Insights

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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23 Results found.

Solutions

HMA works with states to add Respite Care programs

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Expanding access to medical respite care for individuals who are unhoused or have no stable housing and are too ill to be discharged to the streets but not sick enough to stay in the hospital and require some supports to recover from their illness or injury.

Medical respite, or recuperative care, according to the National Institute of Medical Respite Care (NIMRC) is “an intervention that provides post-acute medical care for individuals experiencing homelessness who are not sick enough to warrant hospitalization, but who are too frail or ill to recover safely in a shelter or on the streets.”

Respite care benefits both providers and patients and saves money. According to a study by NIMRC, respite care results in a 24% reduction in Medicaid cost per enrollee, 30% decrease in hospital admissions, 38% reduction in emergency department visits, and a 92% attendance rate at follow up appointments within 30 days of hospital discharge.

Medical respite is not a housing service. Housing support services like housing stability, shelter, and supportive housing are critical components of the housing support system. Medical respite is the bridge and a safe transition from the medical care system back to the community and other needed services and supports. By providing a safe bed, clean restrooms, nursing assistance, and healthy meals, medical respite services can improve health outcomes and begin a process of addressing other critical health-related social needs, such as stable housing.

HMA offers a full suite of professional health and human services consulting services to organizations across the country. In Minnesota, HMA helped write the legislation that helped Minnesota Medicaid give coverage for respite care and has expertise in creating this model that can be used in other states. Many states lack this benefit and even in Minnesota, where it is now covered, there is a shortage of providers.

Project Spotlight: Minnesota Recuperative Care Benefit

THE TASK:

Legislation was passed requiring Minnesota’s Department of Human Services (DHS) to create a recuperative care benefit through Medicaid. Stakeholder engagement to discuss Medicaid options and to define the benefit. Recuperative Care was not well developed in MN and there were few beds operating in the state.

HOW WE HELPED:

HMA engaged interested individuals as guided by DHS. This included interviewing individuals with lived experience. Our Medicaid and recuperative care SMEs walked everyone through understanding the service and defining the service. In addition, we educated interested parties about the pathways in Medicaid including a state plan amendment and the various waiver options. The group came to consensus with DHS on a state plan amendment. HMA wrote the legislative language and report to support this direction.

THE OUTCOME:

The legislative language was approved. The state plan amendment was submitted and approved by CMS. Recuperative care is now a Medicaid benefit in Minnesota.

HMA can help states, providers, and communities create this benefit, implement effective respite services, and adapt the set of national standards for Medical Respite given your state and community needs including:

Safe and quality accommodations

Environmental services

Care transitions into medical respite from other settings

Access to high quality post-acute clinical care

Care coordination and wrap-around services

Safe care transitions out of medical respite to the community

Quality improvement

HMA can also provide technical assistance, help with alternate payment models, workforce and strategic planning to support respite care.

Contact our experts:

Headshot of Tia Cintron

Tia Cintron

Managing Director, Housing Services and Supports

Tia Cintron is an experienced and innovative professional with more than 20 years leading health and social service transformation initiatives … Read more
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Kenneth Cochran

Managing Director, Delivery Systems

Kenneth Cochran is a healthcare executive with more than 20 years leveraging his clinical, business and academic background to deliver … Read more
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Paul Fleissner

Managing 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 Margaret Kirkegaard

Margaret Kirkegaard

Principal

Dr. Margaret Kirkegaard has extensive front line experience and an impressive breadth of knowledge about healthcare and its delivery. A … Read more
Solutions

HMA helps expand and support FQHCs across the country

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Community Health Centers (CHCs), also known as Federally Qualified Health Centers (FQHCs), are community-based health care providers that are vital lifelines in medically underserved areas.

Funded by the Health Resources and Services Administration (HRSA), they provide comprehensive primary and preventative care, dental services, mental health and substance use services, and supportive services like transportation and translation, for patients to access health care. In addition, we have supported more than 20 states to write their CCBHC planning grant applications to initiate a state-run CCBHC model. Most recently, we had 100% success rate for our FY23 planning grant applications, resulting in four states receiving one year planning grants to build a state-run CCBHC model.

FQHCs partner with HMA for expert guidance in strategic planning, board development, finance and operations, clinical improvement, understanding federal and state policy, advancing health equity, grant writing, community health needs assessment, expanding practice scopes, and executive coaching. HMA’s consultants bring extensive real-world and leadership experience and expertise working with FQHCs prior to joining HMA, offering FQHCs a range of services and support with:

  • Health equity initiatives
  • Financial reimbursement and diversification
  • Solutions for complex patient populations such as individuals who are uninsured, low health literacy, non-citizens, justice-involved, homeless
  • Responding to rapidly evolving Medicaid/Medicare policy
  • Addressing difficult workforce recruitment and retention efforts

In addition to working with FQHCs, HMA works collaboratively with multiple Primary Care Associations (PCAs) to leverage our expertise benefiting multiple FQHCs.

How HMA can help

HMA’s FQHC value-based payment team has extensive experience working with PCAs, Health Center Controlled Networks, and FQHCs to form integrated delivery systems focused on the Medicaid and Medicare populations to help them progress along the CMS Framework for Value‐based Payments commensurate with their readiness. Current and recent projects have included PCAs and FQHCs in New York, Illinois, Rhode Island, Oklahoma, Wisconsin, Missouri, North Carolina, Montana, and Indiana.

HMA Principal Art Jones, MD, MPH, was the architect of the first FQHC APM in the country that transitioned payment from fee-for-service to capitation. It was adopted by the FQHC he led as CEO and four other Chicago-area FQHCs in 2001. In 2017, HMA helped the Washington Health Care Authority, the Washington Primacy Care Association, and its FQHC members develop a capitated FQHC APM. Since then, HMA has worked with PCAs and FQHCs in New York, Illinois, Rhode Island, Oklahoma, Wisconsin, Missouri, North Carolina, Montana, and Indiana to develop their own capitated FQHC APMs.

HMA Principal Art Jones, MD, MPH, partnered with five Chicago area FQHCs and five hospitals to establish Medical Home Network in 2011, the prototype clinically integrated network focused on underserved communities. Driven to solve social drivers of health and seeking to demonstrate that in the safety net, technology can be deployed to deliver superior outcomes, the network has grown to include 14 FQHCs and three health systems with more than 180,000 Medicaid beneficiaries with delegated responsibility for care management and global risk. It supports 80 FQHCs in eight states in Medicare ACOs. Another HMA principal was CEO of one of the founding FQHCs at the network’s inception. This model has been replicated in other states to benefit communities of need.

FQHCs in some states receive general revenue funding to support operations. HMA has extensive experience with federal-directed payment program rules that can secure matching federal funds that at least double and sometimes as much triple total funding depending on the state’s federal match rate for Medicaid. Directed payment programs require a value-based payment component. HMA has worked with three state PCAs to develop their programs.

HMA consultants assist FQHCs and their clinically integrated networks in assessing the value-based payment arrangements being offered by managed care plans and proactively designing proposals to take to payers. In many cases, HMA joins in active negotiations with the payer.

HMA has several clinically licensed consultants with experience working at and with FQHCs in their pursuit of value-based care. This includes assisting in NCQA Patient-Centered Medical Home certification, implementing care management programs, and designing and implementing new clinical models of care made uniquely financially feasible under APMs.

HMA has several experienced consultants helping individual FQHCs, State PCAs, and FQHC-led clinically integrated networks with their strategic planning process.

HMA has consultants focused on helping providers, including FQHCs, improve their billing and collections systems to improve cash flow and revenue.

HMA experts are uniquely positioned to help FQHCs and other organizations develop strategies and write for New Access Point and Service Area Competitions.

We believe in a data-driven approach to drive actionable insights. We start with an efficient assessment of your current state and prepare a roadmap for success. After our thorough and rapid assessment, our consultants work with your organization on any aspect of implementation to ensure a sustainable, high-performing empanelment environment that drives operational quality and optimizes
current and future revenue streams. A high-performing empanelment environment leads to optimized PCP continuity of care, accountable PCP and care teams driving clinical quality improvement, readily available appointment slots, and patient retention and productivity goals.

No matter the size, HMA empowers FQHCs to thrive in an ever-changing healthcare landscape. With deep expertise at every level, HMA teams partner with FQHCs nationally to address a wide range of operational challenges, including designing innovative school-based care, and expanding community health centers, optimizing scheduling and empanelment, integrating behavioral health care and strategically adopting telehealth solutions, we help FQHCs seize opportunities. Our experience extends to selecting and implementing cutting-edge IT systems for population health management, optimizing participation in the 340B program, and maximizing workforce capacity. HMA is dedicated to ensuring that FQHCs deliver exceptional care to those who need it most.

State PCAs frequently ask HMA to speak on various value-based payment-related topics at annual conferences.

Project Spotlight

Community Health Center, New York

HMA assisted the community health center in creating its strategic approach to value-based care. The project included analysis of current clinical and financial performance under managed care arrangements, workforce optimization, and opportunities to identify shared savings on total cost of care.

Health Center Strategic Planning, California

HMA worked with the board of directors, community stakeholders, clinicians, and staff to create a theory of change and then identify internal and external opportunities for expansion, quality improvement, and financial growth.

Community Health Center Service Area Competition (SAC) Grant, Ohio

HMA supported a CHC in completing its needs assessment and writing its SAC grant.

PACE readiness, Illinois

HMA consulted with an FQHC in Illinois to analyze, plan for, and apply to open a Program for All-Inclusive Care for the Elderly (PACE) focused on the Latinx population.

Learn more about our work

WITH PROVIDER ORGANIZATIONS
with GRANT WRITING

Contact our experts:

Headshot of Warren J. Brodine

Warren J. Brodine

Principal

Warren Brodine partners with communities, federally qualified health centers (FQHCs), and payors to deliver optimal patient and community outcomes, supporting … Read more
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Melissa Corrado

Principal

Melissa Corrado offers a powerful blend of program development, training and implementation expertise to HMA clients. Prior to joining HMA, … Read more
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Iliana Gilman

Principal

Committed to health equity, Iliana Gilman has a proven track record of increasing patient access, fortifying cross-sector partnerships and coalition … Read more
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Art Jones

Principal

Art Jones, MD, has 27 years of experience as a primary care physician and chief executive officer (CEO) at a … Read more
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Jill Kemper

Associate Principal

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

Margaret Kirkegaard

Principal

Dr. Margaret Kirkegaard has extensive front line experience and an impressive breadth of knowledge about healthcare and its delivery. A … Read more
Headshot of Greg Vachon

Greg Vachon

Principal

Dr. Greg Vachon brings a wide range of experiences to consulting engagements providing expertise, insightful analysis, innovative solutions and effective … Read more
Solutions

Housing services and supports are critical to the mission of improving health for all Americans

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Homelessness in America has hit a record high and housing instability is widespread. Millions of Americans are vulnerable to inadequate housing and half of all U.S. renters are spending far more than the recommended 33% of their income on rent.

For many Americans, housing costs are out of reach, as 13 of the 20 largest occupations in the U.S. pay less than the housing wage. This housing crisis is impacting overall health and well-being and utilization of healthcare. Individuals and families struggling with homelessness often experience lower infant birthweights, mental health challenges, chronic disease, and higher mortality.

HMA works at the intersection of housing and healthcare in a variety of ways, including policy, programs, financing, and evaluation. A safe and secure place to live is fundamental to all of the healthcare and human services work we do at HMA. Our experts have developed and worked within programs in public housing authorities, hospital housing partnerships, shelters and transitional housing, post-incarceration transition and 1115 waiver supports, rural housing, and other housing supports.

HMA experts are former state and local public health leaders, directors of community-based organizations, and former senior officers from key federal agencies, setting us apart from other consulting companies.

We understand the complexity of designing and implementing change beyond the theoretical level – we have walked in the shoes of our clients and understand how to provide insight that is meaningful, actionable, and realistic.

Organizations we support

Federal, state and local government agencies

Managed Care Organizations

Public Housing Authorities

Community-based health/behavioral health and human service organizations

Provider organizations (FQHCs, CCBHCs)

Schools and universities

Departments of behavioral and public health

Healthcare systems and providers

Philanthropic organizations

Jails and correctional facilities

We Help Our Clients

Transform their community’s response to homelessness

Improve local housing delivery systems

Facilitate new or expanded community partnerships 

Address systemic barriers

Build capacity of local partners and resources

Help with targeted impact improvements

Scale interventions to match resources and need 

Increasing system capacity  

Provide management tools for improved decision making

Planning and implementation support for continuum of homeless services

Affordable housing needs assessment

Consultation on shelter and outreach team best practices

Project Spotlight

The problem:
With new funding available and a homelessness crisis growing more acute, the JOHS requested an evaluation of the department’s effectiveness and barriers, as well as the governance model over all homelessness response functions.

How we helped:
HMA conducted a discovery process consisting of 40 stakeholder interviews with local elected officials, County and department staff, and contracted service providers. We also reviewed key contracts, policies and procedures, and other foundational documents; and completed a summary of national best practices to inform future program development. This resulted in a summary of gaps, opportunities and recommendations that HMA presented to a joint meeting of County and City Commissioners, and HMA continues to assist in implementation

The outcome:
HMA presented leaders with findings and recommendations, including reforms to provider payment, system governance, inter-agency partnerships and more). Subsequent contracted initiatives to support implementation include the renegotiation of an Inter-Governmental Agreement and action plans to improve to the shelter system and street outreach systems.

The problem:
Tens of thousands of residents of HUD assisted senior housing in California are dually eligible for Medicaid and Medicare and have complex medical, behavioral health, and health-related social needs.  Affordable housing developers, owners and operators do not have financing to enhance resident supports to prevent homelessness, avoidable hospitalizations, or institutional care transitions. While evidence shows that Medicaid, Medicare and D-SNP plans and healthcare providers would reduce avoidable inpatient and urgent care costs from enhanced resident services, mechanisms to partner with housing organizations have been elusive due to different incentive structures, infrastructure, and cultures in each sector.

How we helped:
Through contracts with LeadingAge California, HMA supported California housing organizations to develop a compelling value proposition for strategic discussions with payers, providers, and foundations. HMA is developing a financing plan and gap analysis to braid and blend Medicaid, Medicare, D-SNP, workforce, behavioral health, and other funding streams to sustainably support enhanced services provided by trusted, culturally and linguistically responsive on-site service coordinators. 

The outcome:
California DHHS and Department of Aging leadership endorsed the goals of the CICH model and are guiding next steps to develop the infrastructure and braided/blended financing plans.  Two health plans in southern California are interested to partner in piloting the model.

The problem:
Housing and community development organizations are trusted resources in low-income rural and urban communities across the US; and they were instrumental during COVID in engaging high-risk communities in prevention activities.  While housing and community development organizations are a natural place for successful CHW programs, most CHW models and training programs have been developed for healthcare organization environments.

How we helped:
HMA co-led a cohort of NeighborWorks network organizations to co-design three housing and community-development organization-centered CHW program models and a toolkit covering every element of standing up and sustaining a CHW program within housing and community development structures, values, and resources.  We provided coaching and technical assistance to learning cohort participants to test toolkit components.

The outcome:
Web-based toolkit Community Health Workers: A Promising Program Model to Advance Health & Well-Being in Affordable Housing and Community Development – NeighborWorks America

The problem:
The organization has requested assistance with establishing healthcare partnerships, designing health care services to meet resident health needs in each affordable housing development, and identifying opportunities to expand health and wellness services.

How we are helping:
HMA is providing guidance in service planning, partnerships, resources, budgeting, and strategies. This may include identification of potential health care partners, design of the health care model, assistance with budgeting for health care service costs, and other consultation as requested.

The outcome:
HMA presented leadership with insight on how to expand embedded health services to optimize resident health across their housing portfolio, assisted with the design of health care services, and helped to build healthcare partnerships.

Our HMA experts are ready to help your organization support your communities.

Contact our experts:

Headshot of Boyd Brown

Boyd Brown

Associate Principal

Boyd Brown is a seasoned policy and operational leader in behavioral health and human service operations including budget development and … Read more
Headshot of Kirsten Bryan

Kirsten Bryan

Senior Consultant

Kirsten Bryan is a certified project manager, urban planner, and consultant experienced in supporting diverse and complex projects spanning healthcare, … Read more
Headshot of Michael Butler

Michael Butler

Associate Principal

During his career, Michael Butler has directed hundreds of program evaluation, organizational development, and technical assistance projects in a wide … Read more
Headshot of Tia Cintron

Tia Cintron

Managing Director, Housing Services and Supports

Tia Cintron is an experienced and innovative professional with more than 20 years leading health and social service transformation initiatives … Read more
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Anthony Federico

Senior Consultant

Anthony Federico is a seasoned government and non-profit leader with 12 years of expertise in housing, homelessness, and healthcare. He … Read more
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Paul Fleissner

Managing Principal

Working to integrate services across systems and communities, Paul Fleissner is a seasoned executive who has developed programs and policies … Read more
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Dena Hasan

Associate Principal

Dena Hasan is a forward-thinking executive with over 20 years of experience in public and private sector healthcare and social … Read more
Headshot of Trish Marsik

Trish Marsik

Principal

Trish Marsik has extensive experience supporting providers, healthcare organizations, and state and federal governments to provide quality behavioral healthcare.  Prior … Read more
Headshot of Charles Robbins

Charles Robbins

Principal

Charles Robbins has been transforming communities for the past three decades. His extensive community-based organization career spans healthcare, child welfare, … Read more
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Madeleine (Maddy) Shea

Principal

Maddy Shea has a passion for health equity and the federal, state and local cross-sectoral expertise to guide community health … Read more
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Nicholas Williams

Associate Principal

Nicholas Williams is a social sector leader, analyst, writer, and consultant with extensive experience and proven results in academic, business, … Read more
Solutions

HMA fosters harm reduction from street to suite

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HMA’s trusted experts have a wealth of harm reduction experience, from training volunteers for community outreach to managing state procurement processes for harm reduction tools, to policy analyses at all levels of government.

Our consultants have worked with stakeholders of all walks of life including people with lived and living experience of drug use, sex work, and homelessness. In fact, we believe in talking to them first to understand local needs and feasible solutions.

What is harm reduction?

The term “harm reduction” is often used to describe:

provision of risk reduction tools, like condoms, naloxone, and sterile syringes;

approach of meeting people where they are and supporting them at their own pace, without judgement, to pursue self-determined goals; and,

philosophy that promotes equitable access to resources for people who use drugs and struggle to meet basic needs due to the impact of social structures.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as a practical and transformative approach that incorporates community-driven public health strategies — including prevention, risk reduction, and health promotion — to empower people who use drugs and their families with the choice to live healthier, self-directed, and purpose-filled lives. 

The President’s National Drug Control Strategy is the first-ever to champion harm reduction to meet people where they are and engage them in care and services.

People are dying from drug overdose at an alarming rate in the U.S. For the fourth year in a row, we have lost over 100,000 people (enough to fill the University of Michigan stadium). Many of these deaths are preventable. Harm reduction interventions proven to stop overdose deaths include making the overdose reversal drug naloxone available to all at risk of overdose, reducing barriers to medications that treat opioid use disorder, and providing supervised drug consumption services for rapid overdose response. Moreover, successful harm reduction programs rely on reducing the stigma of drug use and people who have an addiction.

How HMA can help

Harm reduction is more than handing out naloxone or syringes; it’s a nonjudgemental approach that affirms participant autonomy and engages people in care over the long term.

Here are just a few services HMA can offer to help clients establish, expand, or improve services for people who use drugs, respond to overdose and infectious disease syndemics (combinations of two or more diseases or health conditions that interact within a population, often due to social and structural factors and inequities), and prevent the next drug crisis.

HMA provides training and technical assistance to a range of clients – from community-based organizations conducting outreach, to medical providers wishing to better serve their patients, to large hospital systems wishing to incorporate drug user health into their systems. HMA can:

  • Plan, coordinate and evaluate learning collaboratives.
  • Provide 1-1 coaching to staff and teams.
  • Produce and implement industry-specific toolkits aimed at reducing overdose, like for construction businesses, restaurants or harm reduction vending machines.
  • Train different audiences and teams, including youth treatment providers, primary care settings, and carceral settings, on harm reduction.
  • Support startup of new naloxone distribution and/or syringe services programs and develop capacity building plans for program growth.
  • Improve access to medications for opioid use disorder.

A quality improvement (QI) strategy is vital for healthcare organizations to maximize patient outcomes and satisfaction, achieve efficiency, and ensure compliance with regulations. HMA can:

  • Apply established QI models to increase reach of harm reduction and drug user health services within community-based programs, government agencies, and provider programs and systems.
  • Plan, assess, and evaluate QI efforts.
  • Increase team buy-in for harm reduction as a QI initiative.
  • Provide QI tools such as rapid assessment participant surveys, risk screeners, provider checklists, and guides.

Many funding opportunities require (or can benefit from) a detailed assessment of the community’s need for the services being funded. Our experts can help gather both quantitative data and qualitative stakeholder input to ensure that the client’s proposed plan targets the populations, communities, and gaps in service for which resources will be most impactful. HMA can:

  • Conduct interviews and focus groups with people who use drugs and the service providers they interact with to identify local needs and solutions.
  • Assess and predict drug user health syndemics using infectious disease and overdose metrics.
  • Demonstrate trends among diverse populations, including youth and racial, ethnic, sexual, and gender minorities .
  • Guide efforts to integrate harm reduction into a broader continuum of care, including prevention and treatment interventions.

The legal landscape related to drug use varies across communities and does not always facilitate a public health approach. HMA can:

  • Identify policy options and facilitate choice of the most effective and feasible one for the client’s local context.
  • Evaluate new or existing policies that impact people who use drugs such as Good Samaritan laws, opioid treatment program regulations, and criminal charges.
  • Apply statistical methods to policy evaluation such as time-interrupted analysis.

Multi-sector collaboration is essential to develop sustainable, impactful solutions to reduce physical and structural harms related to drug use. HMA can:

  • Facilitate workgroup-driven policy recommendations for expansion of behavioral health treatment and overdose prevention approaches such as safer supply.
  • Design social media campaigns that center the voices of people most impacted by overdose.
  • Strategize, create, and plan marketing and communications campaigns for harm reduction, stigma reduction, or program promotion.
  • Facilitate community mobilization efforts and multi-sector alliances to generate and implement strategies for policy change.
  • Build harm reduction resource libraries for stakeholder use.

HMA consultants work with clients to review program efficacy and cost efficiency based on process, outcomes, costs and more, considering quantitative and qualitative data sources and using data-driven tools to assess and measure impact. HMA can:

  • Conduct environmental scans of jurisdictional resources to highlight opportunities for and threats to harm reduction programs .
  • Build maps that overlay various metrics of drug user health, including infectious disease burden, overdose, and socio-economic indicators.
  • Map overdose fatality and naloxone saturation to prioritize distribution efforts in areas of high-need.
  • Conduct regression analysis to identify risk profiles and predictive values to evaluate impact.

Project Spotlight

WASHINGTON STATE SAFER SUPPLY WORKGROUP

Contact our experts:

Headshot of Anika Alvanzo

Anika Alvanzo

Principal

Dr. Anika Alvanzo is a distinguished healthcare executive with over 20 years of experience in specialty addiction treatment, behavioral health … Read more
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Jennifer Bridgeforth

Associate Principal

Jennifer Bridgeforth is a dedicated executive with more than 17 years of experience in the healthcare industry. She is a … Read more
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Ana Bueno

Senior Consultant

Ana Paola Bueno is an accomplished nonprofit professional with more than 16 years of senior level experience in the state … Read more
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Mayur Chandriani

Senior Consultant

An experienced non-profit manager, Mayur Chandriani is committed to programs focused on immigrant healthcare, maternal and child health and community … Read more
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Tricia Christensen

Senior Consultant

Tricia Christensen is a harm reduction and drug policy expert focused on high impact relationship building and policy change to … Read more
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Liddy Garcia-Bunuel

Principal

Liddy Garcia-Buñuel has the vision, passion and expertise to effect organizational and systematic change. She takes a collaborative approach. She … Read more
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Rachel LaFlame

Research Associate

Rachel LaFlame, MPH, is a driven, early career professional interested in the intersection of public health and policy. She is … Read more
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Nicole Lovitch

Research Associate

Nicole Lovitch is a skilled generalist researcher with extensive public health and healthcare experience. She has worked with clinicians, providers, … Read more
Headshot of Trish Marsik

Trish Marsik

Principal

Trish Marsik has extensive experience supporting providers, healthcare organizations, and state and federal governments to provide quality behavioral healthcare.  Prior … Read more
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John O’Connor

Managing Director

John O’Connor is a seasoned executive with extensive management, program, strategy, media, fundraising and advocacy experience in dynamic foundation, corporate … Read more
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Charles Robbins

Principal

Charles Robbins has been transforming communities for the past three decades. His extensive community-based organization career spans healthcare, child welfare, … Read more
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Deborah Rose

Associate Principal

Deborah Rose is an experienced executive with a demonstrated history of designing and scaling new initiatives in the healthcare industry. … Read more
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Erin Russell

Principal

Erin Russell is a dedicated harm reduction expert with an unwavering commitment to public health and equity.   Prior to joining … Read more
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Kate Washburn

Associate Principal

Kate Washburn is a public health and program leader with over 20 years of experience in both public health departments … Read more
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Chris Wilks

Senior Consultant

Chris Wilks is a senior consultant for HMA. She manages long-term research projects and works closely with clients and project … Read more
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Emily Wilson

Associate Principal

A multi-disciplinary public health leader, Emily Wilson is passionate about bringing people together to solve the most pressing problems in … Read more
Solutions

HMA helps Justice Involved/Behavioral Health services implement the Sequential Intercept Model (SIM)

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The Sequential Intercept Model (SIM) provides a framework to help local governments divert individuals with behavioral health issues from the criminal justice system into community resources.

The model serves communities by helping them identify opportunities for diversion programs, known as “intercepts”, with the highest potential for success based on community strengths and needs. Created by Policy Research Associates in 2004 and promoted by SAMHSA’s GAINS Center, SIM identifies critical diversion points tailored to each community’s strengths and needs.

Key Benefits of Implementing SIM

Guides ongoing stakeholder meetings and county programming by establishing a common language for justice and diversion programs to support sustainability and adaptability over time.

Supports community analysis and integration of new policies by providing a clear visualization of system resources and gaps.

Facilitates collaboration and ensure efficient use of resources by enhancing communication and relationships across systems.

Collects local data for system analysis to identify grant opportunities and funding for critical intercept program development.

Development of a SIM report that highlights current state, gap, and opportunities for improvement.

Educates county leaders on best practices to help assess new programs and identify areas for improvement.

Addressing Community Challenges

SIM supports development of community prevention programs that lower the chance of initial involvement into criminal justice for many, helping provide the needed level of treatment support. The framework further allows jurisdictions to develop meaningful and effective programs to address issues faced by justice-involved individuals, such as unstable housing and income, high overdose risks, and the impact of evolving policies. Many existing programs lack sustainability due to reliance on temporary funding, and traditional planning has been reactive rather than proactive. SIM offers a comprehensive framework for communities to support individuals with behavioral health issues, improving safety and resource efficiency.

HMA’s services include:

  • Facilitating stakeholder meetings and data collection.
  • Mapping current systems and identifying key intercepts.
  • Developing SIM reports to highlight gaps and opportunities.
  • Leading strategic planning for program development.
  • Setting measurable goals and evaluation plans.
PRAinc.com – THE SIM MODEL SAMHSA.GOV – the sim model

If you are ready to talk about implementing a SIM and the next steps for your organization, reach out to our experts today.

Contact our experts:

Headshot of Jessica Perillo

Jessica Perillo

Senior Consultant

Jessica Perillo is a driven healthcare professional with extensive experience in the behavioral health, public health and public safety fields. … Read more
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Jon Rubin

Principal

Jon Rubin is a human services leader with over 20 years of experience in strategic planning, identifying and analyzing problems, … Read more
Solutions

HMA helps organizations prioritize, identify, win, and implement grant funding

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Grants from both government and foundations can be an essential component of a provider’s growth strategy. Every year billions of dollars are distributed to support program growth, quality improvement, training, and other essential needs. HMA works with a wide variety of healthcare clients, including Federally Qualified Health Centers (FQHCs), community-based organizations, hospitals, provider practices, behavioral health, and managed care organizations.

How HMA can help

HMA’s Grant Prospector is a subscription service that provides clients with a customized and curated list of grant opportunities. Finding the right opportunities and applying for grants that are aligned with your organization’s strategic growth interests can be an essential catalyst for organizational development, service continuum growth, and quality improvements. HMA’s Grant Prospector monitors over 200 government agencies and nearly 100 foundations and sends appropriate opportunities to subscribers weekly.

HMA’s experience has taught us that grants can be a wonderful way to grow an organization if (and only if) the organization is strategic about what grants it pursues and what services it uses grant funding to build. Your strategy should guide your grant pursuits, not the other way around. HMA can help your organization devise a strategy for organizational growth using grants as a catalyst for long-term sustainability.

HMA’s deep pool of grant writers enables us to assign teams with precision, ensuring our clients have access to specific relevant expertise. HMA’s grant writing services are most valuable when a provider needs help designing a program model, complying with complex grant requirements, and navigating strategic challenges in grant writing.

During the 2023 round of CCBHC expansion grants, HMA clients invested $956,000 in HMA grant-writing support. Those clients won 20 awards totaling $80,000,000, for a return on investment of 8,272%.

For clients who prefer to write their own grants, HMA can provide subject matter expertise to enable strategic decision-making and program design. HMA consultants can join early calls to help the client design a program model that complies with the grant requirements, ensures operational sustainability, and addresses the complexities of the procurement.

For clients who prefer to write their own grant applications, HMA can provide a mock scoring service. HMA’s reviewers provide a detailed review and score for the submission, enabling the client to identify any place where points are likely to be deducted. We advise sending a draft to HMA at least a week or two before the application is due so that HMA’s feedback can be integrated before submission.

Many grant applications require a detailed assessment of the community’s need for the services being funded. Our experts can help gather both quantitative data and qualitative stakeholder input to ensure that the client’s grant application targets the populations, communities, and gaps in service for which grant funds will be most impactful.

HMA’s accounting and actuarial colleagues can provide budget and cost report development support when the demands of a grant application outstrip the capabilities and/or bandwidth of the client’s finance team.

Many grants come with complex implementation and reporting challenges. HMA’s experts have the benefit of the experience of hundreds of grant implementations, which enables us to help our clients comply with myriad implementation and reporting requirements. HMA’s project managers help our clients ensure that grants get implemented on time, on budget, and in compliance with funders’ requirements.

HMA has a team of experienced program evaluators who help our clients implement with fidelity, assess impact and outcomes, and comply with grant evaluation requirements. Our evaluators are facile with program outcome data as well as the demands of rigorous stakeholder input.

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Reach out to our experts for more information on how HMA can help your organization’s grant and funding strategies.

Contact our experts:

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Heidi Arthur

Principal

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Kathleen Cahill

Associate Principal

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Josh Rubin

Vice President, Client Solutions

Solutions

HMA knows rural.

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Some 47 to 60 million people live in rural areas in the U.S. Many rural residents must navigate healthcare system challenges people living in urban and suburban areas generally do not face. Developing and supporting rural health programs requires understanding the unique characteristics of rural settings and how these dynamics influence healthcare policy, providers, payers, consumers, and health equity.

HMA understands the multilevel challenges for delivery of quality healthcare and social services to rural populations. From workforce concerns to access issues such as lack of services, transportation difficulties, and socio-economic barriers, we know the difficulties that often keep rural providers and organizations from achieving their full potential to serve and support their communities’ needs.

Changing dynamics in many rural areas also create the need for building awareness and understanding of issues of equity and reducing disparities and how to effectively address them in rural communities. HMA has the hands-on knowledge for practical solutions.

HMA brings together industry-leading policy, program, financial, community, and clinical experts to provide comprehensive solutions that make healthcare and human services work better for people living in rural and frontier areas across the country. With deep experience and through skilled analysis, guidance and technical know-how, our consultants help a wide range of clients successfully navigate the healthcare space. Our team is more than 900 members strong and growing, with expertise that spans the healthcare industry and stretches across the nation.

We offer a full suite of professional health and human services consulting services to clients serving rural and frontier communities, such as:

Critical Access and PPS Hospitals

Federally Qualified Health Centers, Rural Health Clinics, & Provider Practice Groups

Health Plans

National, Regional and Statewide Associations

Federal, State, & Local Governments

Tribal nations & Tribal Health Organizations

Community Based Organizations

Foundations

Our national, multisector, multisystem experience in healthcare and human services enhances our ability to support rural clients in making sustainable, positive impacts in their local communities. Whether your project has run into a snag in the final stages or hasn’t even gotten off the ground, we can provide the expertise and guidance to help you make it a success.

Our areas of expertise include:

Analytics

Behavioral Health

Care Integration

Clinical Services

Community Strategies

Crisis Systems & 988

Government Programs & the Uninsured

Healthcare Actuarial Services

Healthcare Delivery Development & Redesign

Healthcare IT Advisory Services

Investment Services

Justice-Involved Healthcare

Long-Term Services & Supports

Managed Care

Opioid Crisis Response

Public Health

Quality and Accreditation Services

Value-Based Care

Workforce development

PROJECT SPOTLIGHT

Health Equity & Access for Rural Dually Eligible Individuals (HEARD) Toolkit

With funding from Arnold Ventures, HMA created the HEARD Toolkit, a robust discussion of the access challenges facing dually eligible individuals in rural areas and a portfolio of actionable solutions to address these challenges. Dually eligible individuals in rural areas reside at the intersection of a major public health crisis and a fragmented Medicaid and Medicare delivery system. They experience poor access to services and to integrated care programs (ICPs) to address their whole person needs.

HMA designed this Toolkit to help policymakers address access issue dually eligible individuals in rural areas have to navigate every day. For example, addressing access must encompass getting to a comprehensive Medicaid and Medicare services continuum that includes home- and community-based services (HBCS), as well as ICPs. A primary focus on equity can help states, local communities, payers, and providers begin to address issues of access for these very vulnerable individuals in rural communities. The Toolkit provides examples and ideas for rural providers and communities to address equity and improve services and supports for dually eligible individuals.

Learn more about the Toolkit

For example, HMA can assist rural communities and the organizations that support their needs with:

Rural-specific workforce solutions

Programs addressing Social Determinants of Health/Health-related Social Needs

Payment system reforms

Development of integrated care programs for Dual Eligibles

Substance Use Disorder/Opioid Use Disorder prevention, treatment, and recovery services

Behavioral health services and supports

Justice-involved carceral healthcare and transitions

Long-term services and supports and home and community-based services

HMA understands the multilevel challenges for delivery of quality health care and social services to rural populations. From workforce and care access issues to transportation difficulties and technology barriers, to socio-economic differences, we can help rural providers and organizations overcome challenges and achieve their goals to serve and support their communities’ needs.

Other Rural Health Project Examples:

HMA is supporting review and reform of the primary care payment environment in New Mexico working under a contract with Mercer. New Mexico’s Medicaid program had identified multiple challenges the primary care providers faced across the state, including rural sustainability and fiscal soundness. HMA’s approach includes coupling data analysis with stakeholder engagement. Our work to date includes designing, testing, and evaluating new primary care alternative payment models (APMs); fiscal, policy, and/or programmatic implementation recommendations related to the multi-payor roll-out of a primary care APM; and supporting primary care practitioners related to NM Medicaid APM implementation. Additional project work will include more provider specific analysis, recruitment for pilot testing and provide education, analysis and training for providers, health plans and state regulators.

HMA is working with the Colorado Department of Health Care Policy and Financing (HCPF) to perform a dynamic heat mapping as the first phase of a three-phase project that includes an environmental scan of home and community-based services (HCBS)/Medicaid. HMA is creating a tool that HCPF can leverage to update and track progress to close provider gaps. In subsequent work HMA will identify potential geographic regions which would benefit from reimbursement structure changes, including geographic adjustment factors to apply to preexisting fee-for-service rates or other mechanisms to effectively address identified care gaps. Based on these results, HMA will recommend strategies and best practices to expand the provider network in rural areas to avoid care deserts and assure access to services for all Medicaid members.

Over the past six years, HMA has supported tribal communities in Montana with an array of data and evaluation expertise specific to behavioral health system assessments and evaluation activities. To date, we have conducted feasibility assessments for tribes considering options to 638 their behavioral health services, evaluated high-fidelity wraparound services in tribal communities through the Montana Systems of Care program, supported efforts to discern a concept design for a joint tribally operated Substance Use Disorder (SUD) Continuum of Care, and assisted tribally operated clinics in best practices in opioid prescribing and addiction treatment.

The Georgia Health Policy Center provides technical assistance for grantees of HRSA’s Rural Health Programs. HMA created a primer and additional tools, including a webinar, designed to inform and support rural provider leadership on Value-Based Care. The primer serves as a self-paced guide helping organizations consider national trends and experiences, assess their current state and readiness, understand benefits and barriers of Value-Based Care. The primer and tools are used by the technical assistance team and rural health grantees.

HMA has worked with HSHS for over 10 years, providing a wide range of services including:

Grant surveillance related to strategic plans, project management, grant program development, and narrative writing for multiple state and federal grants including USDA, HRSA, and SAMHSA. 

Expanding access to medication assisted treatment (MAT) in emergency departments by activating a team of HMA experts to implement a global assessment of readiness to adopt MAT, create a comprehensive training curriculum, assist with development of policies, workflows and standardized orders; and provide technical assistance required to address stigma and implement change. HMA also aided in writing the successful proposal for state funding for this project.

Stakeholder engagement for a hub-and-spoke model of telehealth network, assessed strategic priorities across multiple diverse stakeholders, and developed a strategic plan for HSHS’ Wisconsin rural healthcare provider telehealth network.

Development of the Illinois Telehealth network composed of 21 rural healthcare providers across Illinois. HMA provided technical expertise on the adoption of telehealth services and the development of clinical protocols and led strategic planning efforts. The network now functions to support the members in disseminating best practices, implementing telehealth service lines, sharing clinical protocols, removing barriers, and promoting evaluation.

HMA is currently assisting HSHS’ rural behavioral health team in devising new models of community-based withdrawal management processes consistent with recent changes in Wisconsin’s regulations. HMA experts on residential substance use disorder and integrated care provide technical assistance, training, and evidence-based policy development.

HMA supported the Texas Department of Agriculture, State Office of Rural Health (SORH) by leading SORH’s three-year strategic plan and design future programs. For the needs assessment, HMA conducted a systematic assessment that included an environmental scan of rural health key issues and trends, online survey of rural Critical Access Hospitals (CAHs) and prospective payment systems (PPS) hospitals in Texas identify needs and gaps, and an analysis of publicly available data to identify health needs and differences between rural and urban residents. Informed by this assessment and close collaboration with SORH staff, HMA developed a strategic plan to guide the next three years of SORH’s programming, as well as created work and evaluation plans for the SORH and Flex grant programs. Other tasks included assessment of Texas rural hospital telemedicine readiness, recommendations for value-based payment models for rural hospitals, and opportunities to support rural hospitals in reducing health disparities.

Our depth and breadth of experience has helped a diverse range of healthcare industry leaders focused on rural and frontier areas. What can we do for you?

Contact our experts:

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Kathleen Cahill

Associate Principal

Kathleen Cahill is a solutions-driven C-Suite executive with more than 40 years of experience in healthcare operations, working for entities … Read more
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Kenneth Cochran

Managing Director, Delivery Systems

Kenneth Cochran is a healthcare executive with more than 20 years leveraging his clinical, business and academic background to deliver … Read more
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Dan Castillo

Managing Principal

Dan Castillo is a seasoned healthcare executive with over 20 years of experience in health administration. He specializes in health … Read more
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Shannon Brown Joseph

Senior Consultant

Shannon Brown Joseph is a dynamic and accomplished workforce development liaison with experience in federal and state funded programs, diversity … Read more
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Rebecca Kellenberg

Principal

Rebecca Kellenberg specializes in assisting public and private health care organizations with Medicaid and CHIP policy analysis and implementation. With … Read more
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Jill Kemper

Associate Principal

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

Principal

Dr. Margaret Kirkegaard has extensive front line experience and an impressive breadth of knowledge about healthcare and its delivery. A … Read more
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Sarah Oachs

Associate Principal

A collaborative health and human services professional, Sarah Oachs has vast experience in organizational leadership and assessments, operations management, and … Read more
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Bill Snyder

Principal

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Emily Wilson

Associate Principal

A multi-disciplinary public health leader, Emily Wilson is passionate about bringing people together to solve the most pressing problems in … Read more
Solutions

Public Health Preparedness Services

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“Public health problems pose special challenges. They are generally enormous in scale, stem from numerous and highly complex causes, play out in the public eye, impact a vast array of stakeholders, and require unusually long-term solutions. The massive scope and complexity of such problems, including conditions such as uncontrolled childhood mortality, suboptimal maternal health, HIV/AIDS, cardiovascular disease, and cancer, among others, affect millions worldwide. Furthermore, the health issues quickly trigger a host of other family, economic, and social problems that ruin lives, erode communities, and weaken countries.”

– Journal of Public Health, Fostering public health leadership article

Concerned about another crisis?

Health departments play a critical role in achieving health security, including preparing communities for potential threats, mitigating those threats, responding to emergencies, and aiding in the recovery process. Over the past few years, public health has been faced with heightened scrutiny, lack of trust, and the need to evolve and keep up with the latest natural disasters, environmental, and infectious disease threats.

How HMA can help

HMA assists state, local, territorial, and tribal health departments with:

Plan writing, including emergency operations, hazard mitigation, medical counter measures, mass fatality, pandemic, continuity of operations, and crisis communications.

Reviewing and synthesizing emergency plans, policies, and procedures into actionable and meaningful abbreviated checklists.

Training and exercise development, including tabletop exercises, full scale exercises, hot wash debrief facilitation, after action report writing.

Workforce analyses, including determining if your health department is adequately staffed to respond to an emergency and maintain the foundational public health functions.

Capacity building and strategic infrastructure investment, including spending plans, funding, and development of action plans.

Staff/workforce resilience and morale, including team building, workforce assessments, and strategic planning.

Equity and Inclusion, including access and functional needs.

Infection control, including facilitating trainings, plan writing, and compliance.

Our Colleagues and Expertise

HMA public health preparedness experts applicable experience and expertise to assist public health agencies in preparing, mitigating, responding to, and recovering from public health emergencies.

  • Managing and coordinating Public Health Emergency Preparedness (PHEP) grants and emergency response and recovery activities at state, local and territorial health departments.
  • Developing emergency operation plans, procedures, and guidelines for emergency response projects.
  • Multifaceted public health strategic planning, which incorporates health services access, social service integration, workforce sustainability, data modernization, and environmental considerations.
  • Former staff from the National Association of County and City Health Officials (NACCHO)’s public health preparedness program.
  • Supply chain management of medicines and other health technology resources.
  • Development of evidence-based infection control practice, policy, and procedures.
  • Colleagues educated via the Association of Professionals in Infection Control and Epidemiology (APIC) in infection control prevention practices and public policy.

Project Spotlight

HMA worked with El Paso County Public Health (EPCPH) leadership to extend the reach of EPCPH staff during this pandemic and support the quick development of a COVID-19 recovery plan and an After Action Report (AAR). HMA gathered background information, intelligence, and templates from EPCPH staff, drawing from the prior COVID-19 plans. HMA documented best practices from other counties where HMA currently supported COVID-19 response planning and conducted interviews with EPCPH staff as needed to provide input into the plans. HMA drafted two plans: 1) a COVID-19 recovery plan, including a review of the transition back after COVID-19, health department continuity of operations (COOP) as it moved back to normal and indicators for return to work, and 2) an AAR for EPCPH’s positives and negatives related to the following: variances, EH (masks, capacity) compliance (masks, capacity), case investigation/contract tracing, and data analytics as well as med surge.

HMA evaluated COVID-19 response activities within the Hospital Association of California (HASC) member facilities and partners across the regions served. HMA reviewed a representative sample of member facility and partner agency plans developed and utilized during the response. We reviewed relevant annexes, guidance from local and state public health, member facilities, and federal agencies activated, alongside open-source information. HMA also examined documentation developed during response and recovery, including situation reports, memorandums of understanding, messaging to facilities, memos about response, training, and exercise events to perform an analysis of activities and references. In addition, this project garnered input from other key healthcare and government stakeholders in the regional market, including emergency medical services, public health, city and county governments, transportation, and others via online surveys and small group interviews. The creation of a Mid-Action Report/Best Practices Plan was particularly important to document lessons learned, best practices, and improvement items to inform ongoing efforts and future readiness initiatives to improve HASC’s capabilities and the planning needs of its members.

Contact our experts:

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Brent Barkett

Principal

A purpose driven leader and recognized expert in healthcare value transformation, Brent Barkett has a unique combination of clinical application, … Read more
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Lisa Harrison

Associate Principal

Lisa Harrison is a physician associate with more than 20 years of direct experience in clinical practice as a primary … Read more
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Zipatly V. Mendoza

Senior Consultant

Zipatly V. Mendoza has more than 15 years of program management experience and a demonstrated ability to administer public health … Read more
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Yamini Narayan

Senior Consultant

A diversified professional who thrives on solving the most complex questions in health policy, Yamini Narayan is a skilled researcher … Read more
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Hannah Savage

Consultant

Hannah Savage is an experienced public health professional with skills in program evaluation, data analysis, survey development, survey analysis, and … Read more
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Linda Vail

Principal

Linda Vail is an accomplished public health leader, creative problem solver and strategic thinker. She has extensive experience in opioid … Read more
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Emily Wilson

Associate Principal

A multi-disciplinary public health leader, Emily Wilson is passionate about bringing people together to solve the most pressing problems in … Read more
Solutions

Summary of the CMS managed care final rule and its impact on states, managed care organizations and providers

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On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality Final Rule (CMS-2439-F). 

CMS created a fact sheet which concisely reviews the final rule’s key provisions, as well as an applicability dates chart, which serves as a reference guide to the various applicability dates for different provisions in the final rule. The final rule creates new flexibilities and requirements aimed at enhancing accountability for improving access and quality in Medicaid and CHIP by principally addressing these topic areas:

  • ILOSs are defined as substitute services or settings for a service or setting covered under the state plan and can be leveraged by Managed Care Organizations (MCOs) to address unmet health-related social needs (HRSNs).
  • They must be offered to all members and must be voluntary as well as documented in MCO contracts.
  • ILOSs cannot exceed 5% of total capitation.
  • If ILOS costs exceed 1.5% of total capitation, states must provide additional documentation to CMS to demonstrate medical appropriateness and cost-effectiveness.
  • When an ILOS is terminated, states must develop a transition plan to arrange for state plan services and settings to be provided in a timely manner.
  • States must make available online a “one-stop-shop” where members can learn about and compare MCOs based on quality and other variables.
  • Mandatory quality measures are established.
  • The methodology for calculating the quality ratings displayed on each state’s MAC QRS is also established.
  • Although guidelines exist, states can submit their own version of a MAC QRS to CMS for approval.
  • Provider incentive payments must be tied to clearly defined, objectively measurable, and well-documented clinical or quality improvement standards to be classified as incurred claims (in alignment with private market MLR regulations).
  • Prohibits the inclusion of indirect administrative costs that are not directly related to improving quality as QIAs as incurred claims in the numerator (in alignment with private market MLR regulations).
  • Imposes additional expense allocation methodology requirements (in alignment with private market MLR regulations).
  • Requires SDPs to be included as both incurred claims (for payments made by MCOs to providers) and premium revenue (for payments made by states to MCOs).
  • Sets maximum appointment wait time standards of no more than 15 business days for routine primary care (adult and pediatric) and obstetric/gynecological services and 10 business days for mental health and substance use disorder services (adult and pediatric).
  • Enforces these standards using secret shopper surveys and requires states to contract for the secret shopper surveys.
  • Requires states to post the appointment wait time standards as well secret shopper survey results.
  • A remedy plan must be implemented for any MCO that fails to meet these required standards for access.
  • States must also conduct an annual enrollee experience survey for each MCO.
  • Codifies ACR payment ceiling, which applies to hospitals, practitioner services at academic medical, and nursing facility services.
  • Requires “hold harmless” attestation.
  • Allows for SDPs at 100% of Medicare without prior written approval.
  • Removes network provider requirement to receive payment.
  • Prohibits use of interim payments based on prior period data even if ultimately reconciled.
  • Prohibits use of separate payment term where SDPs are paid separate from capitation rates.
  • Explicitly states that SDPs must result in “stated goals and objectives.”
  • Requires states to submit detailed, provider level SDP data to the Transformed Medicaid Statistical Information System.

Implications for States

The final rule creates opportunities for states to leverage new flexibilities to further policy goals but also creates new administrative burdens. MCOs and providers will look to states to comprehensively understand final rule’s requirements and be prepared to manage the steps necessary to achieve compliance over a multiyear implementation process.

Implications for MCOs

As states move to comply with the final rule, MCOs will be immediately downstream from the steps taken by states to do so and MCOs need to prepare accordingly. Proactive actions by MCOs to not only engage with states early but also to prepare financially and operationally for the different provisions of the final rule over time will put them in the best position possible.

Implications for Providers

The most significant implications for providers in the final rule are related to SDPs, where a new level of accountability will be required. All topics covered by the final rule, however, have provider implications.

Looking ahead

The provisions of the final rule range in their effective dates from as early as the final rule’s effective date, July 9, 2024, to as late as the first rating period on or after four years after July 9, 2024.

Because of these variable effective dates, states, MCOs, and providers will need to comply with the final rule immediately in some cases, while having significant lead time to do so in other areas. Sub regulatory guidance is also forthcoming and must be monitored for and digested.

HMA stands ready to support states, MCOs, and providers in analyzing and responding to the strategic, financial, and operational impacts of the final rule’s provisions in specific markets and organizational contexts.

If you have questions or want to connect with our expert team members, e-mail [email protected].

Solutions

HMA can help develop and operate PACE programs

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The vast majority of hospitalizations are among patients 65 years and older due to their comorbid chronic illnesses and their requirement for age-appropriate care management. While the aging population increases, nursing home availability and state funding for home-and community-based services have decreased. As a result, the Centers for Medicare and Medicaid Services (CMS) care model Program of All-Inclusive Care for the Elderly (PACE), has boosted growth.

A program aimed at keeping low-income older adults living in the community and out of nursing homes, PACE has been a safe haven for many. Currently offered in 32 states, the program provides home care, prescriptions, meals, and transportation to participants.

The local PACE centers also bring enrollees together to socialize and receive a variety of medical services. Many PACE providers have reported high satisfaction rates among participants. Further, a 2021 report by the Health and Human Services Department found PACE enrollees were significantly less likely to be hospitalized, use emergency departments, or be referred to nursing homes compared to Medicare Advantage members.

Our clients

HMA works with national and state associations, managed care organizations, delivery systems, federal and state public health programs, as well as interested and existing PACE programs to support the promotion and continued improvement of the PACE model. Having led PACE programs, managed care organizations, delivery systems, and federal and state public health programs, the HMA team of multidisciplinary experts is skilled in PACE program design, strategy, growth, and operations. We have direct experience working in and with PACE organizations in policy, application processes, and operational readiness, day-to-day operations, and audit preparation and response.

How HMA can help:

HMA’s team can help organizations strategically identify, plan, and implement the development of a new PACE. HMA’s experts are experienced in leading an organization through the strategic planning processes, educating and orientating an interested sponsor organization in their PACE market of interest, and all of the variables, including the desired PACE service areas, federal and state waivers and licensure requirements, and restrictions, the state, and federal application timelines and processes, and pre- and post-implementation processes and as well as ongoing business operations.

The state and federal application process involves multiple steps and can feel daunting. HMA is well versed in these processes and has assisted many PACE programs across the county complete these applications. HMA will work with you side by side to navigate all of the application requirements including completing and submitting the Notification of Intent to Apply (NOIA), Navigating and Working with State Agencies, and completing the CMS Application.

Although many states operate in similar ways, there are nuances that make each a bit different. HMA consultants have worked with many state agencies across the country, both in states with PACE programs and states without. Whether your state(s) have existing PACE programs, or you are looking to be the first one in the state, HMA has the experience and expertise to help navigate those state-by-state differences. Our PACE team includes previous state Medicaid and federal leaders, providing valuable contacts and knowledge within the state systems.

Achieving performance targets requires advanced systems of care delivery and agile information technology tools for real-time monitoring and managing populations and participants. Effective operating and reporting systems are critical to the success of PACE organizations’ operations. HMA has evaluated system requirements for PACE and can help you identify, select, and implement operating processes and systems. To optimize operations efficiency, we also offer solutions for tracking and managing revenue, participant care costs, productivity, and downstream payments. We can also work to implement telehealth and remote patient monitoring technologies.

Contracting with specialty and ancillary healthcare providers along the continuum of care will be increasingly critical for managing participant care, outcomes, and costs under the PACE model. We can assess the scope and effectiveness of current contractual relationships, including contract language review, reimbursement, reporting requirements, and other elements critical to compliance and operational compliance and success, across a wide range of healthcare and social service providers.

HMA has extensive policy experience with the legislative requirements that govern PACE at both the state and federal level. We can help evaluate the impact of new requirements or legislation to inform your position with regulators. In addition, HMA team members have existing relationships with the National PACE Association as well as various state PACE Associations.

HMA experts are experienced and are well versed in providing data analytic services to both prospective and fully operational PACE programs. Using a full analytics suite, our experts can help with Part D needs including Bid preparation and Part D Reconciliations. Additionally, we can assist organizations with risk adjustment operations and support, forecasting, market analysis, vendor auditing, and strategic support. 

HMA is available to help organizations develop PACE capabilities from concept to implementation and beyond, including post-implementation and ongoing PACE operations. 

Contact our experts:

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Debby McNamara

Associate Principal

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Don Novo

Managing Principal

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Jason Pettry

Senior Consultant

Solutions

Achieving and Sustaining Success in the Health Insurance Marketplaces: Considerations for States and Managed Care Organizations

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The successful operation of the health insurance marketplaces created by the Affordable Care Act remains a key federal and state policy priority and an important business opportunity for managed care organizations (MCOs). At Health Management Associates (HMA), we are prepared to support both states and MCOs to achieve success in the operation of and participation in the marketplaces as these markets continue to evolve in the coming months and years.

Our team is made up of former state-based and federal marketplace leaders, insurance commissioners, state Medicaid directors, other senior government officials, payer executives, and provider leaders—meaning that we have the first-hand experience to navigate the complexities of marketplace establishment, operations, and participation toward successful outcomes. Our consultants have had expansive experience in this market since its inception. We have worked as and for federal and state regulators, enabling us to understand regulator goals. Additionally, we have worked for and with local, regional, and national MCOs on market entry strategy and/or profitability strategy. Our team has looked at the same problems from many angles and has the broadest historical perspective on the challenges and opportunities in this market.

CONSIDERATIONS FOR STATES

For states, operating a state-based marketplace (SBM) that flexibly meets the health coverage needs of the population in an efficient and responsive way is a common and critical goal. HMA understands the importance of establishing and continually operating a strong and lasting SBM capable of weathering and protecting against current and future threats to access and affordability. Key SBM policy outcomes include:

Local Control and Better Coordination

SBMs can increase enrollment and reduce gaps in coverage for families through closer alignment with the Medicaid program, customer-centric policies and procedures, and local, tailored engagement and outreach.

Lower Costs and Improved Consumer Protections

SBMs can establish plan design standards, coverage requirements, and consumer protections to improve choice and competition, lower out-of-pocket costs, and protect access to the affordable care individuals need and deserve.

Universal Coverage

Through innovative enrollment initiatives, federal waivers, and affordability programs, SBMs can be a catalyst for additional reforms to put the state on the pathway to universal coverage.

To be able to successfully accomplish the policy aims outlined above, states must excel across and within a range of strategic and operational areas including: organizational development and implementation, governance and project management, vendor procurement and oversight, strategic policy development, maximizing federal funding and financial management, federal compliance, stakeholder engagement, and communications and training. HMA can support states in all these areas with services that enable operations, regulatory compliance, strategy, and policy advancement.

CONSIDERATIONS FOR MCOS

For MCOs, the marketplace represents a key business opportunity where existing capabilities can be leveraged as part of a successful growth strategy. With our extensive regulatory expertise and expansive state market knowledge, HMA understands that customized support is necessary to allow MCOs to succeed in the marketplace as either a new market entrant or an existing participant. For MCOs, the marketplace has the following features:

A Highly Regulated Environment

At the federal and state levels, the marketplace environment has strict standards in terms of plan design, rating rules, network adequacy, marketing practices, producer (broker and agent) activities, and marketing practices.

Significant Public Funding

As a result of the marketplace premium tax credits, most marketplace consumers qualify and as a result, significant public funding is involved.

An Evolving Market

The end of the Medicaid continuous enrollment condition as of March 31, 2023, which has been in effect throughout the Coronavirus Disease 2019 Public Health Emergency, makes providing coverage in the marketplace even more critical—as millions of individuals transition to this market after losing Medicaid coverage.

How HMA can help

HMA can support clients every step of the way in the planning and execution of efforts to participate in and optimize performance for the marketplace. To achieve and maintain success in the marketplace, MCOs must excel across strategic, operational, and analytical areas including:

Market analysis and feasibility

Operational gap analysis

Product management scoping

Vendor procurement

Regulatory filings development and implementation

Actuarial analytics

Provider contract reimbursement analysis, and

Network development

HMA can bring to bear a comprehensive continuum of services to solve your most pressing marketplace challenges.

If you have questions about how HMA can support your state or MCO related to the marketplace, please contact Zach Sherman, managing director or Patrick Tigue, managing director.

Contact our experts:

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Zach Sherman

Managing Director

Zach Sherman is an Affordable Care Act (ACA) expert and Health Insurance Marketplace leader with extensive experience with start-ups and … Read more
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Patrick Tigue

Senior Vice President, Practice Groups

Patrick Tigue is an accomplished executive with experience leading and managing critical efforts to achieve strategic health policy goals on … Read more
Solutions

Privacy and Security Assessment and Support Services

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One of the most important challenges for a health data organization is ensuring that its policies and procedures remain compliant with the dynamic landscape of federal and state privacy and security statutes, regulations, and industry standards.

HMA brings applicable experience and expertise to assist state agencies, non-profit organizations, and other entities that are responsible for all-payer claims databases, hospital discharge databases, and other datasets containing confidential and sensitive health data with:

Reviewing existing policies and procedures to identify gaps and needed updates to ensure compliance with regulations and adherence to best practices and industry standards.

Recommending revisions based on the assessment review and helping prioritize changes based on risk analysis.

Updating policies and procedures based on the approved recommendations.

Developing a training program for staff regarding the updated privacy and security policies and procedures via in person training, virtual training, and/or creating training videos.

HMA’s privacy and security assessment and support services capabilities include the following qualifications and expertise:

Holding leadership roles at state health data organizations and on the National Association of Health Data Organizations Board

Coordinating health information technology (HIT) for state Medicaid agencies

Leading state value-based purchasing agencies

Founding HIT strategic consulting firms

Experience with the National Association of County and City Health Officials

Project management and strategic planning support for multiple state agencies and data organizations

Privacy and security legal expertise

In addition, HMA offers the knowledge and experience of more than 700 consultants to supplement our privacy and security expertise with local healthcare knowledge and support to comprehensively address an organization’s needs.

Contact our experts:

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Craig Schneider

Principal

Craig Schneider is a leader in developing and implementing payment reform strategies, promoting all-payer claims databases (APCDs), and engaging stakeholders … Read more
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Stuart Venzke

Managing Director, IT Advisory Services

Stuart Venzke has over 30 years of experience improving the effectiveness, efficiency and responsiveness of health and human services (HHS) … Read more