1309 Results found.
Midwest Health Plan Earns NCQA Accreditation
THE CLIENT
A managed care health system serving the comprehensive needs of communities and offering care delivery sites across the Midwest.
THE CHALLENGE
The client wanted to expand its reach by offering its Marketplace product in in a nearby state. T he state requires either National Committee for Quality Assurance (NCQA) accreditation or Centers for Medicare and Medicaid Services (CMS) approval to determine network adequacy and allow plans to operate in the state. The client, already established with HMA in other states, reached out to secure our services to help them with the accreditation process.
While NCQA accreditation is never easy, this process was complicated by several factors including a six-month timeline in order to start processing requests during the open enrollment period, as well as a complex company structure.
APPROACH
Working on-site, HMA’s experts assembled a team from the client’s staff to assist with the accreditation process and completed a second-level review of every document as they readied the accreditation submission. After submission, HMA consultants helped the team answer two rounds of complex questions in response to requests from NCQA.
The biggest challenges were questions regarding the company’s organizational structure because the plan operates under different names in different states. Multiple-state accreditation is a challenge to explain to NCQA, but HMA’s seasoned experts were able to create a very clear document and explanation that showed the organizational structure and sole ownership of the health plan. This was crucial because it was a non-typical issue and questions needed to be answered in a satisfactory manner in order to ensure accreditation and the ability to sell the plan’s product during open enrollment for 2020.
In addition, in order to ensure the accreditation was secured in time, our team was able to obtain an expedited decision from NCQA. Preparing for accreditation is usually a year-long process, but the team was able to complete the process and secure accreditation in less than six months.
RESULTS
The client was granted interim accreditation status on November 15, 2019, in time for the plan to enter the marketplace for open enrollment. Coming up just two points short of a perfect score, the plan reached its goal of opening services in the state.
In addition to helping the client reach its goal, HMA experts continue to work with the company to tailor and implement a Survey Ready Model to ensure they are prepared for the next accreditation cycle. HMA also is providing accreditation services to the client in two additional states.
The company president and chief executive officer said accreditation would not have been possible without HMA’s expertise and guidance.
West Virginia releases Medicaid managed care RFP
This week, our In Focus section reviews the West Virginia Mountain Health Trust request for proposals (RFP) released by the West Virginia Department of Administration (DOA) for the Department for Health and Human Resources (DHHR) on December 17, 2019. Mountain Health Trust (MHT) is the statewide physical and behavioral Medicaid managed care program. West Virginia will award contracts, worth over $1.5 billion, to three managed care organizations (MCOs), with implementation beginning July 1, 2020.
Health Management Associates Acquires California-based Firm NPO Solutions
Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the acquisition of NPO Solutions, a California-based management consulting firm that specializes in expanding the capacity of social sector organizations.
Jonathan Blum to Join HMA as Managing Principal
Jonathan (Jon) Blum will join HMA as a managing principal on Aug. 31 working out of the Washington, DC office.
He has more than 20 years of senior-level experience working in public and private healthcare financing organizations, including the Centers for Medicare and Medicaid Services (CMS).
Hospital Charges and Reimbursement for Medicines: Analysis of Cost-to-Charge Ratios
This report is an update to a previous report examining hospital markups for separately paid drugs. Our prior analysis examined hospital charges and reimbursement for 20 drugs and found that hospitals marked up charges for those drugs, on average, 487 percent of their acquisition cost. We also found that hospitals receive 252 percent of estimated hospital acquisition cost from commercial payers. Hospital reimbursement data was obtained from the Magellan Rx Management Medical Pharmacy Trend Report™: 2016 Seventh Edition (the Magellan report) and charges were calculated from Medicare claims data. For more information, please refer to our prior analysis.
HMA Expands West Coast Footprint, Opens Office in Los Angeles
Health Management Associates (HMA), a leading independent national consulting firm specializing in publicly funded healthcare, continues its growth with the opening of a new office in downtown Los Angeles.
Health Management Associates Acquires California Firm Care Integration Partners
Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the acquisition of California healthcare consulting firm Care Integration Partners (CIP).
Health Management Associates, Community Care of North Carolina Form Strategic Partnership
Today, Health Management Associates (HMA) and Community Care of North Carolina, Inc. (CCNC) announced the formation of a strategic partnership that will leverage the complementary skills and expertise of both organizations to offer providers and payers innovative solutions for the challenges of today’s healthcare landscape.
Health Management Associates to Acquire Firm Founded by Seema Verma
WASHINGTON, D.C. – Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the signing of an agreement by which HMA will acquire SVC, a consulting firm which is owned by Seema Verma, founder and president, and recently confirmed Administrator of the Centers for Medicare & Medicaid Services (CMS).
SVC will become HMA Medicaid Market Solutions, a new subsidiary of HMA.
Donna Checkett Joins HMA as Vice President of Business Development
LANSING, MICHIGAN – Health Management Associates (HMA) announced today that Donna Checkett, current Aetna vice president for Medicaid growth, will join the independent national healthcare research and consulting firm as vice president of business development on Feb. 6. Checkett will lead new business strategy for HMA.