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HMA Insights: Your source for healthcare news, ideas and analysis.

HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Blog

Turning Insight into Action: The New Operating Reality in Behavioral Health

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Thousands of behavioral health leaders, clinicians, advocates, and industry partners convened during NatCon 2026, April 27–29 in Denver, CO—one of the sector’s largest annual gatherings. This year, the event was more focused and pragmatic than in recent years. Although behavioral health providers still face significant pressure, there was also a noticeable shift toward how organizations can move toward sustainable models for growth, technology adoption, and integrated care delivery.

Health Management Associates (HMA) colleagues attended the event to listen, connect, and contribute to the meaningful conversations. Many of the themes and industry trends we have been tracking emerged consistently throughout the conference. In this article, our behavioral health experts discuss their collective insights and the road ahead for behavioral health interest-holders.

Key Themes from NatCon 2026 

Financial resilience remained at the forefront.

Behavioral health organizations continue to respond to constrained funding conditions, evolving reimbursement dynamics, and the need to diversify revenue beyond unstable and uncertain grant support and rate reimbursement volatility.

Operational visibility was closely tied to financial resilience.

Leaders discussed the need for a clearer, more real-time understanding of their performance. Performance was considered broadly to include financial indicators, clinical outcomes, and workforce capacity. Data and measurement have moved from a “nice to have” to “essential” for effective engagement with payers.

Innovation conversations are shifting toward implementation.

Artificial intelligence (AI) and digital tools were still hot topics, but the discussion has moved toward implementation and effective deployment. Conversations centered on practical use cases such as clinical documentation support, measurement-based care linked to improved health outcomes, and better integration with electronic health records (EHR).

This year’s conference highlighted enduring opportunities and challenges for the field, including:

  • Core service priorities, such as crisis response, suicide prevention, collaborative care and increased opportunities around Certified Community Behavioral Health Clinics (CCHBCs), and value-based payment strategies for financial resilience 
  • Workforce sustainability, with organizations looking to reduce administrative burden, strengthen recruitment and retention, and support staff well-being while demand for services continues to rise

Behavioral Health Industry Trends

The industry trends emerging from NatCon 2026 suggest that behavioral health organizations are entering a more disciplined operating environment to maximize efficiencies and ensure long-term sustainability in what seems sometimes to be a chaotic environment. Organizations are placing greater emphasis on their Medicaid strategy, managed care contracting, and value-based arrangements that reward outcomes and continuity of care. There is also continued momentum behind integrated models that connect behavioral health with primary care, public health, and community-based supports. Rather than treating mental health and substance use services as isolated programs, providers are increasingly building coordinated systems that address whole-person needs across settings.

Another notable trend is that technology is becoming a clearer differentiator. Some organizations are piloting or scaling technology, while others are taking a more cautious approach. Discussions surrounding AI in particular appeared to have matured significantly, with attention moving from abstract concerns toward change management, sequencing of use cases, return on investment, governance, and clinician trust. In that sense, technology is moving from being a side initiative to a strategic differentiator.

Transformation in the Behavioral Health Field

We were struck by the level of alignment across different parts of the field. Many of the themes we heard reinforced what providers experience daily—the need to manage uncertainty while continuing to meet the growing demand for services and more intentional use of data, infrastructure, and outcomes measurement.

More broadly, the conversations throughout the conference pointed to a field that is moving toward greater pragmatism. There is still a clear need for additional resources, but there is also growing recognition that adaptability will serve an equally important role.

How We Can Help

One of the most valuable aspects of NatCon is the opportunity to compare experiences across organizations and regions. The themes emerging from this year’s conference reflect broader shifts happening across the behavioral health landscape. 

A key role of our team is to connect what we hear in different settings and share it in a way that is useful for others in the field—highlighting emerging approaches, surfacing common challenges, and creating opportunities for peer exchange.

For questions about the market dynamics or approaches to strengthen your organization’s adaptability,  contact one of our HMA experts.

Blog

Why Children’s Behavioral Health Demands Action Now

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Practical Strategies for Medicaid, Schools, Hospitals, and Communities

During Children’s Mental Health Awareness Week, May 3–9, and Mental Health Awareness Month, we are spotlighting actionable solutions across the US children’s behavioral health system. This post is intended for children’s behavioral health providers, state Medicaid agencies, school-based health centers, hospitals, local government agencies, local education agencies (LEAs), child welfare agencies, and philanthropic organizations that are working to strengthen prevention, crisis response, care coordination, and community-based continuums of care. HMA has a robust and growing team of behavioral health experts who support this work and have developed a series of case studies showcasing practical strategies implemented with clients—from crisis system design and referral pathway improvements to financing and implementation roadmaps.

Children’s Mental Health Awareness Week is a reminder that children’s behavioral health and youth mental health are not niche issues. They are systemic issues that require coordinated action across Medicaid, education, public health, hospitals and health systems, child welfare, and local government—especially where schools and community partners are on the front line.

The need remains substantial. The Centers for Disease Control and Prevention’s (CDC’s) 2023 Youth Risk Behavior Survey results, released in 2024, showed that 40% of high school students reported persistent feelings of sadness or hopelessness, even as some measures improved from 2021 levels. CDC also highlighted how bullying, safety concerns at school, racism, unfair discipline, and frequent social media use are tied to youth mental health risks.

The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 2024 National Survey on Drug Use and Health, released in 2025, adds another important dimension. Among adolescents ages 12–17, the 2024 survey found that:

  • 15.4% experienced a major depressive episode within the past year
  • 10.1% had serious thoughts of suicide
  • About 40% who had a major depressive episode in the past year did not receive mental health treatment

The data show that progress is possible when systems respond with real capacity, access, and support. That is why this moment calls for more than awareness. It calls for action that is operational, financeable, and grounded in what works.

At HMA, we work with child-serving systems that are trying to solve real problems, including how to strengthen crisis response, improve referral pathways, build a more coherent continuum of care, and connect strategy with implementation.

Over the coming weeks, we will feature three examples that reflect different parts of the children’s behavioral health landscape.

1. Children’s hospital mental health strategy and crisis response

This case study will highlight work to help a children’s hospital strengthen its mental health approach and support next-stage crisis system design.

In this engagement, HMA partnered with Rady Children’s Hospital Orange County to move pediatric behavioral health from strategy to implementation—aligning emergency department (ED) mental health workflows, clarifying pediatric crisis pathways, building an investment-ready fiscal pro forma, and advancing priority programs to strengthen access and care coordination. This work can inform hospitals and health systems, Medicaid agencies, and community partners seeking to reduce ED boarding and improve pediatric crisis response.

2. County-level ecosystem and referral system improvement

This case study will show how local systems can bring multiple stakeholders together to improve referral pathways and make behavioral health more accessible for children, youth, and families.

HMA supported a county-led effort to strengthen cross-system referral pathways by aligning agencies around shared intake and triage practices, clearer roles and accountability, and more navigable access points for families. This approach is relevant for local government agencies, LEAs, school-based health centers, child welfare agencies, and community providers working to reduce fragmentation and speed connection to the right level of care.

3. Building a stronger children’s behavioral health continuum in New Orleans

This case study will focus on assessing gaps, identifying opportunities, and supporting a more coherent community-based continuum for children’s behavioral health.

HMA helped deliver the first integrated view of pediatric behavioral health in New Orleans, LA, aligning schools, healthcare, philanthropy, and government around a shared understanding of unmet needs and critical system gaps, as well as charting a prioritized roadmap to strengthen and better coordinate the continuum of care.

What It Means for Key Child-Serving Audiences

  • Children’s behavioral health providers: Prepare for stronger care coordination expectations (warm handoffs, follow-up after crisis, shared care plans) and increased demand for community-based alternatives to the ED
  • State Medicaid agencies: Focus on financeable crisis continuums (including pediatric crisis response), payment and contracting approaches that support access and continuity, and data/reporting that demonstrates outcomes
  • School-based health centers and LEAs: Strengthen referral pathways, clarify roles between schools and providers, and build protocols that support early identification while keeping students connected to safe learning environments
  • Hospitals and health systems: Improve pediatric ED mental health workflows, create clearer crisis pathways, and develop investment-ready business cases for behavioral health capacity and partnerships
  • Local government agencies: Convene cross-system partners, establish shared intake/triage and accountability, and use implementation roadmaps to move from planning to operational change
  • Child welfare agencies: Align behavioral health access for children and youth involved with child welfare, reduce handoff failures, and integrate crisis planning into placement stability and permanency strategies
  • Philanthropy: Target catalytic investments that fill continuum gaps, build capacity for implementation (not just planning), and support cross-system governance and measurement

The common thread among these examples is a simple belief: Children’s behavioral health improvement does not happen through aspiration alone. It happens when organizations and public systems translate urgency into design, partnerships, financing strategies, and implementation steps.

That is also why children’s behavioral health is so relevant. National data still point to high levels of distress and suicide risk among adolescents, despite recent improvements. CDC’s findings show how strongly youth mental health is shaped by the environments in which they live, learn, and play—especially their schools and communities.

For leaders in Medicaid, behavioral health, child welfare, education, county government, hospitals, and provider organizations, the question is not whether children’s behavioral health deserves attention, but rather is how to build systems that respond earlier, coordinate better, and support children and families more effectively.

We hope this series contributes to that conversation by sharing practical examples of work that can inform future action.

Other Resources on Children’s Behavioral Health and Youth Mental Health

Contact us to discuss how HMA can support your children’s behavioral health strategy—whether you work for a Medicaid agency, hospital/health system, school-based health partner, LEA, local government agency, child welfare agency, provider organization, or philanthropic funder. We can help with crisis continuum planning, care coordination design, referral pathway improvement, financing and pro forma development, and implementation support.

Solutions

Children’s Behavioral Health Consulting

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HMA Solutions

Children’s Behavioral Health Consulting

Cross‑System Solutions for Schools, Health Systems, and State & Local Agencies

The US children’s behavioral health system is facing significant strains. Workforce shortages, fragmented funding and accountability, and rising demand are converging in the places where children spend time and receive care. Healthcare systems are seeing the impact in emergency departments and inpatient units, schools are expected to respond to student needs without sufficient capacity, and state and local agencies face pressure to align policy, financing, and programs across behavioral health, Medicaid, child welfare, and education.

How HMA Can Help

HMA partners with child-serving systems to translate urgency into practical, financeable, implementable improvements, strengthening the continuum from prevention and early intervention to crisis response and recovery. Examples of services we provide include:

Landscape assessments and needs analyses (qualitative and quantitative)

Stakeholder engagement and facilitated convenings (including family, youth, community, and cross-agency partners)

Gap analysis and service continuum design (school-, community-, and facility-based)

System and model redesign, including governance, referral pathways, and care coordination across settings

Strategic planning and implementation support (operational roadmaps, change management)

Regulatory and policy analysis to support compliant, scalable program models

Workforce strategy and provider training to build sustainable capacity

Financial modeling, including fiscal pro formas and revenue cycle considerations

Site assessments and facility studies to support service expansion and optimization

Who We Serve

We support providers, health systems, children’s hospitals, schools, school-based entities (including local education agencies [LEAs]), state and local government agencies and community-based partners working to improve children’s behavioral health.

Common Challenges

Fragmentation across child-serving systems,

Workforce shortages and training needs,

Misaligned financing and accountability, and

The operational challenge of coordinating care across school, community, and clinical settings.

Where We Help

Hospitals and Health Systems
Strengthen pediatric behavioral health strategy and operations—improving crisis pathways, clarifying roles across ED/inpatient/outpatient settings, and connecting clinical services to community and school-based partners

Schools, LEAs, and School-Based Entities
Build sustainable school mental health approaches—right-sizing service tiers, strengthening referral and care coordination, and aligning school-based services with Medicaid, community providers, and crisis systems

State and Local Government, Child-Serving Agencies, and Community-Based Partners
Advance cross-system solutions—aligning policy, financing, and accountability across behavioral health, Medicaid, child welfare, and education, while building implementable continuums of care that improve access and equity. 

HMA Differentiators

Cross-setting expertise. We work across schools, community-based systems, and healthcare delivery settings, helping partners design handoffs and shared accountability rather than isolated programs.

Implementation and financing. We connect strategy to operations and the realities of financing, reimbursement, and sustainability so plans can move toward successful implementation and delivery.

Multidisciplinary team. Our team includes clinicians, program administrators, researchers, and former state and local leaders with deep knowledge of children’s behavioral health ecosystems. Many of us are parents and grandparents ourselves who are passionate about and personally invested in this work.

Partnership-first approach. We bring a collaborative, community-grounded process that centers children, youth, and families and builds durable cross-sector relationships.

Local context, national perspective. We tailor solutions to market dynamics, resources, and policy environments while bringing lessons learned from diverse geographies and client types.

Other Resources

Blog

Why Children’s Behavioral Health Demands Action Now

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Spotlight

Improving Youth Behavioral Health Through School-Based Initiatives

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Spotlight

From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

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Let’s strengthen children’s behavioral health—together.

Whether you’re leading in a hospital or healthcare system, a school or LEA, or a state or local agency, we can help you align partners and build an implementable plan across the continuum of care.

Contact us to discuss your priorities and identify next steps.

Brief & Report

Case Study Report: Lessons Learned from HealthySteps Technical Assistance in California

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This report synthesizes insights from multiple efforts to support the financial sustainability of HealthySteps sites in California, including federally qualified health centers (FQHCs), community clinics (non-FQHCs), private practices, and other settings. Led by the HealthySteps National Office and Health Management Associates (HMA), the technical assistance (TA) elevated challenges, strategies and best practices to achieve sustainability informed by learning collaboratives, individualized TA sessions, and financial modeling exercises. This report complements additional resources that the HS National Office and HMA developed which are available via the HealthySteps (HS) Sustainability website.

Solutions

Solutions for behavioral health workforce shortages

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HMA Solutions

Solutions for behavioral health workforce shortages

Growing demand and need for BH services is outpacing workforce capacity nationally.
 
In 2024, 43 of the 44 states responding to an NRI survey reported a behavioral health workforce shortage[1]. States, Health Plans and Provider Associations are all struggling with how to manage the problem.
 
A standardized approach to assessing BH workforce shortages can help states and organizations better design sustainable workforce solutions, especially considering challenges federal funding changes and the need for diverse care needs across rural and urban areas across the US. Recommendations are grounded in lived experience, policy fluency, and practical feasibility.

[1] Source: https://www.nri-inc.org/media/tghpz5uu/smha-workforce-shortages-2023.pdf

Design and Implementation

Support infrastructure and policy alignment grounded in community partnerships

Expert Analysis

Interpret data using specialized tools, knowledge, experience, and context

Strategic Planning

Define goals, align resources, and guide decisions

A Standardized Approach

HMA’s framework helps states, health plans, and provider associations and organizations design sustainable workforce solutions, especially considering challenges like the need for diverse care needs and regionally appropriate strategies. Our work delivers measurable, generalizable, lasting improvements, and provides a window into obvious partnership opportunities for workforce development projects in both rural and urban communities. The recommendations are grounded in lived experience, policy fluency, and practical feasibility.​

Our Services

With a deep understanding of current and emerging shifts in care and policy, our BH workforce consultants are well equipped to provide support and implementation of workforce initiatives across a variety of content areas over a flexible duration.

Rapid Deployment of Existing Strategies

Preparation & Education

Evaluation & Analysis

Implementation & Support

Strategic Assessment

Regulatory & Policy Consulting

Proven Results

HMA has worked on national projects aimed at resolving workforce shortages.  HMA is a founding member of the Workforce Solutions Partnership, a collaboration among the College for Behavioral Health Leadership and the National Council for Mental Health Wellbeing.  HMA has a national lens on the behavioral health workforce experiences and has worked with clients to identify pathways to strengthen and diversify the workforce in ways that are equitable, sustainable, and community informed. Our established services ensure that we translate insights from our methods into actionable and meaningful recommendations for workforce development. 

HMA Differentiators

Many of our team members are former executives and clinical leaders from the BH workforce sector, including doctors, policy experts, social workers and administrative leaders from health plans, health systems, community-based organizations, FQHCs, and government agencies at the local, state and national levels. Our clinicians bring decades of experience leading BH care in inpatient, outpatient and emergency department settings.

OUR EXPERTISE

HMA subject matter experts with national BH workforce experience analyze existing data—such as strategic plans, funding streams, licensing, and workforce initiatives—to identify policy gaps, infrastructure readiness, and innovative care models.

With a deep understanding of current and emerging shifts in care and policy, our BH Workforce consultants are well equipped to provide specialized services.

Contact our experts:

Headshot of Paul Fleissner

Paul Fleissner

Senior Principal

Working to integrate services across systems and communities, Paul Fleissner is a seasoned executive who has developed programs and policies … Read more
Headshot of Allie Franklin

Allie Franklin

Managing Director

Allie Franklin is a licensed clinical social worker with decades of experience in public, private, and non-profit behavioral health, healthcare, … Read more
Headshot of Jill Kemper

Jill Kemper

Senior Consultant

Jill Kemper has extensive experience improving access to care and care delivery, especially for vulnerable or complex patient populations and … Read more
Blog

MAHA Children’s Health Strategy Report: Driving a New Era for Child Health Policy

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The September 2025 release of the “Make Our Children Healthy Again Strategy Report” marks a pivotal moment in the Trump Administration’s effort to address childhood chronic disease. Building on the work of the Make America Healthy Again (MAHA) Commission—established by executive order in February 2025 and led by US Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr.—the Strategy Report provides a proposed road map for federal, state, and local action.

The MAHA child-focused Strategy Report is already driving the Trump Administration’s healthcare agenda. Though the report sets ambitious goals, public health entities, state governments, and other experts have raised concerns that several recommendations run counter to established scientific research or lack sufficient evidence.

In this article, Health Management Associates (HMA) experts highlight the areas of focus in the Make Our Children Healthy Again Strategy Report and offer specific recommendations, initiatives, and considerations for stakeholders. Earlier editions of In Focus have addressed the commission’s formation, initial assessment, and the administration’s growing focus on childhood health (Spotlight on Development of President Trump’s Children’s Health Strategy).

Key Components of the MAHA Strategy

Advancing Critical Research to Drive Innovation

The strategy identifies broad areas of research to inform healthy outcomes and positions HHS to direct initiatives in collaboration with the US Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and other agencies. Examples include:

  • Support the MAHA Chronic Disease Initiative, advance the Real-World Data Platform linking data from claims, electronic health records (EHRs), and wearables
  • Establish a working group on mental health diagnosis and prescription, led by several HHS agencies, to focus on SSRIs (selective serotonin reuptake inhibitors), antipsychotics, mood stabilizers, and stimulants
  • Study food for health, with the National Institutes of Health (NIH) Office of Nutrition coordinating research initiatives across HHS and the US Departments of Agriculture and Veterans Affairs (VA)
  • Identify opportunities to strengthen the use of repurposed drugs for chronic disease
  • Address vaccine injury data collection and analysis, as well as mental health research focused on screen time and prescription practices

Realigning Incentives and Systems to Drive Health Outcomes

The report recommends improvements to transparency and efficiency in regulatory processes to address nutrition, fitness, pharmaceuticals and vaccines, and care delivery and payment to address chronic disease. Specific initiatives include:

  • Updating the Dietary Guidelines for Americans and developing an “ultra-processed food” definition
  • Promote breastfeeding through the Special Supplemental Nutrition Program for Women, Infants, and Children
  • Updating hospital food service nutrition guidance
  • Developing options to get “MAHA boxes” of healthy food to Supplemental Nutrition Assistance Program (SNAP) enrollees
  • Support states with SNAP waivers to encourage healthy food purchases among SNAP participants
  • Enhance oversight of direct-to-consumer pharmaceutical advertising and develop a new vaccine framework
  • Establish Medicaid managed care quality metrics for nutrition coaching and fitness, and work with states to develop prescribing safeguards for school-age children
  • Promote evidence-based prevention and wellness initiatives and restructure agencies to reduce conflicts of interest

Increasing Public Awareness and Knowledge

Major campaigns will involve:

  • Launching the “Make American Schools Healthy Again” initiative to assist states with promoting physical activity and nutrition in schools
  • Expanding education on environmental exposures, fluoride, and pesticide safety
  • Increasing awareness of opioid dangers, vaping, and screen time impacts
  • Training school and library staff to respond to opioid overdoses

Fostering Private Sector Collaboration

The strategy emphasizes the administration’s work to advance private sector partnerships aligned with MAHA priorities, including partnerships to achieve the following:

  • Improve nutrition in government-funded programs (schools, VA hospitals, prisons)
  • Support community-led initiatives to reduce chronic disease in children

Key Considerations for Partners and Stakeholders

Early engagement is critical as federal agencies begin implementing over 120 recommended actions.

States, providers, health plans, and community organizations should identify how their current approaches to children’s health could align with the MAHA initiative and strategy report, as well as where these new ideas might conflict with present policies. This assessment will identify opportunities to maximize new federal funding opportunities and additional resources.

Progress toward the Strategy Report’s specific goals will require coordinated efforts across agencies, sectors, and communities. Stakeholders should consider how and when to engage in research, policy development, and public awareness campaigns outlined in the report.

Connections to Trump Administration Priorities and Broader Opportunities

The report’s recommendations are already influencing federal agency actions and are driving congressional hearings and new legislation at the federal and state levels.

The US Department of Agriculture’s (USDA), for example, is working with states to approve SNAP waivers to restrict the purchase of junk food with federal benefits. HMA experts are tracking the SNAP waiver actions, and as of September 2025, a total of 12 states have received USDA approval for waivers that restrict the purchase of soda, candy, and other unhealthy foods with SNAP benefits. Other states are considering similar waivers, and the USDA is providing technical assistance to support these efforts.

The FDA has enhanced oversight of direct-to-consumer pharmaceutical advertising, including new enforcement activities and rulemaking on drug safety disclosures in ads. This approach aligns with MAHA recommendations and Trump Administration priorities for transparency and consumer protection.

HHS is also pursuing a new vaccine framework; however, states retain significant authority over school-based immunization requirements, and several are considering alternative approaches or maintaining broader vaccine recommendations than those outlined in the MAHA report. Recent legislative actions in some states seek to shift authority for determining school-based immunization requirements solely to the legislature, reflecting ongoing debate and federal-state dynamics.

Connect with Us

As implementation of the Make Our Children Healthy Again Strategy Report advances, all stakeholders must be ready to engage, partner, innovate, and drive change that will shape the future of child health.

HMA guides state and local government, providers, plans and other partners through the multi-pronged strategies and recommendations in the report as well as the complexities of federal funding opportunities, such as the new Rural Health Transformation Program. We are helping state and local policymakers plan for MAHA and Trump Administration priorities, which includes guidance on how to leverage innovative approaches like SNAP waivers to promote healthy food access for children and families.

With deep expertise in policymaking and operational management, HMA consultants are enabling states and their partners to accelerate their work, build sustainable models for child health improvement, and position themselves to take advantage of new federal, state, and local policy opportunities driven by the MAHA report. To discuss questions about the impact of the report contact our experts below.

Webinar

Webinar Replay- Beyond the Bill: How Pair Team and MCOs Are Meeting Community Needs Under HR 1

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This webinar was held on October 2, 2025.

As Medicaid evolves under HR 1, Managed Care Organizations face increasing pressure to meet new engagement requirements while ensuring vulnerable communities don’t fall through the cracks. This shifting landscape demands scalable, innovative care models that go beyond compliance – focusing instead on meaningful connections, coordinated support, and whole-person care.

In this session, Jami Snyder, former HHSC Commissioner of TX and Medicaid Director of AZ, joined Neil Batlivala, CEO and Co-Founder of Pair Team, and Dr. Nate Favini, Chief Medical & Strategy Officer, to explore how Pair Team and its MCO partners are meeting this moment. Learn how their model combines technology, care coordination, and community-based partnerships to engage hard-to-reach members and address social drivers of health.

We heard real-world examples of how payers and partners can come together in smarter, more connected ways. By aligning efforts and building trust, they can drive better outcomes and create stronger community connections for the people who need support the most.

Learning Objectives:

  • Briefly break down HR 1’s most critical provisions and what they mean for Medicaid and MCO operations.
  • Discover how Pair Team and MCOs are co-designing solutions leveraging technology.
  • Identify best practices for engaging populations facing barriers such as behavioral health needs, housing instability, and transportation challenges.

Featured Speakers:

Carter Kimble, Principal (Moderator) Health Management Associate
Jami Snyder, Former HHSC Commissioner, Texas; Former Medicaid Director, Arizona
Neil Batlivala, Founder and Chief Executive Officer Pair Team
Nate Favini, MD,MS, Chief Medical Officer Pair Team

Brief & Report

Understanding Substance Use Disorders & the Use of Medications for Treatment

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Education Materials for Patients, Families, Educators and Non-Prescribing Providers

This is a comprehensive set of substance use disorder (SUD) education materials for patients, families, educators, and non-prescribing providers. In recognition of September being National Recovery Month, this document is fully downloadable for community use without restriction.   

The toolkit was made available through a joint effort of the California Department of Health Care Services Opioid Response Project and Health Management Associates. Coaching and technical assistance for this project was funded through DHCS by State Opioid Response Funds from SAMHSA. The bilingual patient education materials are written in accessible language for most audiences, in both Spanish and English. 

The materials can be used to broadly disseminate information across a community or with individual patients, family members and non-prescribing providers. These SUD educational materials were created using the latest research and information available. They are meant to be concrete and easily accessible with simple language that promotes increased understanding of each topic.  Some of the topics touched upon include evidenced-based treatment options such as Medications for Addiction Treatment (MAT) and Medications for Opioid Use Disorder (MOUD).  

Solutions

From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

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HMA Spotlight

From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

Hospitals across the country are facing unprecedented levels of behavioral health (BH) challenges that impact every facet of operations, from the emergency department to discharge planning. Extended lengths of stay, ED boarding, workplace violence, and staff burnout present clinical issues and pose operational, financial, and reputational risks.
 
Individuals with BH needs arrive in emergency departments daily, even if the hospital lacks a dedicated BH inpatient unit. These patients require coordinated care across all clinical sites.  
 
HMA offers an end-to-end partnership helping hospitals identify and implement solutions in ways that build internal capacity and deliver measurable results.

Rapid assessments to identify high-impact opportunities

Financial modeling and reimbursement optimization

Strategic and operational planning for BH integration

Partnership development and M&A advisory for BH service lines

Implementation support with measurable results

Effective Strategies

HMA partners with hospitals to address these challenges with a vision of improving care and operations. Our team offers practical, high-impact solutions that enhance patient care, support your workforce, streamline operations, and promote financial stability. Contact us to discuss how solutions can be tailored to your hospital’s unique needs. Let’s address your most urgent behavioral health challenges now, before they impact care delivery and financial stability.

Six Priority Areas

While every hospital faces unique behavioral health challenges, the pressures they create are consistent. HMA partners with your leadership and frontline teams to focus on six proven priority areas that create lasting impact. Together, we develop solutions that improve care, strengthen operations, and build resilience across your organization.

  • Rapid stabilization protocols
  • Integration of psychiatric expertise into acute care workflows
  • Boarding reduction strategies

Value: Reduce length of stay, improve throughput, and protect staff safety.

  • Cross-continuum care pathways
  • Partnerships with community providers
  • Readmission prevention frameworks
  • Accreditation readiness (The Joint Commission, DNV (Det Norske Veritas))

Value: Improve continuity, patient satisfaction, and reduce high-cost utilization.

  • Optimizing reimbursement (e.g., unbundled billing for injectables)
  • Service line financial assessment

Value: Unlocking new revenue streams.

  • Joint ventures with behavioral health providers
  • Sell-side preparation and merger and acquisitions support
  • Community and payer alignment

Value: Expand service capabilities while sharing risk and resources.

  • Staffing models to provide effective and efficient care while reducing burnout
  • Data-driven performance management
  • Technology-enabled workflows

Value: Increase efficiency and retention through optimized operations.

  • Medication Assisted Treatment (MAT) and Medication for Opioid Use Disorder (MOUD) implementation in ED and inpatient settings
  • Peer navigation programs
  • Integration with primary and specialty care

Value: Reduce mortality, avoidable readmissions to EDs, and improve community health outcomes.

Proven Results

Our work with hospitals across the country delivers measurable, lasting improvements that strengthen care delivery, operational performance, and financial health.

  • Reduced ED boarding times by up to 40% through targeted intervention models.
  • Increased reimbursement for behavioral health services by optimizing billing practices for long-acting injectables and other high-value services.
  • Delivered $1.2M in annual savings for a regional hospital through integrated behavioral health response planning.

HMA Differentiators

Many of our team members are former executives and clinical leaders from the behavioral health sector. They bring decades of experience leading behavioral health care in inpatient, outpatient and emergency department settings. HMA provides the depth, agility, and collaborative approach that hospitals need to address today’s most urgent behavioral health challenges while also building capacity for the future. Our proven track record includes hospitals of all sizes and structures, ensuring that solutions are tailored to your market, patient mix, and resources.

Solutions

ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations

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HMA Spotlight

ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations

Applied Behavior Analysis (ABA) is an evidence-based behavior therapy for people with autism spectrum disorder (ASD) and other developmental disorders. In recent years, the diagnosis of ASD and subsequent demand for ABA services has increased. State Medicaid administrations and Managed Care Organizations (MCOs) are tracking increased ABA utilization and wait times for these services, and in some situations are investigating quality of care and/or fraud, waste, and abuse (FWA) concerns. To optimize quality care for members, MCOs who cover these services must have policies regarding ABA benefit structure, clinical guidelines, utilization management, and service delivery. Plans also need to monitor for and identify possible FWA concerning documentation and/or billing practices for these services. MCOs with comprehensive ABA compliance and auditing programs can meet these critical needs.

Our team

HMA’s national presence keeps us at the forefront of ABA-related changes in multiple states. HMA’s team of behavioral health clinicians have years of experience conducting FWA audits and have specific training required to conduct detailed and meticulous ABA reviews. Our team includes operational and clinical subject-matter experts with board certifications in behavior analysis (BCBA, RBT) who can support auditing activities as well as policy review and revision. We will work with your organization’s team to provide the insights necessary to maximize ABA quality of care and cost efficiency.

How HMA can help

We work closely with MCOs to develop a customized scope of services that meet their unique ABA compliance, policy, and strategy needs.

We can help MCOs with:

  • Establishing their own ABA compliance programs
  • Conducting audits of ABA provider claims and associated medical records, using customized audit tools and findings reports, to identify potential FWA, including as part of an MCO’s Special Investigation Unit (SIU) program
  • Reviewing and providing feedback on ABA-related policies
  • Developing ABA-related documentation forms
  • Providing consultation on ABA reimbursement/utilization benchmark development
  • Providing support in building cohesion/collaboration between MCO and local Department of Developmental Disabilities representatives
  • Developing strategies to improve care coordination for youth transitioning to adulthood
  • Assisting MCOs with their Managed Behavioral Healthcare Organizations (MBHO) benefit oversight
  • Demonstrating how to maximize the interface of organizational Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefits and the intersection with ABA services

We produce results

Our auditing team members have supported the SIUs of three Medicaid health plans in different states. We have demonstrated a 12:1 return on investment for our clients, based on associated recoupment of improper payments and estimated prevented loss.

If you have questions about our ABA compliance, policy, or strategic support services, contact our experts below.

ABA Auditing Services Case Study

Contact our experts:

Headshot of Nicole Lehman

Nicole Lehman

Associate Principal

Nicole Lehman is an experienced healthcare professional specializing in the improvement, development, and growth of multifaceted, high-paced managed care organizations. … Read more
Headshot of Shannon Walters

Shannon Walters

Associate Managing Director

Applied Behavior Analysis (ABA) Auditing Services 

Applied Behavior Analysis (ABA) Auditing Services 

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THE CLIENT

HMA’s team of expert behavioral health auditors from Crestline Advisors performs audits of behavioral health services, including applied behavior analysis (ABA) services, for a Medicaid health plan in Virginia (“the client”). The client refers cases to HMA when there are allegations of possible fraud, waste, or abuse (FWA) concerning documentation and/or billing practices for these services.

BACKGROUND

ABA is an evidence-based behavior therapy for people with autism spectrum disorder (ASD) and other developmental disorders. In recent years, the diagnosis of ASD and subsequent demand for ABA services has increased. State Medicaid administrations and Managed Care Organizations (MCOs) are tracking increased ABA utilization and wait times for these services, and in some situations are investigating quality of care and/or FWA concerns. Types of FWA concerning ABA therapy services may include billing for services not rendered, billing for ABA services without documentation of ABA-specific interventions, billing for services by unqualified individuals, or billing more units than the documentation supports, to name a few. We have a deep bench of licensed behavioral health clinicians and coders with many years of experience in conducting audits for MCOs, state Medicaid administrations, and providers. Given our expertise, we understand the importance of the golden thread of documentation that should underlie billing, including assessments and treatment plans which identify the need for ABA services and documentation of ABA service interventions, supervision, and family training.

APPROACH

The client’s SIU team identifies providers of ABA services for whom there is an allegation of potential FWA and provides us with sample claims and medical records to review. We have developed customized audit tools to investigate the unique documentation and billing considerations for ABA. Incorporating state-specific provider/billing manual requirements, we conduct pre- and post-pay audits in which we may identify errors in documentation (misalignment with what is billed on the claim). We then provide a detailed report to the client summarizing the identified errors and potential improper payments. Our team also can assist in the pre-audit phase to develop provider communications to request medical records and provides post-audit support to MCOs to help explain findings to providers impacted by the audit, or to support the MCO in an appeal or fair hearing process.

RESULTS

This is an ongoing project that has already provided significant value to our client in a short period of time. The client’s analysis of our auditing work, which included ABA findings reports as well as findings reports for other behavioral health services, has already identified a 12:1 return on investment, based on associated recoupment of improper payments and estimated prevented loss. Our own internal ROI analysis, focused specifically on ABA audits, also identified a 12:1 benefit. By working with our team, MCOs can expect to see timely and thorough identification of potential improper payments upon which they may act to reduce FWA. Ultimately, reducing FWA leads to increased availability of services for the members who need them most and promotes improved quality of care from qualified professionals. To learn more, email Shannon Walters.

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Addressing the Growing Crisis in Older Adult Behavioral Health

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Imagine a 77-year-old man named Don who lives alone in his small apartment after his wife, Marcia, suddenly died a year ago. She had been his constant companion and long-time caregiver, making sure he took his medications for diabetes and bipolar disorder. Now he is socially isolated, lonely, and depressed. When he neglects to eat, his blood sugar levels tend to drop, and he becomes light-headed. He won’t call his doctors then; he doesn’t want to bother them. Besides, it was his wife who used to communicate with his doctors and psychiatric team about any concerns. Without her, he doesn’t have much motivation to do anything.

Don illustrates several U.S. demographic and epidemiologic trends:

He is a “Baby Boomer” driving the ongoing aging of this country. Within the next 20 years, the number of Americans aged 65 and over will exceed the number of those under 18. The population of working age, including those available to care for older adults, will decline by 5 percent. As a result, the emerging care gap between the numbers of Americans who need care and those who can provide it will greatly increase.

Like greater numbers of older Americans, he has at least two chronic illnesses, adversely affecting his overall functioning and quality of life. According to a 2025 Centers for Disease Control research summary, chronic conditions put him at risk for higher healthcare costs[1]. The combination of chronic physical and mental health conditions will likely mean very high health care costs.

Like increasing numbers of older Americans, he has a behavioral health disorder. About 25% of older adults have a diagnosable mental, substance use, and/or cognitive disorder. These conditions are often exacerbated by social isolation and loneliness, which is associated with increased rates of both mental and physical health problems.

Unfortunately, about half of older adults with mental or substance use disorders do not get treatment or are treated by primary health care providers who have limited training in addressing geriatric psychiatric concerns. As a result, only about a third of people who get treatment receive what is “minimally” adequate treatment. Only about half of those who get treatment from mental health professionals receive adequate care.

The low utilization by older Americans of behavioral health services reflects several access challenges including: 

  • Access to providers who are clinically, culturally, linguistically, and generationally competent are in short supply. The shortages are most acute for rural residents. There is also a shortage of geriatric mental health professionals participating in the Medicare program.
  • Service access is also problematic. Many treatment programs are in hard-to-reach locations. There is also a tremendous shortage of services in home and community settings, due to workforce shortages.
  • Discrimination including stigma and ageism, plus the lack of awareness about mental illness and the effectiveness of treatment result in reluctance to seek or accept behavioral health services.

Unlike many of his contemporaries suffering from a behavioral health condition, Don does have long-standing behavioral health treatment which has been effective for most of his lifetime for managing his bipolar disorder. But without his wife’s support, his attendance and adherence have faltered. He now needs other sources of support and guidance, as well as more intensive treatment, or he faces several major risks:

  • He may wind up being taken by ambulance to hospital emergency rooms for falls. *
  • He may be admitted to the hospital for broken bones, diabetic complications, or even a stroke or heart attack.
  • He may deteriorate further and become unable to care for himself, eventually transferring from a hospital to a long-term care facility.
  • He may suffer premature death.

Older Americans, like Don, need not suffer injury and decline in addition to grievous loss. With the right systems of behavioral health, supported by care coordination and person-centered care plans, they can recover, adapt, and remain in their homes, as most Americans prefer.

HMA has the expertise to create and strengthen those systems of care. To learn more about How HMA Can Help.

[1] Watson KB, Wiltz JL, Nhim K, Kaufmann RB, Thomas CW, Greenlund KJ. Trends in Multiple Chronic Conditions Among US Adults, By Life Stage, Behavioral Risk Factor Surveillance System, 2013–2023. Prev Chronic Dis 2025;22:240539. DOI: http://dx.doi.org/10.5888/pcd22.240539

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