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Brief & Report

Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomes


With the support of State Health and Value Strategies, Ellen Breslin and Anissa Lambertino of Health Management Associates, in partnership with Dennis Heaphy of the Disability Policy Consortium and Tony Dreyfus, prepared a recently released issue brief “Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomes.”

This brief answers two key questions for state policy makers:

  1. Why should Medicaid programs account for social determinants of health (SDOH) in setting payments and in measuring quality?
  2. What methods can Medicaid programs use to examine SDOH and account for them in their payment and/or quality improvement policies?

Case studies from Medicaid agency efforts in both Massachusetts and Minnesota will be used to answer these questions.

This brief was prepared to accompany the recent State Health and Value Strategies webinar “Using Social Determinants of Health Data in Medicaid Managed Care.”

Brief & Report

Report Examines State Medicaid Coverage of Perinatal and Maternal Benefits


Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey

This report, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes the status of Medicaid benefit policies for perinatal and family planning services in 40 states and the District of Columbia.

While inpatient and outpatient hospital care must be covered for pregnant women under the federal scope of Medicaid, it is up to the discretion of states to define which other maternal benefits are included. Most states cover a broad range of perinatal services such as ultrasounds and prenatal vitamins. Other services are less likely to be covered by the states, including parenting classes and breastfeeding education.

Key findings in the report are presented in the areas of:

  • Perinatal services
  • Counseling and support services
  • Delivery and postpartum care
  • Breastfeeding services

HMA’s Kathleen Gifford co-authored the report along with Usha Ranji, Alina Salganicoff and Ivette Gomez of the Kaiser Family Foundation and Jenna Walls. This report serves as a companion report to Medicaid Coverage of Family Planning Benefits: Results from a State Survey, released in September 2016 by the same authors.

Brief & Report

Report Shares Lessons as Affordable Housing Providers, MMC Programs Forge Partnerships


A growing body of literature continues to validate the importance of addressing the social and structural determinants of health to improve health outcomes, and promote opportunity and economic mobility. Affordable, service-enriched housing plays a vital role in this work, with a growing momentum to collaborate across the health and housing sectors through lessons learned from research and demonstration projects across the nation.

Stewards of Affordable Housing for the Future (SAHF) members are experienced nonprofit housing providers that have collaborated with healthcare stakeholders for many years. However, few have had direct partnerships with insurers. Beginning in 2014, SAHF engaged its members in efforts to “match-make” business relationships with Medicaid payers to implement joint initiatives that would demonstrate and assess the contributions of service-enriched housing to the healthcare system.

On April 24, SAHF, in partnership with Health Management Associates (HMA), and with support from the Kresge Foundation, released its report, The Path to Partnership: Lessons Learned in the Pursuit of Joint Initiatives between Affordable Housing Providers and Medicaid Managed Care Programs. SAHF members who participated in this matchmaking activity included Mercy Housing, Volunteers of America (VOA) and National Church Residences. HMA worked with SAHF members on market scans, and HMA initiated outreach to potential health plan partners, which resulted in joint initiatives in Atlanta, Denver and Pittsburgh.

The report identifies the following lessons learned from the efforts to date:

  • Joint initiatives must address the problem of scale;
  • Housing providers must be willing to adapt services to meet the requirements of the healthcare system;
  • Housing providers must present a business case to potential health plan partners that includes primary and secondary benefits;
  • HIPAA compliance needs to be addressed as a potential barrier; and
  • Healthcare partners and housing providers need to be realistic about joint initiative resource requirements.
Brief & Report

Medicaid and Health Policy Highlights from Governors’ Proposed Budgets


Governor’s Proposed Budgets for FY 2018: Focus on Medicaid and Other Health Priorities

This issue brief, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes governors’ proposed budgets for state fiscal year (FY) 2018.

Despite nearly half of the states facing budget challenges for FY 2018, many governors are recommending enhancements to Medicaid and increasing the use of managed care and community-based long-term services and supports. With ongoing debate of the Affordable Care Act at the federal level, several governors still view Medicaid expansion as a solution to addressing top health priorities, including the opioid epidemic and healthcare for those involved with the criminal justice system.

This issue brief reviews 48 proposed state budgets. Key findings are presented in the areas of:

• Provider payment rates and taxes
• Eligibility changes
• Benefits, premiums and cost-sharing
• Delivery system and managed care reforms
• Community-based long-term services and supports
• Medicaid administration
• Initiatives to fight the opioid epidemic
• Initiatives to enhance behavioral health services
• Health-related corrections and criminal justice initiatives

HMA’s Kathleen Gifford and Nicole McMahon co-authored the issue brief along with Larisa Antonisse, Elizabeth Hinton and Robin Rudowitz of the Kaiser Family Foundation.

Brief & Report

The Case for Relationship-Centered Care and How to Achieve It


American healthcare has entered a period of unprecedented debate regarding our healthcare delivery system. Adjectives such as affordable, accountable, integrated, and coordinated care routinely used to describe healthcare, but in the midst of reorganizing healthcare, have we lost the critical element of healthcare?—namely, “care” itself?  This element of true caring within the healthcare debate is often relegated to the realm of patient or consumer satisfaction. The concept of authentic caring in healthcare, as opposed to healthcare as a transaction for acquiring health care services, is best embodied in the paradigm of relationship-centered care. Beach et al developed a conceptual framework for defining relationship-centered care that is founded upon four principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable.[1]

While Beach posits that relationship in healthcare deserve attention because they are morally valuable, we sought to examine whether relationship-centered care can actually help achieve the Triple Aim —lower costs, better health outcomes, and better experience of care. We examine the value of relationships in healthcare within four domains:

  • social connectedness or supportive interpersonal relationships outside of healthcare,
  • therapeutic relationships between patients and their healthcare team,
  • relationships within the healthcare team, and
  • relationships between the healthcare team and the community.

Assembling the available research, we developed a framework for primary care practices to assess their ability to foster therapeutic relationships and harness the power of relationships to improve health outcomes.

[1] M.C. Beach, T. Inui, et al, “Relationship-centered Care, A Constructive Reframing,” J Gen Intern Med 21 (2006): S3–8.

Brief & Report

Linking Medicaid and Supportive Housing: Opportunities and On-the-Ground Examples


Research suggests that a broad range of social factors affect individual and population health. Indeed, acknowledging the role of social factors in determining health, the U.S. Department of Health and Human Services’ Healthy People 2020 report included as one its four overarching goals for the 2010-2020 decade: “Create social and physical environments that promote good health for all.”1 Housing has been identified as one such social determinant of health, as individuals experiencing homelessness or unstable housing situations face significant challenges in obtaining care and managing chronic conditions, and lack of housing and poor housing conditions can themselves adversely affect health. There is growing evidence that supportive housing can contribute to improved health outcomes for individuals experiencing homelessness or at risk of homelessness.2 Supportive housing can also promote the goal of community integration of individuals with disabilities and elders who need long-term services and supports (LTSS).

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Brief & Report

The Relationship Between Cancer Diagnosis and Patient Productivity, Caregiver Burden, and Personal Financial Hardship


Cancer is the second most common cause of death in the United States, and an estimated 1.6 million newly diagnosed patients are expected in 2016. However, recent research indicates that overall cancer death rates in the United States have decreased by 1.5% per year from 2003-2012. There were more than 15.5 million survivors alive at the beginning of 2016; this number is expected to increase to 20.3 million in 2017.3 Research has shown that the impact of cancer extends beyond clinical treatments and can cause financial hardship for patients and their families.4 However, not as much is known about the impact of cancer on productivity and the economic burden on caregivers. The following study aimed to determine the prevalence and sources of financial hardship among cancer survivors and their caregivers.

View poster here: MEPS Analysis of Cancer Survivors

Brief & Report

Annual Survey Finds Slower Growth in Total Medicaid Spending Nationally


Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017

Growth in Medicaid enrollment and total Medicaid spending nationally slowed significantly in fiscal year 2016, and it looks like a continued slowdown will occur in fiscal year 2017. This is just one finding in the 16th annual 50-state Medicaid Budget Survey conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured and in collaboration with Health Management Associates (HMA) and the National Association of Medicaid Directors.

This report highlights policy changes implemented in state Medicaid programs in FY 2016 and those implemented or planned for FY 2017 based on information provided by the nation’s state Medicaid directors. Key findings are presented in the areas of:

  • Eligibility and enrollment
  • Managed care and delivery system reforms
  • Long-term services and supports
  • Provider payment rates and taxes
  • Benefits (including prescription drug policies)
  • Projections for 2017

HMA’s Vernon K. Smith, Kathleen Gifford, Eileen Ellis and Barbara Edwards authored the report along with Robin Rudowitz, Elizabeth Hinton, Larisa Antonisse and Allison Valentine of the Kaiser Family Foundation.

Two additional issue briefs were developed as well:

Medicaid Enrollment & Spending Growth: FY 2016 &2017, which provides an analysis of national trends in Medicaid enrollment and spending.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2016 and FY 2017, a collection of four case studies of Medicaid programs in Maryland, Montana, New York and Oklahoma.

Brief & Report

Report Evaluates Uncompensated Care and Medicaid Payments in Texas Hospitals


HMA was engaged by the Texas Health and Human Services Commission to perform an independent evaluation of Texas’ Uncompensated Care Pool, as required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, to submit to the Centers for Medicare and Medicaid Services (CMS). The report was submitted to CMS on August 31st.

Consistent with the approach it has taken in other states that operate uncompensated care pools, CMS required Texas to commission a detailed analysis of the state’s uncompensated care costs, payments and the impact of environmental factors and potential policy changes. Pursuant to the waiver Special Terms and Conditions (STCs), the report includes the following:

  1. A detailed description of the composition of current Medicaid hospital payments.
  2. Analysis of Medicaid financing and how the non-federal match is funded.
  3. Estimated cost incurred by hospitals to provide services to Medicaid beneficiaries compared to the cost to the corresponding payments received.
  4. Estimated cost of uncompensated care provided by hospitals and the portion of uncompensated care attributed to charity care.
  5. Analysis of the adequacy of Medicaid payments in relation to cost incurred by hospitals.
  6. Analysis of Texas Medicaid payment adequacy relative to other states.[1]
  7. Assessment of recent economic and environmental trends within Texas that may impact future reimbursement levels and the cost of caring for low-income populations.
  8. Estimated financial impact of: 1) implementing a Medicaid expansion for low-income adults; 2) Medicaid DSH reductions required by the Affordable Care Act (ACA); 3) reestablishing supplemental upper payment limit (UPL) payments; and 4) fully funding Medicaid hospital costs through payment rates.

[1] Note that this portion of the analysis and report were completed by Deloitte Consulting.

Brief & Report

Initiative to Decriminalize Mental Illness: Recommendations for a Treatment Center and Continuum of Care


The Baton Rouge Area Foundation (BRAF) tapped HMA to assess and recommend a comprehensive model of care for individuals in East Baton Rouge (EBR) Parish with behavioral health and substance use needs who, under the current system in place in EBR, may otherwise end up behind bars. HMA also took into account a model proposed by the Clinical Design Committee, which the BRAF convened.

The report, recently presented to BRAF, provides the following recommendations:

  • Embrace a model of care that promotes a continuum-of-care strategy across the community and that focuses on targeted population health interventions—the provision of services that focus on outcomes for specific groups of people.
  • Plan and implement a set of priority diversion processes and services, modeled after the diversion programs located in Bexar County, Texas, and tailored to meet the needs of the EBR community.
  • Work toward a system of care that over time includes expansion of services anticipated to leverage the results of implementing the recommendations.

The report also lays out business plan and implementation components for the proposed crisis care and diversion center currently being called “the BRidge Center,” that are designed to address the challenges EBR is currently facing, with the goal of stopping the cycle of criminalization of people with behavioral health issues.

The report’s recommendations are based on an analysis of the current East Baton Rouge system of care that is available to support people with behavioral health issues, recommendations offered by over 35 EBR behavioral health and criminal justice leaders, and a review of national best practices and literature.

Brief & Report

HMA Releases Medicaid Managed Care White Paper


Medicaid Managed Care is the subject of a recently released HMA white paper.

In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

  • Planning and implementation
  • Stakeholder engagement
  • Procurement approaches
  • Outreach and enrollment
  • Contract management and monitoring
Brief & Report

The Value of Medicaid Managed Care


In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

  • Planning and implementation
  • Stakeholder engagement
  • Procurement approaches
  • Outreach and enrollment
  • Contract management and monitoring