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Brief & Report

Learning from COVID-19-related flexibilities: moving toward more person-centered Medicare and Medicaid programs

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A new person-centered assessment framework and issue brief, authored by HMA experts in conjunction with Manatt Health, examine the temporary regulatory Medicare and Medicaid flexibilities implemented during the COVID-19 public health emergency (PHE) and aimed at ensuring access to care for older adults and people with chronic conditions and disabilities.

As these temporary flexibilities are currently set to expire in April 2022, the report provides insight and guidance for policymakers as they assess the impact these regulatory policy changes are having on advancing person- and community-centered care and consider possible permanence of these changes.

The framework is designed to help facilitate these conversations and decisions and assess the potential for continuation of the regulatory flexibilities to advance person- and community-centered care, facilitate access to care in the least intensive or least restrictive setting, and better align Medicare and Medicaid program rules.

HMA colleagues Jennifer Podulka, Yamini Narayan, and Keyan Javadi contributed to the framework and research.

Brief & Report

Issue brief examines greater flexibility for primary care models

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An issue brief released today outlines new Medicare payment models that offer greater flexibility and aim to shift more care to primary care models, moves that can improve quality and reduce costs. HMA authors, Jennifer Podulka, Yamini Narayan, and Lynea Holmes found the two newest primary care payment models, Global and Professional Direct Contracting (which will be re-branded as Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) beginning January 1, 2023) and Primary Care First offer more flexibility than previously released approaches and represent a promising step forward for primary care.

The report, Increasing Medicare’s Investment in Primary Care, also notes that to increase the likelihood that models achieve overall cost savings and/or quality improvement, one option for the Center for Medicare and Medicaid Innovation is to test approaches that place greater value on primary care and give primary care providers greater flexibility to tailor care for people outside of a fee-for-service system. These changes could improve people’s access to care, the quality of care received, and quality of life.

Brief & Report

HMA, Milbank brief examines nursing facility care

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Residents in nursing facilities faced higher infection rates and worse overall care experiences during the COVID-19 public health emergency highlighting long-standing concerns about the quality and cost-effectiveness of nursing facility care, especially for residents of color.

In a recent issue brief published by the Milbank Memorial Fund that HMA COO Chuck Milligan co-authored with Kate McEvoy, a program officer with Milbank, examined disparities in access, levels of care, and resident outcomes, and provided recommendations and guidance for the Centers for Medicare and Medicaid Services (CMS) on future approach to federal policy in nursing facilities.

The brief, A Call for Federal Action to Improve Nursing Facilities, suggests CMS take the following steps to improve nursing facility oversight and care:

  • Endorse linkage of any further public health emergency-related funding or other federal financial reimbursement to quality improvement.
  • Align Medicare and Medicaid efforts to promote payment policies that are based on risk adjustment for complex care and incorporate value-based payment principles, eliminate unintended consequences of federal policies such as routine approval of nursing home bed taxes, and adopt a common foundation of quality measures.
  • Expand existing guidance on rebalancing long-term services and supports.
  • Enhance conditions of participation for nursing homes and hospitals by including structural measures such as census and staff turnover.
  • Build out existing mechanisms like Care Compare to enhance public transparency, availability, and usability of cost report and ownership information and to provide timely and complete information on nursing facility citations.
Brief & Report

Issue brief proposes local option for uninsured

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Examining the more than 3 million non-elderly poor adults in states without Medicaid expansion, the HMA team of Matt Powers and former HMA colleagues Nora Leibowitz and Jack Meyer, have authored an issue brief proposing a local health insurance option to fill gaps for these individuals who frequently lack access to meaningful healthcare.

The brief, Considerations for a Local Health Insurance Option in Medicaid Non-expansion States, published by the Milbank Memorial Fund, recognizes the critical role local entities and providers play in providing care and proposes a Local Choice Option, could:

  • Provide a comprehensive insurance product that promotes appropriate access to healthcare and better health outcomes
  • Repurpose funding now used only for direct care to provide healthcare more efficiently
  • Support local customization and create an alternative to an open-ended entitlement program in states where that is not currently politically tenable

The brief concludes a Local Choice Option would be a sound investment with the potential for quick implementation and benefits of health insurance not currently available to people living in poverty in non-expansion states.

Brief & Report

Report examines the value of community behavioral health providers and their networks

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A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.

An HMA team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, The Value of Community Behavioral Health Providers & Their Networks with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).

Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.

New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:

  • Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
  • Warehouse and including data sharing requirements in future managed care contracts.
  • Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
  • Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.
Brief & Report

Second behavioral health issue brief focuses on workforce crisis and call for immediate action

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The National Council for Mental Wellbeing (National Council) and HMA have released the second in the series of three issue briefs examining the ongoing, and exacerbated, workforce and staffing crisis facing behavioral health services providers and facilities.

The brief, Immediate Policy Actions to Address the National Workforce Shortage and Improve Care, focuses on clinical transformation and provides short-term recommendations to support states in addressing the workforce shortages, provider burn-out, recruitment and retention.

Recommendations include:

  • Adopting transformative clinical approaches and team-based care
  • Identifying short-term actions and developing long-term strategies for improvement
  • Expanding the workforce to build a more robust provider pipeline
  • Increase adoption of in-person/telehealth hybrid models

HMA and the National Council colleagues contributed to the briefs and surrounding research.

Brief & Report

HMA experts evaluate differences between Medicare Advantage and Fee-For-Service Medicare responses to the challenges of the COVID-19 pandemic

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In a new report released by the Better Medicare Alliance (BMA), HMA colleagues Zach Gaumer and Elaine Henry concluded that the greater flexibility of the Medicare Advantage plan model enabled plans to offer providers additional support during 2020 that were not found within the Fee-For-Service (FFS) Medicare program. The report’s findings were previewed in a recent panel discussion during the BMA’s Medicare Advantage Summit. 

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Brief & Report

National Council for Mental Wellbeing and HMA have partnered to create a three-part series that examines behavioral health workforce crisis

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As demand for behavioral health services continues to grow, accelerated by the COVID-19 pandemic, staffing and workforce capacity to deliver services has not kept up with demand. In a three-part series of issue briefs, colleagues from Health Management Associates (HMA) and the National Council for Mental Wellbeing (the National Council) offer immediate steps states can take to increase capacity and build a more stable workforce.

The first brief in the series focuses on Policy, Financial Strategies and Regulatory Waivers, and outlines solutions that can be implemented quickly to reduce administrative burden and maximize existing provider resources.

Several HMA and the National Council colleagues, contributed to the briefs and surrounding research.

Brief & Report

Study examines Austin LGBTQIA+ community, quality of life

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A new report summarizing the ShoutOut Austin Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual (LGBTQIA+) Quality of Life Study, has been released. The report summarizes research conducted by HMA Community Strategies (HMACS) which included town hall meetings, surveys, stakeholder interviews, and focus group responses from a diverse group of community members.

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Brief & Report

HMA brief examines options for CMMI to refine approach for testing Medicare program improvements

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A recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous HMA report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.

The brief examines options for how CMMI could refine their approach to testing ideas for improving the Medicare program. HMA colleagues Jennifer Podulka, Yamini Narayan, and Lynea Holmes wrote the brief which was supported by Arnold Ventures.

HMA’s earlier brief examined the progress the Innovation Center has made in learning from Medicare-focused models during its first decade and raised questions to guide policymakers as they plan for the next phase of the Innovation Center’s work. In the new report, the team returns to those questions and offers potential answers.

The brief outlines seven pairs of competing goals and offers four recommendations that may, in part, help to balance these competing goals, as they are designed to increase the transparency of Innovation Center efforts and improve the likelihood that more models succeed in decreasing spending or improving quality. The recommendations include:

  • The Department of Health and Human Services (HHS) should establish a National Healthcare Transformation Strategy
  • CMMI should articulate a vision for how different models work together
  • CMMI should tailor models to test ideas that address the largest areas of spending growth and key areas of quality concerns, including
    • Include Part D in models
    • Include Part C in models
    • Promote primary care as a counterbalance to excessive low-value care
    • Address social determinants of health and other drivers of quality and access disparities
  • Congress and HHS should revisit the Physician-Focused Payment Model Technical Advisory Committee (PTAC)
Brief & Report

Strategic approaches to utilize ARPA funds to support older adults issue brief authored by HMA

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A new issue brief, authored by Madeline Shea and Aaron Tripp, provides an overview of key provisions of the American Rescue Plan Act (ARPA) of 2021 which offer the potential to make communities better places to grow older. ARPA provides an opportunity for states to build sustainable, person-centered systems and infrastructure for older Americans. These provisions aim to allow older Americans to age in their home and communities.

The provisions examined in the issue brief include addressing both long-standing and emerging needs of older adults for state government officials, including staff of Medicaid, aging, and housing and community development agencies; state legislators and their staff; and advisors to governors.

The ARPA funds are now available to states and local governments and will allow the development of better systems for older Americans. Key areas of opportunity outlined in the brief include

  • Building integrated data systems
  • Expanding affordable housing with services
  • Enhancing quality measurement and value-based purchasing models
  • Developing workforce recruitment and retention strategies
  • Ensuring access to internet services and assistive technology
  • Aligning Medicaid and Medicare services and payments
  • Creating ongoing structures to engage stakeholders in designing innovative and integrative approaches to meet community needs and monitoring their effectiveness over time