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25 Results found.

Case Study

Helping life science manufacturers navigate Medicare payment systems

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The HMA Medicare team was asked to apply our subject matter expertise—and access to Medicare
claims information—to provide a fully formed picture of the reimbursement process for this new
drug formulation. Our work involved researching other precedents and the implications of those
precedents for the reimbursement of this new formulation, as well as the existing product.

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Case Study

Patient journey analysis for a new oncology drug

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Bundled payment can serve as a disincentive to provide high-cost drugs, so the client was interested
in pursuing reimbursement policy options that would ensure appropriate reimbursement to these
facilities, thus ensuring patient access to the drug during the treatment regimen.

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Case Study

Ensuring appropriate payment for transformative therapies to secure patient access to CAR Ts

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CAR T therapies first entered the market in late 2018. These transformative treatments for certain
types of cancer involve modifying a patient’s own cells to fight the cancer—producing a long term,
potentially curative response. Initially, CAR T therapy was administered to patients in the inpatient
hospital, where Medicare payments are bundled so that the hospital gets a single payment for the
entire hospital stay. The cost of the CAR T therapy greatly exceeded the payment rate the hospital
would receive, leading to concerns that hospitals would be reluctant to provide CAR T.

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Case Study

New Mexico: Hospital Global Budgeting

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The Client

The New Mexico Office of the Superintendent of Insurance (OSI) was directed by its state legislature to explore hospital global revenue budgets and other innovative hospital payment models over several years, and to explore key elements of affordability and accessibility of coverage and care, including hospital global budgeting.

Background

OSI contracted with HMA to build on previous hospital global budgeting research and provide technical assistance in resolving the complex issues surrounding global budgeting, including development of a potential global budget payment model framework. The contract also called for HMA to prepare an implementation framework that involves stakeholder engagement, including a plan for engagement with the Centers for Medicare and Medicaid Services (CMS) Innovation Center and to identify key administrative and data challenges.

Approach

HMA divided the project’s scope into two phases:

Phase 1

Develop preliminary policy and model options, including submission of two deliverables:

  • Global Budgeting Principles and Experience in Other States Report
  • Hospital Global Budget Options Paper

Phase 2

Refine the hospital global budgeting model based on OSI’s input on the Hospital Global
Budget Options Paper and develop and submit three additional reports:

  • Recommendations for a Proposal to the CMS Innovation Center, which supports the development and testing of state-based innovative healthcare payment models
  • Implementation and Stakeholder Engagement Plan
  • Administrative and Data Challenges Report on implementing the payment model

Results

HMA developed an overview of principles and global budgeting models developed by other states, policy options, recommendations for how to work with CMS, a blueprint for stakeholder engagement, and an assessment of data needs and challenges. The proposed hospital global budget payment model was informed by the HMA team’s expertise and research on three states’ experience with CMS Innovation Center payment models (Maryland, Pennsylvania, and Vermont). The five public reports can be found at Healthcare Affordability and Accessibility Research Projects. These reports detail a plan for budgeting and governance that will enable the creation of a value-based payment system that supports a delivery system in which hospitals provide services that their communities need, rather than focus on the services most likely to merely enhance revenue. Through leadership and innovation, the state can help ensure a sustainable provider network is available to deliver high-quality and efficient care to all New Mexicans.

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Case Study

Learning collaborative for implementation of medications for addiction treatment (MAT) in county criminal justice systems

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HMA and the California (CA) Department of Health Care Services (CDHCS) are collaborating to expand access to at least two forms of MAT in CA county jails and drug courts in a statewide learning collaborative with technical assistance (TA) and provider coaching. Multidisciplinary teams from 34 counties are participating in the learning collaborative and demonstrating success in rapidly increasing access to MAT in jails and drug courts.

Intro and challenge

The California Jail MAT Expansion Project elevates jails as a key part of the safety net for addictions treatment by bringing together teams in each county that include stakeholders in county justice and substance use disorder system of care, centered on the jail and with each County sheriff as the lead sponsor. Teams have access to shared learning activities and ongoing individualized technical assistance and coaching from HMA subject matter experts (SMEs).

The project launched in May of 2018 when teams were invited and the first 22 teams were convened in August of 2018 in person in this large, statewide initiative designed to dramatically change the treatment landscape in jails and drug courts.

In undertaking this transformation HMA coaches and SMEs must understand and respond to the unique regulatory oversight, policies, and procedures in jail operations requiring customized approaches to introduce and expand MAT inside the jail. Both adaptive and technical change strategies are deployed to assist jails in changing their culture and operations to treat substance use disorder (SUD) like other chronic, treatable diseases. HMA coaches and SMEs stay deeply involved with county teams to initiate and support change over time.

There are now 34 participating teams and the data reported from 22 teams as of June 2021 confirms they had provided MAT to almost 15,000 individuals while in custody. When the project began in September 2018 less than 25 people were receiving MAT while incarcerated in the 22 initial participating counties.

Strategy/Approach/Interventions

Teams are required to submit an application to participate in the learning collaborative that includes information about the current state of MAT in their jail and drug court. This information is supplemented by calls with their assigned HMA coach to further understand their current operations, resource capacity, and goals. All county teams are convened for a collaborative learning session to “jump start” their implementation plan. This session includes fundamental information on MAT and related components of evidence-based substance use disorder treatment in jails and justice settings. On an ongoing basis each team is assisted by their coach to establish and execute goals and action steps

that align with the overarching goals of the learning collaborative. Coaches identify challenges and barriers at their sites and these themes inform ongoing webinar trainings and sessions at additional learning collaborative convenings. Bringing together a cohort of county teams provides an opportunity to understand at a broad scale the state of MAT in California jails and design targeted interventions to accelerate their implementation of MAT. Broad themes, such as biases against MAT among providers and custody staff; custody concerns about diversion of medications; and payment mechanisms for the medications and sufficient staff capacity to offer the treatment arise across the cohort and are subsequently targeted with training and hands-on coaching support. This ongoing collection of information from counties and close contact with teams and the HMA Team’s clinical expertise inform the unique approaches at each location.

Critical elements of the change effort include:

  • Improved SUD screening, assessment, treatment options and planning to include at least two forms of MAT are core themes and goals of the learning collaborative. This messaging and expectation accelerate implementation by “setting a bar” for teams’ efforts while providing them with individualized assistance to overcome challenges in meeting their goals.
  • Engagement across the treatment ecosystem in the county including advisors from state associations of counties, sheriff departments, treatment providers, and the state prison system connects the counties with emerging policy and best practice from their professional peers.
  • Multidisciplinary teams: MAT in jails and drug courts requires an integrated approach inclusive of medical and behavioral health care staff, custody/security and other justice professionals, and county providers and leadership

This implementation model drives rapid, systemic change that would likely not be possible with individual county efforts. Scaling is accelerated by the learning collaborative model in which barriers that are identified by multiple county teams, such as regulations for methadone in the jail, or practice of a healthcare vendor serving multiple sites, are addressed at the levels of state policy or corporate leadership and addressed in group learning opportunities.

Lessons Learned

  • The approach has to be tailored for each jail. Each jail and county have resources, concerns, and goals unique to them and the technical assistance must incorporate this understanding and meet them where they are to be effective.
  • The aim – improved SUD treatment systemwide – including transitions when individuals enter the corrections system and again at release – needs to be addressed as a countywide problem that needs a countywide solution.
  • Implementation of MAT in jails should be sponsored by the Sheriff and key partners from probation, jail custody, jail healthcare, drug courts, local county drug treatment programs, and the county administrator’s office must be included in planning and implementation.
  • Do not underestimate the prevalence and impact of stigma. There is an ongoing need for broader education about addictions treatment including Probation and parole, judges and district attorneys, the community, children’s and family services, and even community providers and the self-help support community need to understand MAT as treatment, and more specifically, not as ongoing substance use that is construed as problematic.
  • Do not go too fast: it is important to build supportable, sustainable implementation If teams are not given sufficient support and opportunity to evolve in their understanding and development of the implementation program they may fail. At the same time a sense of urgency is important because people are dying due to lack of access to needed treatment.

Key Successes/Outcomes

  • As of June 2021, almost 15,000 individuals in jail in California have received MAT during their period of incarceration. About one third of those were initiated on MAT while in jail and others that had been receiving MAT in the community were continued on their customary dose when incarcerated. At the inception of the learning collaborative initiative in September 2018 the initial 22 participating county jail teams reported a total of less than 25 people who were receiving MAT while incarcerated. After one year of participation in the learning collaborative counties reported that 1,646 detainees had received MAT in custody, and 678 were in-custody initiation of treatment with buprenorphine. This represents rapid implementation and scaling driven by the learning collaborative model.
  • All participating jails now provide naloxone to individuals with opioid use disorder (OUD) on release, a critical element to protect the safety of those individuals post release.
  • The program was so successful the state awarded additional funding to maintain the 1st cohort and fund additional teams in 2020 and 2021. There are currently 34 counties participating that collectively represent 86% of the population of The project model has been replicated in 16 counties in 15 states in a national initiative with Arnold Ventures and the Bureau of Justice Administration; and in the states of Pennsylvania and Illinois.

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Case Study

Pipeline research and policy recommendations to address new innovative therapies

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The client was looking for an experienced team who could assess the current pipeline of innovative therapies, examine current reimbursement policies to assess long-term compatibility with the adoption of innovative therapies and novel delivery mechanisms, and make policy recommendations to address any challenges identified through the process. HMA, The Moran Company, and Leavitt Partners, both HMA subsidiaries, were selected as the team with the needed expertise and capacity to create several deliverables. These deliverables were focused on the impact of the upcoming pipeline of certain innovative therapies on different payment systems, as well as working with the client’s team to develop and refine federal and state policy recommendations to address identified challenges. 

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Case Study

Laying the foundation for modernizing Indiana’s public health system

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Even before the COVID-19 pandemic, Indiana’s public health system, administered primarily at the local level, struggled to meet the state’s public health challenges. The pandemic further exposed the system’s deficiencies, as well as the geographic, racial, ethnic, and socio-economic disparities in health outcomes that exist across the state. Recognizing that the state can and must do better, Governor Eric Holcomb appointed a 15 member Governor’s Public Health Commission (“the Commission”) charged with examining the strengths and weaknesses of Indiana’s public health system and making recommendations for improvements.

The Commission held monthly meetings from September 2021 through July 2022. Its work was driven through the following six workstreams led by designated policy advisors who conducted research, engaged experts and stakeholders, and developed draft recommendations for the Commission’s consideration: 1) governance, infrastructure, and services, 2) public health funding, 3) workforce, 4) data and information integration, 5) emergency preparedness, and 6) child and adolescent health.

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Case Study

Reforming Colorado’s behavioral health system

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Like many states Colorado has historically struggled with a mixture of challenges relating to its public behavioral health system including funding issues, duplicate processes across multiple state systems, and the absence of a cohesive statewide strategy, which has proved increasingly problematic for Coloradans, especially those with complex needs. The state set out to create a system with a coherent vision and strategy that could provide high quality, equitable and accountable care to all Coloradans. 

In 2019, Colorado Governor Jared Polis created a Behavioral Health Taskforce (BHTF) charged with evaluating and setting a roadmap to improve the state’s behavioral health system. The BHTF created a set of more than 200 recommendations that were both structural and programmatic in nature. The most significant structural change was a recommendation to create the Behavioral Health Administration (BHA)—a single accountable entity that would reduce fragmentation across sectors and programs and build a more strategic approach to ultimately improve behavioral health outcomes. 

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Case Study

Multiple clients accepted into ACO REACH Model

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In early 2022 HMA and Wakely Consulting Group, an HMA Company, assisted multiple clients with their applications to participate in the new Centers for Medicare and Medicaid Services (CMS) Medicare Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model program. The purpose of this model is to improve quality of care for Medicare beneficiaries through better care coordination and increased engagement between providers and patients including those who are underserved. ACOs and participating providers are held responsible for patients’ total cost of care and must meet certain quality metrics. In return, they have more flexible payment arrangements, can achieve shared savings, and can provide additional services such as telehealth, home-based care, and more options for post-acute care.

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Case Study

Texas Action Plan: Strategic Plan Development

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Background:
Texas Health Action (THA) is a community informed, non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment. THA provides sexual health and behavioral health programs and services with an expertise in serving LGBTQIA+ people and those impacted by, or at risk of, HIV in Texas.

The Challenge:
In 2021, THA underwent a merger that created a need for the development of a unified vision, direction, and business model to align and expand sexual health and behavioral health services. When THA began the process of creating a new strategic direction and priorities, HMA was engaged to support the development of a three-year strategic plan reflecting changes present in a post-COVID-19 pandemic world. The objective of the strategic planning process was to create a dynamic and actionable plan, while refining and reestablishing the organization’s Mission, Vision, Values and Beliefs.

Case Study

Expanding access to CenteringPregnancy group care through telehealth

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Poor birth outcomes, especially for communities of color, are a persistent health issue for our country. While there is no “cure” for preterm birth, the leading contributor to poor birth outcomes, group prenatal care is an evidence-based practice to reduce pre-term birth, especially for urban African American communities.

Group prenatal care provides a host of other benefits including improved breastfeeding rates, enhanced parental knowledge, and better pregnancy spacing. In addition, decreasing preterm birth provides tremendous cost savings.

The Centering Health Institute (CHI) has developed a successful model of group prenatal care called CenteringPregnancy™. CenteringPregnancy empowers patients, strengthens patient-provider relationships, and builds communities through three main components of health assessment, community building, and interactive learning delivered as a series of group visits with pregnant individuals at similar gestational age.

While more prenatal providers are offering Centering as a model of care, not every pregnant individual has access to this model. Maternity care in rural America is facing a crisis in access, and the COVID-19 pandemic required organizations to shift to care delivered through telehealth.

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Case Study

Strengthening MAT processes and OUD care in emergency departments

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The prevalence of opioid use disorder (OUD) and the resultant harms from this disorder continue to escalate in the United States. The CDC’s National Center for Health Statistics released a report noting that in 2020, drug overdose deaths in the United States increased by nearly 30% over the previous year, reaching an all-time high of more than 100,000. The majority of these deaths are attributable to opioids.

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