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HMA News

Adaptation Health to Become Part of Health Management Associates

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Today, Jay Rosen, founder, president, and co-chairman of Health Management Associates (HMA), and David Kulick, co-founder of Adaptation Health, announced that Adaptation Health is joining HMA. It will continue to operate as Adaptation Health, an HMA Company.

Founded in 2017, Adaptation Health is an innovation consultancy and incubator based in New Orleans that works with state Medicaid programs and managed care organizations (MCOs) to drive adoption of new delivery and engagement solutions. Adaptation brings together leaders from these sectors to solve systemic problems in publicly funded healthcare.

“Like HMA, Adaptation Health has innovation in its DNA,” Rosen said. “I’m excited to pair HMA’s unmatched Medicaid expertise with Adaptation Health’s creative approach and laser focus for tackling the complex challenges related to Medicaid to benefit those the program serves.”

Adaptation Health has worked across dozens of states and MCOs to build private market innovation through expert vendor sourcing, diligence, and deployment driving improvements in member care, acceleration of equity, and supporting positive evolution in public market delivery. They have directly worked with over 500 startups and early Medicaid-focused companies to enable best-in-class solutions for the public good.

“We are very excited to join HMA as they are pre-eminent Medicaid experts. We believe that through this partnership Adaptation Health can continue to support states and MCOs across the country in accelerating Medicaid performance, value, and innovation.” Kulick said.

Kulick will continue to lead Adaptation Health, an HMA Company. Terms of the transaction were not disclosed.

Founded in 1985, HMA is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. Clients include government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. With offices in more than 20 locations across the country and over 500 multidisciplinary consultants coast to coast, HMA’s expertise, services, and team are always within client reach.

HMA: https://www.healthmanagement.com/

Adaptation Health: https://www.adaptationhealth.org/

HMA News

Health Management Associates, The Focus Group Merging

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Today, Jay Rosen, founder, president, and co-chairman of Health Management Associates (HMA), and David Kulick, founder and managing director of The Focus Group, announced the merger of the two firms. The Focus Group will continue to operate as The Focus Group, an HMA Company.

Founded in 2014, The Focus Group, based in New Orleans, helps healthcare clients navigate the intersection of healthcare policy, payment, and delivery by devising and implementing strategies that create change and fuel growth. Led by public market and business transformation experts, Kulick and Alex Rich have partnered with hundreds of company executives to solve complex challenges and deliver high-value projects. The Focus Group services include market intelligence, strategy development, business transformation, and go-to market execution for providers, payers, life sciences, health foundations, and private equity investors.

“The Focus Group brings extensive expertise across the healthcare spectrum, driving growth for a wide array of clients,” Rosen said. “We’re excited to add their unique approach to managing change and commitment to innovation to our impressive lineup of experts as we continue to expand the ways we can serve our clients and partners.”

“We are thrilled to merge with HMA and drive greater value to our clients. This is a strategic opportunity to link HMA’s vast depth in healthcare policy and payment with our focus on commercial growth to lead the charge together for positive evolution in healthcare delivery,” Kulick said.

Kulick and Rich will continue to lead The Focus Group, an HMA Company, as managing directors. Terms of the transaction were not disclosed.

Founded in 1985, HMA is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. Clients include government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. With offices in more than 20 locations across the country and over 500 multidisciplinary consultants coast to coast, HMA’s expertise, services, and team are always within client reach.

HMA: https://www.healthmanagement.com/

The Focus Group: https://www.thefocusgroup.solutions/

Webinar

Community response teams: reducing overdose deaths and addressing stigma

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Community Response Teams are vital cross-sector, data driven, community-based collective action initiatives that address the local opioid crisis through harm reduction education, Naloxone distribution, and data. During this webinar, HMA speakers will address the rationale, framework, funding, and implementation of successful initiatives that serve as models for other states, including case studies from California and Delaware.

Learning Objectives

  • Create local community collaborations focused on opioid education, Naloxone distribution, and reducing stigma.
  • Understand the four critical concepts of the Community Response Team framework: prepare, use data, prevent, and co-design with community.
  • Understand how counties in California and Delaware implemented the framework.

Speakers

Nayely Chavez, Senior Associate
Liddy Garcia-Bunuel, Principal
John O’Connor, Managing Director

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Don’t miss other webinars in this series, which will address:

  • Industry-Specific Outreach and Education (October 25)
  • Faith-Forward Collaborative (November 8)
  • Equity-Centered Approaches to Supporting Community Prevention and Treatment (November 15)
Blog

HMA perspectives on the 2022 federal policy landscape

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This week, our In Focus section looks at the current federal policy landscape and trends and the legislative outlook for the remainder of 2022 and beyond. Experts from HMA continue to monitor developments in this area and provide additional updates as more information becomes available.

Legislative Branch

To date in 2022, Congress passed multiple comprehensive bills, including the Inflation Reduction Act (IRA), which was signed by President Biden on August 16, 2022. The IRA extends Exchange plan premium tax subsidies through 2025, institutes an out-of-pocket drug spending cap for Medicare beneficiaries, expands Medicare, Medicaid, and CHIP coverage protections for certain vaccines, allows Medicare to negotiate drug prices, and implements a penalty payment in the Medicare program for prescription drug prices that rise faster than the rate of inflation.

Going forward, stakeholders have an extensive list of immediate Medicare payment issues for Congress to tackle while lawmakers continue to consider fundamental reforms to the program. Priorities include mitigating Medicare payment reductions scheduled for 2023; providing relief to address inflationary cost pressures; extending the 5 percent bonus for physicians participating in Advanced Alternative Payment Models (APMs), which expires at the end of 2022 for Accountable Care Organizations (ACOs); and permanently expanding telehealth access and payment policies after the federal COVID-19 public health emergency (PHE) declaration expires. Many stakeholder groups are also urging the Senate to act on the House-approved legislation, Improving Seniors Timely Access to Care Act (H.R. 3173), to reform Medicare Advantage prior authorization policies.

Congress did not include major Medicaid proposals in the Inflation Reduction Act. Medicaid stakeholders want Congress to revisit certain Medicaid policies in one of the remaining legislative vehicles this year. Significant proposals of interest include closing the Medicaid coverage gap in non-expansion states, enhanced coverage for justice involved populations, and expanding support for home and community-based services (HCBS). States and some stakeholders have also sought more certainty in the timing and guardrails for ending the COVID-19 Public Health Emergency (PHE) policy that links enhanced federal Medicaid funding with the requirement for continuous Medicaid coverage.

Congressional leaders and key influencers are laying the groundwork for 2023 legislative efforts. Congress is likely to defer action on most major legislative issues until after the November mid-terms, including finalizing federal fiscal year 2023 funding for most departments. A change in control of either or both chambers of Congress will likely lead to greater scrutiny of the Biden Administration’s health care policies and actions, which have largely gone untested by this Congress.

Executive Branch

Executive orders have been a major source in driving federal workstreams in 2022. Following enactment of several major bills, implementation responsibilities have shifted to the Executive Branch and stakeholders will have multiple opportunities to further shape and support new programs, regulatory and policy updates, and funding opportunities. Executive orders passed include:

  • Advancing Racial Equity and Support for Underserved Communities, January 21, 2021
  • Promoting Competition in the American Economy, July 9, 2021
  • Improving the Customer Experience, December 13, 2021
  • Access to Affordable, Quality Health Coverage, April 5, 2022
  • Equality for LGBTQI Individuals, June 15, 2022
  • Protecting Access to Reproductive Healthcare Services, July 8, 2022

The Administration will continue to address COVID-19 emergency needs while stepping up efforts to support states, health plans, providers and other stakeholders as they prepare for the post-COVID environment. The current PHE declaration expires October 13, 2022, but since HHS has not signaled that it plans to end the PHE in October, another extension is likely until January 11, 2023. The next advance notification about the end of the PHE would be Nov. 12, 2022. Once the PHE declaration expires, numerous Medicare and Medicaid, TANF, and SNAP flexibilities will end, including Medicaid’s continuous coverage requirement and certain telehealth flexibilities, among others. Additional federal agency guidance is expected to support post-PHE transitions.

The Centers for Medicare & Medicaid Services (CMS) plans to advance new policy direction across several service and delivery areas, including strengthening long-term services and support and innovations via Section 1115 demonstration programs. CMS is expected to approve transformational 1115 proposals in additional states. Several state proposals focus, in part, on building capacity among local and regional entities and community-based organizations to address social drivers of health. Many state proposals are also strengthening behavioral health delivery systems and seek to meet enrollees’ urgent behavioral health needs. Additionally will want to monitor CMS’ regulatory efforts to align and strengthen managed care and fee-for-service (FFS) access and network adequacy policies as well as updates to the agency’s in lieu of services policy in managed care programs.

The Administration is also expected to accelerate work on its top policy priorities and regulatory agenda in advance of the next Presidential election, and this will require ongoing engagement among health care stakeholders.

For additional information on these and other policies, please contact Andrea MarescaAmy BassanoZach GaumerJon Kromm, or Kevin Kirby.

Webinar

Opportunities for advancing Minnesota’s behavioral health crisis systems and services

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With the help of newly available federal funding, states like Minnesota are poised to dramatically advance crisis systems and services to address the needs of individuals who experience behavioral health crises. During this webinar, speakers will provide an overview of key behavioral health crisis initiatives nationwide, including a look at specific community efforts that can inform the development of improved systems and services in Minnesota.

Learning Objectives

  • Understand the differences between crisis systems and crisis services.
  • Find out how communities are advancing crisis systems and services by leveraging national opportunities.
  • Assess the implications of SAMHSA’s focus on block grant funding for crisis services.
  • Learn how the new national 988 call number and allocations for 988 infrastructure support can drive improved crisis response.

Speakers

Sue Abderholden, Executive Director, NAMI-MN
Suzanne Rabideau, Senior Consultant, HMA
Robin Trush, Principal, HMA
John Volpe, Principal, HMA

Webinar

Developing a Strategy for the Certified Community Behavioral Health Clinic Demonstration RFP

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The Bipartisan Safer Communities Act offers states new funding for expansion of the Certified Community Behavioral Health Clinic (CCBHC) Demonstration. The next CCBHC Planning Grant RFP for states is anticipated to be released in the fall of 2022. In this webinar, the first of a two-part series, experts from HMA and the National Council for Mental Wellbeing will:

  • Overview the CCBHC Demonstration opportunity and what the evidence for the model demonstrates
  • Share how states have used the CCBHC model as a transformational opportunity that can help behavioral health care systems achieve broader health quality and access goals
  • Discuss lessons New York and Michigan have learned from their CCBHC efforts, including key takeaways from the application and implementation processes

Speakers

Kristan McIntosh, Principal, HMA

Heidi Arthur, Principal, HMA

Dave Schneider, Managing Principal

Rebecca Farley-David, Senior Advisor, Public Policy and Special Initiatives, National Council for Mental Wellbeing

 

Stay Tuned for Part Two:

In our follow-up webinar, HMA and National Council for Mental Wellbeing will review the specific requirements of the Substance Abuse Mental Health Services Administration (SAMHSA) Notice of Funding Availabilities (NOFA), once released, and share recommended activities for states to have a successful application.

Blog

The basics of evaluating PBM contracts

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This week, our In Focus section highlights an issue brief from Wakely, an HMA Company, The Basics of Evaluating PBM Contracts, published September 2022. The brief provides an overview of the basic financial elements of a pharmacy benefit manager (PBM) contract. Evaluation of a traditional request for proposals (RFP) or PBM contract should begin with financial analysis of the following four key elements: discount guarantees (typically understood as point-of-sale ingredient costs), dispensing fees, rebate guarantees, and PBM administrative fees. This paper addresses various points of consideration when attempting a financial analysis of these contract elements.

Payors today face unprecedented degrees of complexity when conducting a PBM RFP or evaluating PBM contracts. To stay competitive, payors must navigate an ambiguous and changing pricing environment. That requires a solid understanding of PBM contracting. In a proposal, some PBMs may offer better AWP discounts while other PBMs offer better rebate guarantees. Alternatively, a payor may find a PBM that offers the best discounts and rebates but charges significantly higher administrative fees. Such analysis will consider the impacts of these key components together with historical and projected drug mix. While any PBM analysis must start with the elements discussed in this paper, a complete analysis must dive below the surface and into the fine print underlying these items.

Link to Issue Brief

Webinar

Webinar replay: How behavioral health organizations can strategically leverage public, private grants

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This webinar was held on September 29, 2022. 

Behavioral health organizations are benefitting from unprecedented access to public and private grant funding. But there are significant risks to simply “chasing funds,” such as mission drift and increased staff burnout within an already overburdened workforce. During this webinar, speakers from HMA and LAPA Fundraising outlined concrete steps behavioral health organizations can take to ensure they are pursuing the type of grants that support their overall mission.

Join us to:

  • Garner strategies and approaches for successfully winning grant dollars
  • Obtain an overview of current and upcoming funding opportunities that behavioral health agencies can use to build capacity and better serve their communities
  • Understand the tools and tactics organizations need to enhance their ability to attract both public and private grants
  • Develop a long-term strategy for diversifying agency funding for use in both growing existing behavioral health programs and seeding new and innovative initiatives

Speakers

Kristan McIntosh, Principal, HMA
Jessica Williams, Managing Director of Grants, LAPA Fundraising

Brief & Report

HMA consultants author Well Being Trust brief, “Naloxone for Overdose Reversal: Challenges and Opportunities”

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Efforts to reduce America’s opioid-related overdose deaths are being hampered by glaring inconsistencies in U.S. policies and practices from one region, health system, and community to another. So states a new Well Being Trust brief, “Naloxone for Overdose Reversal: Challenges and Opportunities,” written by HMA consultants Barry Jacobs and Helena Whitney, released September 15, 2022. The 10-page, intensively researched report also makes four policy recommendations calling for easier access to naloxone for providers and consumers, as well as more consistent naloxone prescribing and community distribution practices throughout the country.

Blog

Delaware substance use disorder treatment system needs assessment

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This week, our In Focus highlights a Health Management Associates Institute on Addiction (HMA IOA) report, Delaware Substance Use Disorder Treatment System Needs Assessment, published in June 2022. HMA IOA conducted a statewide three-county substance use disorder (SUD) treatment system needs assessment in Delaware. This project began in November 2021 and was primarily funded by New Castle County with contributions from Kent and Sussex counties. The goal was to review the current state of the SUD treatment ecosystem, identify strengths and gaps collecting input from as many Delawareans across multiple sectors as possible, and make actionable recommendations to build a more robust and sustainable future state system.

The final analysis included interviews with key stakeholders, focus groups, a survey of all licensed SUD providers, claims data analysis, and a comparison of Delaware’s public (e.g., Medicaid) outpatient and residential SUD reimbursement rates with selected regional states. This approach provided a unique cross-sector view of where the most significant opportunities for improvement and investment may rest.

The areas of greatest experienced need in the system were reported as: inadequate treatment beds, especially for some populations, like children and youth; lack of residential services for adults, especially those on Medicare and without insurance; needed supports for those experiencing negative impacts from social determinants of health (SDOH), like transportation and housing needs; lack of consistent access and care coordination; lack of adequate reimbursement to sustain the system or expand the treatment system; the need for trauma-informed care (TIC); and the need for more harm reduction and prevention strategies, including greater access specifically to Narcan 4mg Nasal Spray or its generic equivalent.

The study found that Delaware is meeting only 15 percent of SUD treatment needs and only meeting five percent of the need for the highest-intensity services, including inpatient treatment.

The results also showed an apparent discrepancy between what the state is working hard to implement to address the SUD and overdose crisis in Delaware and the community’s perception of, or lived experience with, those SUD treatment services and supports. Additionally, HMA IOA heard about many treatment system strengths from interviewees, town hall participants, and focus groups and included recommendations that are meant to leverage those existing strengths in the future treatment system.

Click here to read the report.