ensure data integrity. Too often, organizations have been unable to successfully stand-up technology and maintain consistent use over time, resulting in staff dissatisfaction and turnover.

This presentation will provide an overview of proven methods for bringing technology governance and leadership into clinical planning and operations, resulting in staff satisfaction, and putting your organization on the path toward those North Stars. Presenters will share lessons in how to bring technology management into clinical planning and operation. This enhanced organizational integration model will drive better outcomes and support the staff experience.     

Learning Objectives:

  • Describe current industry initiatives with technology infrastructure requirements.
  • Define and address common technology pain points for organizations and staff.
  • Define guidance for data governance, data integrity, and staff satisfaction.
  • Provide tools to take an organizational “pulse” and create a path to improvement.

Please join this workshop at NATCON24 on Monday, April 15, 2024 from 4:15 – 5:15 PM CT Location: 100/101, Level 1, ACCC

As longtime leaders in health and human services, HMA’s behavioral health, IT and data experts bring front line and leadership experience to their work supporting Health and Human Services IT projects. Combine this with the broad programmatic and operations expertise of the HMA team—which includes former clinicians, Medicaid directors, and leaders of provider and payer organizations—and we are able to deliver targeted, relevant, actionable advice to our clients. We aim to advance equity and improve quality in state, county, and local program development. Contact us to learn more.

HMA 2024 Spring Workshop summary and key takeaways

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On March 6, HMA convened a spring workshop of 100 healthcare stakeholders interested in making value-based care delivery and payment work better. This event was designed for those engaging in value-based care and payment transformation, but who are looking to learn from peers to overcome challenges; participants included insurers, health systems, data and tech innovators, service providers, and trade associations.

The event’s name implored people to “Get Real” about the challenges we all face, while reminding ourselves of the imperative of making this transition to ensure the sustainability of our uniquely American healthcare system. In between plenary panels, participants were engaged in cohort discussions exploring the opportunities for progress in areas critical to making value-based care work.  While a summary cannot recreate the real-time discussions and simulations from the event, our discussions delivered insights on several critical themes that we believe are important to track. 

EMPLOYERS ARE LEANING IN: For all employers pay, they are getting less value over the past decade; the changes made to ERISA that hold the C-suite accountable for paying fair prices for healthcare benefits is a seismic shift in making healthcare purchasing a more strategic priority for employers.

  • Elizabeth Mitchell of the Purchaser Business Group on Health illustrated the shift in employers’ awareness – due to data transparency rules – that they aren’t getting the quality they thought they were getting for all that they pay. Transparency, plus a recent change to the Employee Retirement Income Security Act of 1974 (ERISA), is bringing employers back to the table with very specific requests for better outcomes, which they are increasingly pursuing through direct contracting and specific quality frameworks for primary care, maternal care, and behavioral health. Participants continued to reflect on this dynamic in all subsequent discussions, underscoring that this could be a really big deal.
  • Cheryl Larson of the Midwestern Business Group on Health talked about the cost pressure on her members leading them to partner in new and different ways, expressing optimism about all payer solutions and other innovative approaches to leverage the cost data that are now available. In her closing plenary session, she said “this issue of accountability on employers…I am excited and optimistic that there are things we can do to get there faster now.”

Data & Technology HAVE TO IMPACT DECISION MAKING: Patients are using the system the way it is designed today, so we can’t just blame them for poor outcomes…we have to actually stop doing things that don’t work and start measuring things the right way.

  • Dr. Katie Kaney opened with a dinner keynote discussing her efforts to create metrics that give purchasers a better measurement of whole person care, including clinical, genetic, behavioral, and social factors. Audience members remarked that this was a novel approach to quantify what has become accepted correlation in adverse health outcomes.
  • Ryan Howells, Dave Lee, and Stuart Venzke led discussions on Data & Technology, diving into updated federal regulations that present both opportunities and challenges for stakeholders, as well as ways to create corporate strategies that include data and technology, as these issues are no longer optional for anyone in this business. The breakout discussions talked about where we are today vs where we need to be – bridging the gap between data and decision making.

Payment & Risk TOOLS ARE ALIGNING INFORMATION TO ACTION:  Achieving meaningful risk-based contracts is possible but the details matter…mismatched data and information leads to unequal buying power, which cannot be the case in value-based care.

  • Kelsey Stevens, Scott Malan, Hunter Schouweiler, and Kate de Lisle led discussions on Payment & Risk, including an exciting hands-on simulation exercise that helped participants understand ways to increase premium scores by implementing risk-based payment approaches within the care delivery system; this session provided very concrete takeaways for those who attended by combining a simulation with a discussion on measures of success to improve risk-based contracting strategies.
  • Amy Bassano and Kate de Lisle discussed their recent publication on the expanded ecosystem of value-based care entities, looking at the “enablers” who are working with providers and payers to manage risk. This groundbreaking landscape of this market segment highlighted a set of Guiding Principles to ensure these entities are aligned with CMS, provider, and patient goals. Participants had lots of questions for the presenters and were anxious to read the HMA full report.

CARE DELIVERY MEASURES MUST BE TANGIBLE TO PROVIDERS AND PATIENTS: Value-based care requires aligning the right metrics with the right incentives, ensuring providers understand not only WHY but HOW they help improve patient outcomes.

  • Rachel Bembas, Dr. Jean Glossa, and Dr. Elizabeth Wolff led discussions on Care Delivery Measures, underscoring the importance of involving clinicians in the establishment of outcomes measures, as well as ensuring that the diversity of patient experiences are included. Participants remarked that we have a lot of “messy” data today, so we now have to ask the next set of questions on how we best use the messy data to make an impact?
  • Former Congresswoman Allyson Schwartz talked about the continuing promise of Medicare Advantage, and the opportunity to convene a new alliance around Medicare quality metrics as well as the increasing pressure to align these metrics across payers. In the closing plenary, she said “We need to define what we want healthcare in America to look like and then go out and get it…. We have to align the measurements and the standards we use so that providers understand what’s needed and it benefits government, taxpayers, and beneficiaries…we should require plans to have risk-based contracting with providers.”

Policy & Strategy HAVE TO STAY THE COURSE TO ALIGN INCENTIVES: Policymakers can help or hinder movement forward to ensure success…value-based care has to be more than a section in an RFP, but part of the entire scope of paying for outcomes-based care delivery.

  • Governor and former HHS Secretary Mike Leavitt reminded us of the political and policy journey that got value to where it is today, and the unique moment we are in right now that gives us hope as we enter this post-pandemic phase of healthcare spending and policy. He reflected, “We are beginning to see regulations and mechanisms to hold people accountable for healthcare costs…we have to integrate value and caregiving or we will never get to value.”
  • Theresa Eagelson, former Illinois Director of Healthcare and Family Services, talked about the opportunity for states to expand value-based care by setting strong expectations through contracting and by thinking differently about policy choices. She reflected on the role of state administrators, “When we sit here and talk about value-based care, do we know what our north star is? Have we mastered what we want to see in RFPs (for Medicaid)?  We’re working on a good FQHC model in Illinois, but should it be just for FQHCs? We need to spend more time together, across payers, across plans and providers and consumers to figure out what success looks like.”
  • Caprice Knapp and Teresa Garate led a discussion on state and local Policy & Strategy to support integrated care and services that are required to achieve better outcomes. There is a need for services to better coordinate and manage care across social and health services, bringing contracting and payment expertise to more efficiently serve patients. The highly anticipated Medicaid managed care rule can help guide states in updating their approach. Federal analysis of Medicaid data is needed to set benchmarks before we can get to total cost of care approaches.
  • Amy Bassano and AnneMarie Lauterbach led a discussion on federal policy alignment of Medicare FFS and Medicare Advantage, particularly looking at drug spending and the very real burden of medical debt as a driver of policy change. Participants reflected that half the country is indirectly covered through some public insurance. It’s just being done hyper-inefficiently.

HMA is leading the way on value-based care and is committed to continuing these dialogues to drive local, state, and national change. HMA’s value-based care expertise draws from our acquisition of Leavitt Partners and Wakely Consulting Group, two firms with deep ties and expertise on policy, strategy and risk-based pricing strategies, as well as recruitment of clinicians and operational experts who have led organizations through this transition. We will continue to advance the dialogue – and the work – to drive value as a critical way to ensure that our systems of health and healthcare are more affordable, equitable, and sustainable.

Let’s keep the conversation going! Click here to learn more about how HMA can help you succeed with value-based payments and check out the newly released value-based payment readiness assessment tool for behavioral health providers.

State teams convene to strengthen collaboration across child welfare, behavioral health, and Medicaid

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This week, our In Focus section highlights the Children’s Behavioral Health (CBH) State Policy Lab, held February 7−9, in Baltimore, MD. Health Management Associates, Inc., (HMA), in partnership with national philanthropies and associations, hosted the Policy Lab, which provided an unprecedented opportunity for state cross-systems teams to conduct in-depth work toward creating an equitable behavioral health system of care for children and youth.   

Background 

The lack of collaboration and misaligned strategies and policies across state child welfare, behavioral health, and Medicaid has contributed to unsatisfactory outcomes for children and youth in our communities. The COVID-19 public health emergency exacerbated these issues, as the rate of mental health and substance use disorders (SUD) increased and many families experienced traumatic events during this time. Increasingly, states and local jurisdictions are exposed to threats or actual class action lawsuits based on the inadequate care of children and youth involved in the child welfare settings.  

Fortunately, federal and state efforts and investments to address the youth systems of care—including schools, community, delivery systems, and community-based child placing agencies—are in motion. Though the diversity of efforts being implemented across local and state agencies are critical, these complex issues require collaboration across multiple systems, including Child Welfare, Behavioral Health authorities, Medicaid, and K-12 Education. A cross-sector strategic approach will enable comprehensive identification of gaps, policy solutions, and best practices, as well as highlight opportunities for cross-sector braided or blended funding to build a system of care that supports the needs of multi-system children, youth, and their families.  

Child Behavioral Policy Lab 

The current behavioral health crisis presents an opportunity to address long-term challenges and divisions and to build a truly comprehensive approach. This is why HMA sponsored the Children’s Behavioral Health State Policy Lab which convened key partners within a state and across states. The Annie E. Casey Foundation, Casey Family Programs, National Association of State Mental Health Program Directors (NASMHPD), the Child Welfare League of America (CWLA), the American Public Human Services Association (APHSA), National Association of Medicaid Directors (NAMD) and MITRE, a Children’s Behavioral Health (CBH) State Policy Lab, joined HMA in funding, organizing and providing consultation support for the meeting. 

The nine participating states—Georgia, Kansas, Kentucky, Maryland, Missouri, Pennsylvania, Texas, Utah, and Wisconsin—were selected through a competitive process based on the goals and commitment of the state and the thorough analysis of gaps and opportunities, demonstration of collaborative state interagency partnerships, and engagement of youth and adults. 

The participating states committed their leadership teams to join the Policy Lab in laying the foundational work of development of statewide plans that would advance their collective goal of creating a more united system of care. Participants learned about intergenerational trauma and resilience. The sessions also provided participants with data that helped provide context to the problems we are trying to solve. Presenters included Aliyah Zeien, a national child welfare policy advocate and youth ambassador, with lived experience who highlighted that 25 percent of foster youth will spend time in prison or other enforcement systems within two years of leaving the child welfare system. Her experience and reflections served as call for action to actively engage families and youth in all system planning, advocacy, and policy work.  

Key areas of focus 

Following these brief educational sessions, each state had substantial “team time” to develop a road map and set of next steps for continuing their work after the Policy Lab. Expert facilitators guided state teams through discussions on three key issues:  

  • Service array. State teams were challenged to define their array of services and develop collective agreements on how to develop enhanced treatment options for children and their families. With an emphasis on building a full continuum of care with community-based supports and fewer children in residential facilities, each team considered challenges such as eligibility, access, and workforce. Prevention, diversion, and engagement of people with lived experience to help with system development were common commitments in state action teams.  
  • Financing. The teams considered their statutory authority, funding streams, funding partners, contract vehicles, and financing mechanisms. They also worked on ideas for blending and braiding funding, with a focus on Medicaid and leveraging collective opportunities to develop staff and contractual resources.  
  • Governance. State teams worked through difficult conversations, including how to measure success, how to manage accountability and monitoring, how to collaboratively design services and case practice, while meaningfully sharing data and creating interoperability within their systems while respecting confidentiality and privacy concerns.  

What’s Next  

Since the Policy Lab program, most participating states have embarked on next steps identified during the workshop, such as vetting their plans with state leadership, creating an ongoing team for implementation, and identifying community partners. HMA and HMA Companies, including Leavitt Partners, are collaborating with our Policy Lab partners and the state agencies to further develop these plans and prepare for implementations that rethink our approach to services for youth and their families. 

For more information about the Policy Lab and follow-on work, please contact Uma Ahluwalia ([email protected]), Christina Altmayer ([email protected]), Jon Rubin ([email protected]), and Sarah Scholle ([email protected]). 

Federal policymakers consider current and future spending measures on simultaneous tracks

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This week, our In Focus section covers Congress’s and the Administration’s parallel efforts to finalize fiscal year (FY) 2024 spending bills and begin the budget process for FY 2025.  

Congress approved a bipartisan package for some of the FY 2024 spending bills, and on March 9, 2024, President Biden signed the Consolidated Appropriations Act of 2024 into law (PL 118-42). Programs funded through this measure include the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and other federal nutrition supports, rental assistance for safe and affordable housing, and veterans medical care and benefits.  

Several mandatory funding extensions of public health programs and health-related policies also found their way into the 2024 consolidated appropriations package, including extending the Community Health Center Fund, delaying reductions in the disproportionate share hospital allotments, defining Certified Community Behavioral Health Centers (CCBHCs) as a Medicaid service, extending incentive payments for certain Medicare providers, and mitigating the impact of cuts to the Medicare physician fee schedule.  

These policies, however, addressed a narrower set of issues than the expansive and bipartisan legislation that has been moving through both chambers of Congress. For example, House and Senate members have worked on respective bipartisan policies affecting price transparency, pharmacy benefit managers, and Medicare site-neutral policies, among others.  

Meanwhile, President Biden released the FY 2025 Budget proposal March 11, 2024, kicking off the annual budget process. Like the administration’s FY 2024 budget proposal, the FY 2025 plan emphasizes deficit reduction and continues to make equity and Medicare solvency cornerstones of the budget. Health-related priorities include expanding access to affordable healthcare services, lowering drug costs, improving maternal health, addressing the mental health and substance use disorder crises, and enhancing biodefense and preparedness activities.  

Check out the FY 2025 budget analysis from Leavitt Partners, a Health Management Associates, Inc. (HMA), company, here, and a deeper dive into the Consolidated Appropriations Act of 2024 here. 

What We’re Watching 

Congress is continuing negotiations on the outstanding spending bills, including the one that funds the Departments of Health and Human Services, Labor, and Education through September 2024. Lawmakers are working to reach an agreement before the next funding deadline of March 22.  

The administration’s FY 2025 budget proposals are generally being characterized as a blueprint for President Biden’s re-election campaign and, if successful, a policy agenda for his second term. Though Congress has already begun holding hearings on the budget request, members on both sides of the aisle will likely focus on issues that resonate in an election year.  

Regardless of the outcome of the November elections, Congress has an opportunity to address unfinished business during the lame duck session later this year.  

HMA and Leavitt Partners collaborate to monitor legislative and regulatory developments in healthcare and adjacent spaces and to assess the impact of policy changes on the healthcare industry. 

CMS announces innovation in behavioral health model

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This week, our In Focus section highlights the Innovation in Behavioral Health (IBH) model, which the Centers for Medicare & Medicaid Services (CMS) announced January 18, 2023. It is the third state-based alternative payment model that the CMS Center for Medicare and Medicaid Innovation (Innovation Center) has released in recent months. HMA wrote about the Transforming Maternal Health (TMaH) Model here and States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model here.  

IBH Model Overview  

This model is designed to improve the quality of care and health outcomes for people with moderate to severe behavioral health conditions through person-centered care that integrates physical health, behavioral health, and health-related social needs (HRSN). Its objective is to improve care through healthcare integration, care management, health equity, and health information technology. 

CMS will select up to eight state Medicaid agencies for participation in this eight-year model that will begin in fall 2024. Participating states must partner with the agencies that are responsible for mental health and/or substance use disorder treatment to ensure coordination and alignment of policies. Model participants will develop and implement the IBH model in partnership with at least one Medicaid managed care organization or another intermediary as applicable. 

Community-based behavioral health organizations and providers in selected states can choose to engage as practice participants in the model. Community-based providers can include safety net providers, community mental health centers, public or private practices, and opioid treatment programs. Practice participants will be responsible for coordinating with other members of the care team to comprehensively address behavioral and physical health needs and HRSN, such as housing, food, and transportation for patients. Practice participants will conduct HRSN screenings, refer patients to specialists and community-based resources, and more. They will be compensated based on the quality of care provided and improved patient outcomes. 

Opportunities and Considerations  

The model will include three pre-implementation years during which states and practice participants will receive Medicaid and Medicare funding for development and capacity building. Medicare will provide practice participants with a per-beneficiary-per-month payment in pre-implementation years to support health IT, electronic health records (EHR), practice transformation, new workflows, and staffing investment necessary to implement the model. Starting in year four, the Medicaid alternative payment model must be implemented, and Medicare will begin making performance-based payments. 

Notably, the announcement materials do not indicate the maximum funding amount selected state Medicaid agencies are eligible to receive in IBH. The cooperative agreement funding for selected states will support implementation preparations, such as statewide health IT infrastructure, supporting practice participants, stakeholder convening, and developing the Medicaid alternative payment model.  

What’s Next  

The Innovation Center expects to release a Notice of Funding Opportunity (NOFO) in spring 2024. More details on the requirements, including payment methodologies and funding, are expected to be included in the NOFO.  

The HMA Behavioral Health and federal policy teams will continue to monitor developments in IBH and analyze the opportunities for states and providers in this model. HMA experts are also assessing the relative opportunities of the IBH model alongside other Innovation Center opportunities and initiatives already underway in states.  

The core design elements and objectives of the IBH are illustrative of the issues that HMA’s experts and industry leaders plan to discuss at HMA’s Spring Workshop, The HMA Spring Workshop: Getting Real About Transforming Healthcare Quality and Value.  

For more information on the IBH model, contact Amy Bassano, Melissa Mannon, Barry Jacobs, and Jennifer Hodgson. 

Devising a framework for non-profit fundraising

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Money is always “top-of-mind” among non-profit leaders, from CEO’s at Federally Qualified Health Centers (FQHCs) to Executive Directors at Community-based Organizations. To supplement projects and retain the ability to further their missions, non-profit organizations (NPOs) need funding. When non-profits and funding sources are not well aligned, programs are cut, curtailed, or never launched. Assisting clients in pursuing alternative funding sources requires a creative yet methodical approach to promote success and boost organizational sustainability.

Devising a framework for non-profit funding presents challenges. Funding models/strategies cannot be too general nor too specific. There is not a single approach, a one size fits all model or sourcing strategy for non-profits to pursue. Instead, non-profit leaders must clearly articulate the funding model or strategy that best supports the growth of their organization and use that insight to examine the potential funding opportunities preeminently associated with organization-specific success. For example, a community health center serving patients covered by Medicaid and a non-profit organization doing development work in housing for the homeless are both funded by the federal government, yet the type of funding each receives and the decision makers controlling that funding are very different. Utilizing the same funding methodology for the two would not be productive. Fortunately, there are multiple methods and strategies to acquire funds. Non-profits should be strategic in seeking approaches suitable to their needs and capabilities and be creative in pursuing more than one model to acquire supplemental funds.

The core success of NPOs is based on a range of funding options, private grants and government grants, corporate sponsorships, private funding, endowments, and community fundraising. There is also a considerable amount of money available from the public sector, businesses, charitable trusts, foundations, in-kind donations, and local and state legislative bodies. The goal of any successful fundraising campaign is to convey fully what the money is or will be supporting and clearly articulate the projected positive outcomes that will be derived from the funding. Once the project is fully clarified, the next step is research. Many funding avenues exist. The NPO must decide which funding sources are best suited for each project and pursue those options.

When choosing potential funding sources, NPOs must consider the size of their organization, their mission, and various other defining characteristics. Once this internal due diligence is completed, revenue needs should be clarified, and a tactical fundraising strategy outlined. Creating a “ratio” with the end-result in mind allows for revenue diversification and avoids the too heavy reliance on one income source. For example, an NPO might project obtaining 50% of needed revenues from grants, 20% from a corporate sponsorship, and the remaining 30% from a foundation. Once the funding sources have been identified, the types of decision makers and the motivations of these decision makers must be evaluated. Then, a tactical roadmap designed to obtain the needed funding should be implemented. 

As society looks to the non-profit sector to solve important problems, a realistic understanding of funding models is increasingly important to realizing these aspirations. As consultants whose mission is to turn challenges into triumph for our clients, championing efficacious, high-yielding funding models ensures long-term viability for the organizations we serve.

Success relies on planning. It is much better to be proactive than reactive. Consider your organization’s funding needs, do your research, and lay the groundwork before diving into any fundraising pursuit. An assessment of your organization’s current funding strategies is essential. What is working; what is not? Is the current funding source reflective of the organization’s mission and values? Use the answers to these questions to make decisions and recommendations on which fundraising strategies to source. Get creative! Brainstorm unconventional ways your organization will stand out to potential funders, but be analytical. Balance creativity with data, keeping in mind which funding strategy reflects the best return. Focus time and energy on the funding model that will be most reliable, profitable, and feasible.

The non-profit world rarely engages in a succinct conversation about an organization’s appropriate long-term funding strategy. That is because the different types of funding that fuel non-profits have never been clearly defined. More than a poverty of language, this represents and results in a poverty of understanding and clear thinking. As consultants, HMA can provide an outside perspective and sort through the minutia presenting a clear, methodical, appropriate path to fundraising success.

Potential links to aid in your fundraising endeavors:

https://www.fqhc.org/funding-opportunities
https://www.samhsa.gov/grants
https://www.usgrants.org/business/mental-health-services
https://www.ruralhealthinfo.org/topics/mental-health/funding
https://about.bankofamerica.com/en/making-an-impact/grant-funding-for-nonprofits-sponsorship-programs
https://theathenaforum.org/grants

HMA works with a wide variety of healthcare clients, including FQHCs, community-based organizations, hospitals, provider practices, behavioral health, and managed care organizations, and can help with:

  • Grant Writing
  • Technical Assistance
  • Strategic Planning
  • Financial planning, Implementation and Optimization

For more information about how HMA can help your organization’s grant and funding strategies, contact our experts below.

The role of specialized managed care in addressing the intersection of child welfare reform and behavioral health transformation

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This week, our In Focus section highlights the efforts of Health Management Associates (HMA) and partner organizations to better coordinate services for children in foster care and for children with behavioral health needs.

First, HMA released an issue brief on November 6, 2023, as part of a partnership between HMA and the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition. Together HMA and NASMHPD experts wrote a series of five briefs on children’s behavioral health.

The brief released last month, “The Role of Specialized Managed Care,” written by HMA experts Heidi Arthur and Angela Bergefurd, with input from Caitlin Thomas-Henkel and Uma Ahluwalia, centered on the intersection of child welfare reform and behavioral health transformation. More specifically, it described how specialized Medicaid managed care plans can ensure better alignment between child welfare and behavioral healthcare services.

The paper emphasizes the role of state-level special needs plans (SNPs) in the delivery of coordinated care and examines the opportunities afforded to states seeking to leverage specialty managed care plans.

Specialized managed care plans can help fill the void by incentivizing the provision of services for children in foster care and specialty services for children with behavioral health needs. Plans in three states — Washington, Arizona, and Ohio — are highlighted, and can serve as examples of how state Medicaid SNPs can be implemented.

Link to Issue Brief

This paper is part of a larger effort that HMA and several partner organizations are supporting. Stakeholders include:

  • NASMHPD
  • The Annie E. Casey Foundation
  • Casey Family Programs
  • MITRE
  • National Association of Medicaid Directors (NAMD)
  • Child Welfare League of America (CWLA)
  • Administration for Children and Families
  • Substance Abuse and Mental Health Services Administration

The goal of these collaborations is to foster dialog between state agencies and stakeholders working to improve the well-being of children and youth with complex needs.

Most recently, HMA hosted a webinar December 12, 2023, featuring speakers from the partner organizations to discuss insights from a federal meeting that took place in November. Webinar speakers also informed participants about plans for a multistate policy lab scheduled for February 2024, where representatives of up to eight state child welfare agencies will participate in a two-day workshop on improving the children’s behavioral health continuum of care in their states. The webinar focused on the overall effort and provided a forum for states to hear from this partnership on the importance of collaborating to strengthen the children’s behavioral health system. Watch the webinar here.

For questions about the brief, please contact Heidi Arthur or Angela Bergefurd. For questions about the webinar or the larger effort, please contact Caitlin Thomas-Henkel or Uma Ahluwalia.

Child and family wellbeing

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Child welfare services face challenges every day to prevent, treat, and reduce risk of maltreatment, neglect, trauma, housing instability, and violence in communities. These issues need to be seen as a priority for public health and community wellbeing and not just the jurisdiction and responsibility of child welfare agencies.

There are many opportunities for improvement in this area, including:

Integrating prevention services within the human services system to help support families and youth experiencing child welfare interventions

Providing technical assistance and supports to systems serving child welfare and justice-involved youth, including: policy and practice reviews, workforce and workload analyses, process re-engineering

Increasing Medicaid providers who offer more community based Evidenced Based and Informed Practices (EBP) among Community Based Organizations (CBO), Providers, and Local Government entities

Developing the workforce to enable prevention programs and building competencies to engage in meaningful interactions with children, youth, and families

Addressing disparities in both experiences and outcomes for children, youth and families, rather than focusing on responding through merely a transactional and compliance driven approach

If your organization works to help meet the needs of children, youth and families impacted by issues like mental health and substance abuse, domestic violence, child abuse and neglect, food insecurity, housing instability, incarceration, and other traumas, Health Management Associates (HMA) can help make your efforts more effective.

Together we can help you move programs upstream with strong prevention and family strengthening approaches and integrate payment models with the human services delivery system to streamline and improve resources. 

HMA can help in the following ways:

Developing system integration models

Strategies to improve school-based mental health support implementation

Provide technical assistance and consulting support regarding service access and expansion of Medicaid utilization for implementation of evidence-informed programs

Workforce planning and strategy

Assist states, counties, hospitals, providers, and MCO’s address the challenges of hospital overstays and behavioral health placements

Provide technical assistance to state and local governments regarding limiting exposure to class action lawsuits or providing expert witness services

Strategic planning

Program evaluation, research and analysis including cost/benefit analysis of programs

Leadership development

Stakeholder engagement

A longtime leader in health and human services, HMA experts have front line and executive level experience providing direction to child welfare programs.

We consult with public and private sector entities who serve children and families to improve, streamline and integrate essential services. We ground our work in human-centered design, lived expertise, and change management and leadership principles in state and county program development.

Contact our experts:

Uma Ahluwalia

Uma Ahluwalia

Managing Principal

Uma Ahluwalia is a respected healthcare and human services professional with extensive experience leading key growth initiatives in demanding political … Read more
John Eller

John Eller

Managing Principal

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
Jon Rubin

Jon Rubin

Principal

Jon Rubin is a human services leader with over 20 years of experience in strategic planning, identifying and analyzing problems, … Read more
Doris Tolliver

Doris Tolliver

Principal

Doris Tolliver is a strategic thinker specializing in racial and ethnic equity, organizational effectiveness, change management, and business strategy development. She … Read more

Child and family wellbeing: family resilience

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This is part of an ongoing series highlighting efforts in human services and family wellbeing. 

For decades, practitioners have recognized that child neglect was often interconnected in some families with stressors associated with familial poverty. Poverty is often a stressor in cases of child neglect, poor health, and even youth incarceration. Food insecurity, housing instability, and family stressors often related to unemployment, incarceration, and domestic violence can in some circumstances, result in parental burnout and lead to poor parenting decisions. There is also a perverse disincentive for families to experience career and wage progression which often results in steep fiscal cliffs with benefits that are needed to stabilize families and guide them towards economic self-sufficiency[1]. There is advocacy and increasing recognition through efforts such as Universal Basic Income Pilot programs and experiments with expanding Earned Income Tax Credits and Child Tax Credits attempting to mitigate catastrophic benefits cliffs that impact child and family wellbeing and economic self-sufficiency.

Public Safety Net programs such as Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, WIC, Free and Reduced School Meals, Child Care Subsidies, Earned Income Tax Credit, Eviction Prevention Grants, and a host of other federal, state, and local programs are intended to support and strengthen families and increase protective factors for children[2].   

Recent investments in the safety net including the childcare tax credit and the Pandemic Electronic Benefit Card (P-EBT) have shown that when concrete supports are provided to families, child maltreatment rates significantly decrease.[3]  

During the height of the COVID-19 pandemic, the federal government implemented a One-Year Expansion of the Child Tax Credit which extended the eligibility to families with little to no income. It helped increase the credit amount families received from $3,600 per qualifying child younger than six years old and $3,000 for qualifying child between the ages of 6 and 17. It also provided monthly payments of $250 to $300 per qualifying child as opposed to an annual payment which aligned with monthly living expenses. According to the US Census Bureau, 2021 saw a historic decline in child poverty which lifted one million children under the age of six out of poverty, and 1.9 million for children between the ages of six and 17.  

More recently States are experimenting with Universal Basic Income projects aimed at reducing child poverty, improving protective factors in families and reducing child maltreatment.[4] These experiments are currently being evaluated, but early research is showing promising signs of reduced child poverty in jurisdictions where these projects have gone live. 

There is considerable literature that shows that changes in income alone, holding all other factors constant, have a major impact on the numbers of children being maltreated. Conversely, reduction in income or other economic shocks to the family increase incidents of child maltreatment. 

A study performed by the Nuffield Foundation noted that internationally, evidence has shown a much stronger relationship between poverty and child abuse and neglect. Research has shown that without government and service providers responding to increased pressures on family life will lead to the risk of more children suffering harm, abuse and neglect.[5]

 Another study by Casey Family Programs on predicting chronic neglect, found that the strongest predictors of chronic neglect were parent cognitive impairment, history of substitute care, parent mental health problems, and a higher number of substantiated allegations in the first CPS report[6]. This suggests that families at risk for chronic neglect face multiple challenges and significant financial insecurity that require significant support.

  • Other significant predictors include:
    • Younger parents
    • Families with a higher number of children
    • Families with a child under age 1

Recognizing these challenges to strengthening the protective factors for young moms, there have been several successful efforts around the country to focus on pregnant and parenting teen and young adult moms. From Health Families America, Nurse Home Visiting Programs, there has been a body of evidence created that shows the strengths of providing wrap around services and home-based interventions for moms and babies. These supports strengthen the mom-baby nurturing relationship and reduce risk of maltreatment and increase protective factors. 

One such organization that has demonstrated significant success in disrupting the cycle of generational poverty is The Jeremiah Program. This is a national organization that aids single mothers and their children to provide coaching and assistance in navigating barriers to education, college access and career support, safe and affordable housing, early childhood education and childcare, and empowerment, leadership, and career training. This supportive program helps build up single mothers to achieve their educational and career goals and gain long-term economic prosperity. 

As child welfare and poverty policies intersect, the current thought leadership is focused on recognizing that economic and concrete supports reduce involvement in child welfare.[7] As the science and voices of children and families with lived experience intersect and rise up, the federal and state policy landscape around alleviating poverty to improve child wellbeing will continue to gain momentum. Family and Child Well-Being indicators significantly reflect racial and ethnic inequalities both in child welfare and across the poverty landscape. Economic stability is also a key strategy to address racial and ethnic inequalities and closing the opportunity gap for all. Over the next 3-5 years we believe there will be a fundamental shift in policy, financing, and outcomes tracking that reflect our commitment to our society’s most vulnerable children and families. That is why it is crucial for States and Local governments to enact policies that would support programming to alleviate poverty and improve child and family resilience and protective factors.

HMA consultants have decades of experience working hand-in-hand with public health, social services, behavioral health, Medicaid, and human services agencies. We help strengthen relationships surrounding policy, practice and revenue maximization in the human services space. Our experts work to help support programs in areas of Nutrition: Women, Infants & Children (WIC), Supplemental Nutrition Assistance Program (SNAP); Financial Support: Child Support, Temporary Assistance for Needy Families (TANF); Child and Adult Welfare Services; Medicaid; Housing and Weatherization; Early Education: Childcare Subsidy, Child Care and Development Block Grant (CCBDG) programs; and Workforce Development and Workforce Innovation and Opportunity Act (WIOA) programs.

If you have questions on how HMA can support your efforts in Child and Family Wellbeing, please contact Uma Ahluwalia, MSW, MHA, Managing Principal or Kathryn Ngo, MPH, BSN, Project Manager.

[1] What Are Benefits Cliffs? – Federal Reserve Bank of Atlanta (atlantafed.org)

[2] Economic Supports Chapin Anderson Nov 2020b (chapinhall.org)

[3] Research Reinforces: Providing Cash to Families in Poverty Reduces Risk of Family Involvement in Child Welfare | Center on Budget and Policy Priorities (cbpp.org)

[4] Understanding The Difference Between Guaranteed Basic Income Vs Universal Basic Income – Orange and Blue Press

[5] https://www.nuffieldfoundation.org/news/relationship-between-poverty-and-child-abuse-and-neglect

[6] Predicting Chronic Neglect – Casey Family Programs

[7] Economic Supports Chapin Anderson Nov 2020b (chapinhall.org)

Crisis and Managed Care 

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Managed Care Organizations (MCOs) are key partners in ensuring members have access to integrated physical and behavioral health care, which includes a robust, coordinated crisis care continuum. MCOs can also manage early intervention and help prevent crises and high-cost utilization through care coordination. 

CRISIS SYSTEM AND SERVICES 

Mental health and substance use distress has increased nationally and has been exacerbated by COVID-19. The Federal government in partnership with States and localities around the country are working to expand access to effective crisis interventions. The creation of the national 988 suicide and crisis hotline combined with new funding and guidance on mobile crisis services are critical to preventing and responding to behavioral health crises.

Health Management Associates (HMA) consultants have deep experience and expertise designing, operating, and overseeing crisis services. This includes a broad portfolio of current projects, working with a range of state and local policymakers, payers, providers, first responders, and communities to implement robust crisis continuums. 

Opportunities for MCOs 

MCOs can play an important role in informing how crisis services meet the needs of their members, and reduce high cost utilization of emergency departments and inpatient care. HMA can help you identify innovative ways to collaborate with States and community-based organizations to drive real access to crisis prevention and intervention services for individuals and families. This work includes building robust crisis continuum networks that include the full array of options, and best practices in crisis response including diversion from and alternatives to expensive emergency department and hospital visits.

This presents an opportunity for MCOs to play a pivotal role in driving better population health outcomes, expanded health equity, improved member experience, and to ultimately reduce the total cost of care.

Our Expertise and Capabilities: 

Evidence-based and leading edge clinical and operational practices

Cross-sector partnerships with law enforcement, emergency service providers and community partners

System change by connecting policy to practice

Defining and measuring key performance indicators and outcomes

Developing sustainable financing models (e.g., rate setting, reimbursement strategies)

Identifying effective workforce strategies including training and maximizing of multi-disciplinary teams (e.g., peers, behavioral health providers, nurses, licensed health care providers)

Maximizing virtual and technology interventions

988 state planning and implementation support

Designing and implementing crisis receiving and stabilization facilities

Conducting certified community behavioral health clinic (CCBHC) readiness and implementation support

Cross-sector crisis collaboration and partnerships, including emergency management services (EMS) and law enforcement

Crisis call hotline and 911 centers collaboration

Individuals with Medicaid and justice system involvement (e.g., 1115 waivers, reentry, and care coordination during transition from jail/prison into the community)

Approaches, programs, and strategies for individuals with complex care needs and high utilizers

Identifying cross-sector technology and information sharing solutions and best practices

Crisis transportation services and financing models, including least restrictive alternatives to law enforcement transport

How HMA can assist MCOs:

Strategic
Planning

Understanding emerging trends and federal and state policies that impact managed care plans, including maximizing funding streams at state and county levels, 1115 justice waivers and school-based mental health, and including key stakeholders in the planning process.

Design and Implementation

Adopting state Medicaid criminal justice reforms (e.g., in reach, care coordination, Medicaid eligibility); engaging local and county stakeholders in building partnerships with health plans; designing and developing requests for proposals (RFPs), procurement support and readiness reviews; and developing utilization management programs and care coordination strategies.

Training
and Support

Assessing benefit design, and developing standards for network development, management, and adequacy; identifying quality, key performance indicators, monitoring and compliance strategies; identification and implementation of evidence-based practices across the age continuum; and developing training standards and oversight. 

HMA Crisis Portfolio Clients:

Health plans

Federal, state & local governments

Health and behavioral health care providers

Hospitals & health systems

Educational settings and academic institutions

Coalitions and advocates

Associations and foundations

Investors

Criminal justice stakeholders and facilities

Law enforcement

Emergency management services (EMS)

Public health departments

Contact our experts:

John Volpe

John Volpe

Principal

John Volpe is an experienced senior health official with a demonstrated record of success at the intersection of health, social … Read more