Managed Care

HMA Completes Acquisition of SVC

SVC, founded by CMS Administrator Seema Verma, is now part of Health Management Associates (HMA). The acquisition, announced March 13 by HMA founder Jay Rosen, was finalized late Friday, March 31. SVC now becomes HMA Medicaid Market Solutions (HMA MMS), a subsidiary of HMA.

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Celebrating Doctors’ Day at HMA

March 30th is Doctors’ Day, and for most physicians that means a special lunch in the hospital cafeteria or a carnation on their white coat. But a few years ago, I hung up my white coat and made the transition to healthcare consulting. The questions immediately started. Won’t you miss seeing patients? What exactly will you do? Did you lose your license? That last one is my favorite. So what exactly is a doctor like me doing in a place like this?

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Loneliness is Lethal: Five Strategies to Improve Health Outcomes by Improving Social Connectedness

This blog post was authored by HMA clinicians Margaret Kirkegaard, MD, MPH, and Jeffrey Ring, PhD

While most people would agree that social relationships improve day-to-day quality of life, do social connections actually provide a health benefit? The answer is a resounding yes!

In 1921, a remarkable study began tracking the lives of 1,500 Americans from childhood to death. It sought to track what factors in life — such as faith, marriage, pets and exercise — increased longevity. The most significant finding was that strong social networks mattered the most. The quality of social connections was more significant than the quantity.[1] In an interview with National Public Radio, lead researcher Howard Friedman notes, “We saw that over and above the number of connections and the frequency of interactions that when those connections involved helping other people, reaching out, being actively engaged to do things for others, that was an added bonus on top of what we already see as quite beneficial from the social contacts themselves.”[2]

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Illinois Issues RFP to Rebid Medicaid Managed Care Programs, Expand Statewide

This week, we reviewed the request for proposals (RFP) issued on February 27, 2017, by the Illinois Department of Healthcare and Family Services (HFS) to rebid the majority of the state’s existing Medicaid managed care program contracts, consolidate multiple programs into a single streamlined program, and expand managed care statewide. The RFP will consolidate the current Family Health Plans/ACA Adults (FHP/ACA) program, the Integrated Care Program (ICP), and the Managed Long Term Services and Supports (MLTSS) program into a single contracting approach, while reducing the number of contracted managed care organizations (MCOs) from 11 to between four and seven. The RFP does not impact the Medicare-Medicaid Alignment Initiative (MMAI) duals demonstration at this time. When fully implemented by the end of 2018, the new managed care program will cover roughly 2.7 million Medicaid beneficiaries in all 102 counties in Illinois.

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Washington Releases Apple Health Fully Integrated Managed Care RFP for North Central RSA

This week, we reviewed the Washington Health Care Authority’s (HCA’s) request for proposals (RFP) for the North Central Regional Service Area (RSA) transition to Fully Integrated Managed Care (FIMC) under the Apple Health Medicaid program. Under the RFP, HCA will contract with fully integrated Medicaid managed care organizations (MCOs) – integrating physical and behavioral health – for the North Central RSA, which consists of Chelan, Douglas, and Grant counties. HCA previously issued a FIMC RFP for Clark and Skamania counties in the second half of 2015. The state eventually intends to transition all counties to the Apple Health FIMC model. Awarded MCOs will begin serving the North Central RSA on January 1, 2018. There are more than 66,200 Apple Health members in the North Central RSA as of February 2017.

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Medicaid Managed Care Spending in 2016

This week, Andrew Fairgrieve and Greg Nersessian reviewed Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. In federal fiscal year (FFY) 2016, Medicaid expenditures across all 50 states and 6 territories exceeded $548 billion, with nearly half of all spending now flowing through Medicaid managed care programs.

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Save the Date for HMA’s 2017 Conference on Trends in Publicly Sponsored Healthcare

The Future of Medicaid is Here: Implications for Payers, Providers and States

Sept. 11-12, 2017
Chicago, IL

Health Management Associates (HMA) is proud to announce its 2nd conference on Trends in Publicly Sponsored Healthcare, Sept. 11-12, 2017, in Chicago. The theme of this year’s event is The Future of Medicaid is Here: Implications for Payers, Providers and States and features as keynote speakers some of the nation’s most innovative healthcare leaders.

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Medicaid Managed Care Procurement Updates in DC, Massachusetts, and Texas

This week we reviewed two active Medicaid managed care procurements – in the District of Columbia and Massachusetts – and a Medicaid managed care request for information issued by Texas. On December 22, 2016, the District of Columbia issued a request for proposals (RFP) to rebid Medicaid managed care organization (MCO) contracts for the DC Healthy Families and Alliance programs. One day prior, on December 21, 2016, Massachusetts issued a request for responses (RFR) from MCOs interested in participating in the MassHealth managed care program, with a focus on preparing for Medicaid ACO implementation, as well as the planned carve-in of managed long-term services and supports (MLTSS). Finally, also on December 22, 2016, Texas issued a request for information (RFI) ahead of an upcoming statewide reprocurement of the STAR+PLUS Medicaid managed care program.

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Quarterly Medicaid Managed Care Enrollment Update – Q3 2016

This week, we reviewed recent Medicaid enrollment trends in capitated, risk-based managed care in 24 states.[1] Many state Medicaid agencies elect to post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. Nearly all 24 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2016. This report reflects the most recent data posted.

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HMA Behavioral Health Expertise on Display at Conferences

Our diverse, interdisciplinary behavioral health team has extensive clinical, policy, operations and funding expertise in mental health and substance use disorder prevention and treatment. Recently members of our behavioral health team shared their expertise at two notable conferences.

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