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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Webinar

Webinar replay: Opportunities for state regulators to shape policy and regulation of treatment for substance use disorder

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This webinar was held on November 2, 2023. 

Health Management Associates (HMA) offered a 3-part series of webinars looking at the effect of proposed regulations on delivery of opioid treatment services to the population facing addiction issues. In this third and final webinar, HMA consultants highlighted opportunities for state regulators to shape policy and regulation of substance use disorder (SUD) treatment.

New federal regulations encourage significant changes to how opioid treatment is provided, with the goal of expanding access and improving patient-centered care. State regulators will need to adapt their regulatory practices and work closely with Medicaid agencies and treatment providers so the new regulations can achieve their intended goals. This webinar discussed how State Opioid Treatment Authorities (SOTAs), licensing entities, and state Medicaid agencies will need to work together to craft updated regulations, facility licensing, and reimbursement practices that advance person-centered care.

HMA experts were joined by Allegra Schorr, VP, West Midtown Medical Group and President of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA). COMPA represents New York State’s Opioid Treatment Programs (OTPs), as well as providers offering office-based medication-assisted treatment, currently providing addiction treatment to over 43,000 New Yorkers.

Learning Objectives:

  • New Regulatory Requirements – Overview of state rules around opioid treatment vs the new requirements.
  • How to Improve SUD Treatment Access – Specific recommendations on statutory and regulatory changes that could lead to more patient centered treatment options.
  • States Leading the Way – Examples from states that are leading the way to expand access and reduce stigma.

Other webinars in this series:

Watch the replay of Part 1 on Opioid Treatment Providers

Watch the replay of Part 2 on Opioid State Payers Aligning Incentives for Treatment

Blog

Michigan releases Medicaid Managed Care RFP

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This week, our In Focus section reviews the Michigan Medicaid Managed Care Comprehensive Health Care Program (CHCP) request for proposals (RFP), which the Michigan Department of Health and Human Services released on October 30, 2023. CHCP covers 2.2 million Medicaid members and is worth approximately $15 billion.

MIHealthyLife

The rebid is part of MIHealthyLife, an initiative that the department launched in 2022 to strengthen Medicaid services through new Medicaid health plan contracts. At that time, Michigan Medicaid sought input from nearly 10,000 stakeholders in an effort to strengthen Medicaid managed care contracts and create a more equitable, coordinated, and person-centered system of care. Based on the feedback, the department designed the RFP with a focus on five strategic pillars:

• Serve the Whole Person, Coordinating Health and Health-Related Needs
• Give All Kids a Healthy Start
• Promote Health Equity and Reduce Racial and Ethnic Disparities
• Drive Innovation and Operational Excellence
• Engage Members, Families and Communities

RFP

Medicaid managed care organizations (MCOs) serve 10 regions, each consisting of multiple counties. MCOs will bid on one or more of the regions throughout the state. Each region requires at least two plans, with the exception of Region 1, a rural area that includes Michigan’s Upper Peninsula, where members are enrolled in a single plan.

As part of the MIHealthyLife initiative, the RFP will include the following changes:

• Prioritizing health equity by requiring Medicaid health plans to achieve National Committee for Quality Assurance Health Equity Accreditation
• Addressing social determinants of health through investment in and engagement with community-based organizations
• Increasing childhood immunization rates, including greater provider participation in the Vaccines for Children program
• Adopting a more person-centered approach to mental health coverage
• Ensuring access to health care providers by strengthening network requirements
• Increasing Medicaid Health Plan accountability and clarifying expectations to advance state priorities

Timeline

Proposals are due January 16, 2024, and implementation is anticipated to begin October 1, 2024. Contracts will run through September 30, 2029, with three one-year optional periods.

Current Market

Michigan currently has nine plans, which serve more than 2.2 million Medicaid and expansion members. The table below provides a breakdown of the plan market share by enrollment.

Link to RFP

Blog

CMS releases Medicaid LTSS expenditures report for FY 2020

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This week, our In Focus section summarizes the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report, which the Centers for Medicare & Medicaid Services (CMS) released on October 17, 2023. The report includes detailed information about Medicaid LTSS expenditures for federal fiscal year (FY) 2020, which runs from October 1, 2019, through September 30, 2020. During this time, LTSS spending grew 20 percent to $199.4 billion from the previous year.

Medicaid LTSS Expenditures

Medicaid LTSS expenditures cover home and community-based services (HCBS), which includes personal care and home health, as well as institutional care, which includes services provided in nursing facilities, intermediate care facilities (ICF) for individuals with intellectual or developmental disabilities (IDD), and mental health facilities. HCBS accounted for 62.5 percent ($124.6 billion) of LTSS expenditures. The remaining 37.5 percent, or $74.8 billion, was directed toward institutional care (see Figure 1).

Figure 1. Medicaid LTSS Expenditures by Type

In addition, Section 1915c waiver program spending accounted for 43.1 percent of HCBS expenditures, followed by personal care at 20.5 percent. See Figure 2 for additional breakouts.

Figure 2. Percentage of Medicaid HCBS Expenditures by Service Category

Nursing facilities accounted for the largest percentage (78.2 percent) of institutional care spending. See Figure 3 for additional breakouts.

Figure 3. Percentage of Medicaid Institutional Expenditures by Service Category

Medicaid LTSS spending accounted for 33.5 percent of total Medicaid spending in FY 2020. States with the highest LTSS as a percentage of total Medicaid spending were North Dakota at 54.9 percent, Wyoming at 54 percent, Kansas at 51.2 percent, Minnesota at 49.6 percent, and Nebraska at 45.2 percent. Texas and Virginia did not report spending for Medicaid LTSS programs, which comprise a substantial share of total LTSS expenditures in those two states (see Table 1).

Table 1. Medicaid LTSS Expenditures by State

LTSS spending per resident also varied from state to state. On average, states spent $679 Medicaid LTSS dollars per state resident in FY 2020. Utah had the lowest Medicaid LTSS expenditures per state resident at $284, whereas the District of Columbia had the highest at $1,554 per resident.

Medicaid MLTSS Expenditures

Medicaid managed long-term services and supports (MLTSS) spending totaled $57 billion in FY 2020. HCBS accounted for $35.7 billion and institutional care accounted for $21.3 billion. As more states adopted and extended their Medicaid managed care programs, MLTSS spending grew 750 percent from FY 2008.

In FY 2020, 25 states had operational MLTSS programs. Of these, nine were Financial Alignment Initiative (FAI) capitated model demonstrations for dual eligible members. New York, Pennsylvania, Florida, and California accounted for 58 percent of total MLTSS spending nationally, with New York representing 23 percent of total national MLTSS expenditures. Three states—Idaho, Texas, and Virginia—did not report MLTSS spending (see Figure 4).

Figure 4. States with MLTSS programs, FY 2020

Source: Mathematica

Iowa had the highest share of MLTSS expenditures as a percentage of total Medicaid LTSS expenses in FY 2020 at 95 percent. Arizona and Kansas followed at 94 percent and Hawaii at 74 percent. The national average was 29 percent. At the lowest end were South Carolina at 4 percent and Rhode Island at 12 percent, both of which are fee-for-service states. Michigan followed at 14 percent.

Contributing Factors to LTSS Expenditures

The COVID-19 public health emergency, which includes the first six months of the pandemic that started in March 2020, had a major effect on LTSS expenditures in FY 2020. Many residents in long term care facilities are covered by Medicaid and disproportionately experienced the most COVID-19 deaths. States began to implement various policies to address the impact of COVID-19 among Medicaid LTSS users. This includes modifying utilization limits for covered services and increasing payment rates for certain institutional services and HCBS.

As mentioned earlier, Texas and Virginia did not report Medicaid LTSS expenditures, which undercut the national total. Other factors that affect the reliability of Medicaid LTSS data include changes in state MLTSS expenditure reporting methods, and changes in state Medicaid LTSS policies and programs.

Link to Report

Note: CMS hired Mathematica to conduct the research, which used CMS-64 Medicaid expenditure report data, state-reported MLTSS data, Money Follows the Person (MFP) worksheets for proposed budgets, CMS 372 data on section 1915(c) waiver program population groups, and U.S. Census data to compile the report

Solutions

School-based Mental Health

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Schools face resource challenges

Public schools face persistent pressure to serve as the central point for addressing children’s overall health and well-being. Behavioral health and access to care challenges were a growing concern affecting school populations even before the Covid pandemic.

Youth are experiencing behavioral health crises at an alarming rate, and schools are struggling with insufficient resources for students to receive the necessary person-centered care and support. Sustainable funding streams, including options like Medicaid and alternate funding methods, could help schools effectively cover expenses. New temporary funding streams are available (e.g., CMS School Based Health Services Program, Bipartisan Safer Communities Act, and multiple state funding initiatives) but schools often lack the necessary infrastructure, administrative support, and awareness of community resources to effectively utilize these funds.

Our Clients

HMA works with state and local education agencies, school districts, county offices of education, departments of public instruction, social service agencies, public health, school boards, and family and parent organizations to support school-based mental health initiatives. 

Through innovations in community partnerships, evidence-based programming, and design that support healthy children and promising futures, there is opportunity to enhance school outcomes. Students’ well-being and mental health directly impact their overall educational experience and achievement. By addressing these challenges and investing in comprehensive BH support within schools, we can help schools design an environment that furthers the well-being and success of all students.

HMA can help school systems:

Add capacity for project management support for whole-child approaches to improved health

Reduce duplication of services

Assess opportunities to better leverage new and existing resources and dollars through blended and braided funding and existing community-based supports to enhance utilization

Strengthen infrastructure and awareness and establish collaborations and partnerships to ensure effective utilization of available funding and shared resources

Break down bureaucratic silos and promote interagency cooperation

Improve information and data sharing

Emphasize preventative behavioral and physical care

Assess strategies for workforce shortages

Develop and implement evidence-based integrated care clinics within schools

Deliver training for administration, staff, parents, and community partners that helps achieve successful adoption

Implement targeted initiatives to address ongoing and pervasive stigma surrounding behavioral health, particularly in specific cultures and communities

HMA has the right team

With our expertise and collaborative approach, we empower schools and school districts to proactively address the youth behavioral health crisis and create a supportive educational environment for all students.

Our team members have extensive careers in school-based mental health, direct clinical behavioral health practice, healthcare systems, as well as government social services and public health, community organizations, and school-based leadership. Our experts have worked with every type of stakeholder, gaining invaluable insights and understanding. We meet schools where they are and help to right-size service offerings. HMA can bring a fresh perspective on school-based services, and help you shift from reactive to proactive.

Contact our experts:

Annalisa Baker

Annalisa Baker

Associate Principal

Along with a comprehensive understanding of the behavioral healthcare continuum, Annalisa Baker’s experience includes business operations, project management, finance, and … Read more
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
John Eller

John Eller

Managing Principal

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
Jennifer Hodgson

Jennifer Hodgson

Principal

Jennifer Hodgson is a licensed marriage and family therapist who maintained a private practice and taught in higher education for … Read more
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
Blog

Cut to the Point: A Summary of 2024 Star Rating Cut Point Changes

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This week, our In Focus section highlights a white paper that Wakely, a Health Management Associates company, released in October 2023, “Cut to the Point: A Summary of 2024 Star Rating Cut Point Changes”. The paper reviews 2024 Medicare Star Rating data, including the Star Rating Technical Notes, which the Centers for Medicare & Medicaid Services (CMS) released October 13, 2023.

The data summarizes how Medicare Advantage Organizations (MAOs) performed on various quality measures during the 2022 measurement year and serves as an indication of changing Medicare Advantage spending in 2025 as a result of changes in Medicare Advantage Prescription Drug (MA-PD) Overall Star Ratings. The publication of the 2024 Star Rating Technical Notes provided an opportunity for Wakely to analyze measure-level cut point changes. This paper looks at the latest cut point changes to determine how the Tukey Outlier Deletion methodology and changes in the overall quality performance have affected Star Rating cut points.

Link to White Paper

Wakely will also host a webinar, Stars and Strikes: 2024 Star Ratings and the Impact of Tukey, at 2:30 pm ET on November 14, 2023. The webinar will cover the recently released 2024 Star Ratings, including an analysis of the expected impact on 2025 Medicare payments. Attendees should expect to hear discussions about the latest program changes and resulting impact on the contract-level star ratings, including implementation of the Tukey outlier deletion methodology. In addition, Wakely colleagues will cover the upcoming changes to the Star Rating program and discuss their potential impact on Medicare Advantage Organizations.

For questions, please contact Suzanna-Grace Tritt, [email protected], or Lisa Winters, [email protected].

Brief & Report

HMA develops brief exploring equity and innovation in children’s behavioral health systems

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Lifting Voices is an initiative developed to inform the transformation of the youth behavioral health care system. The project leaders are parents of children who nearly died on multiple occasions from severe behavioral health conditions, and they are professionals with a deep understanding of the opportunities and challenges faced by behavioral health care policy makers and reformers. They share the belief that their knowledge, desperation, and resources afforded their children access to interventions that should be accessible to every youth who needs them. Their experience of the care delivery system has also inspired their commitment to highlight the urgent improvements necessary to support struggling children and parents affected by the nation’s youth behavioral health crisis.

To learn more about Lifting Voices, see the October 2023 report here.

HMA Principals and behavioral health policy and practice transformation consultants Heidi Arthur, LMSW and Ellen Breslin, MPP partnered with Sheilah Gauch, LISW, M.Ed., Principal and Clinical Director with the Dearborn Academy and Echo Lustig, B.A., young adult behavioral health advocate, to share findings from the first phase of the three-part Lifting Voices initiative at Putting Care at the Center, the annual conference of the Camden Coalition’s National Center for Complex Health and Social Needs Initiative. See: Putting Care at the Center 2023, Elevating behavioral health in whole-person care. Boston, MA, November 1-3, 2023. Please look for us at the Beehive poster station on:

  1. Thursday, November 2 from 2:45 pm – 4:30 pm ET
  2. Friday, November 3 from 8:45 am – 10:30 am ET
Solutions

Using Virtual Research Data Center (VRDC) Data to Answer Big Questions

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Health Management Associates (HMA) is utilizing Virtual Research Data Center (VRDC) data to do what HMA does best: solve publicly funded healthcare’s most challenging problems. The combination of our deep analytics expertise and our nationally renowned subject matter experts can help you solve your toughest challenges.

We are committed to helping clients meet their needs through:

Market Analysis

Want to know how many psychologists are treating Medicaid patients in a county? Or how many duals got NEMT in a year? We can tell you that. How many folks on Medicare got drugs for Memory Loss last year? We can tell you that too. The VRDC allows us to examine the Medicaid and Medicare populations with significant precision to inform your decisions.

Consulting Services

We love hard questions. Carefully designed smaller queries can add up to answer big questions like “Does access to Non-Emergency Medical Transportation help patients managing challenging chronic medical conditions?” or, “Are services critical to patient success being delivered equitably to patient populations?” HMA can help you answer your hardest questions by breaking them into smaller questions that add up to big results. Outcomes Survey (HOS) specific to BH, and align data performance to quality improvement efforts.

Quality Improvement and KPI Benchmarking

HMA’s team of quality experts can help you identify metrics that matter internally to your organization as well as to your payers and providers. We can run metrics against these Medicaid and Medicare data to prepare you to manage risk through deep data analysis and creation of benchmarks that help manage access, cost, quality, and utilization.

HMA’s access to VRDC data through this agreement include:

Data representative of 100 percent of Medicare and Medicaid beneficiaries and their medical experience expressed as claims

Data representative of 100 percent of Part D Drug Event (PDE) data

Detailed Long-Term Care data for all Medicare and Medicaid beneficiaries through the MDS dataset

We can help organizations including:

State and municipal departments of health and public health

Health plans

Provider organizations

Analytics and technology vendors

Private equity

Correctional health

Contact our experts:

Jim McEvoy

Jim McEvoy

Data Analytics Resources Director

Jim McEvoy is accomplished in architecting robust technology solutions for state agencies, health plans and service providers. Jim understands the … Read more
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Eric Pfeifer

Data Analytics Resources Director

HMA News

New experts join HMA in August 2023

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HMA is pleased to welcome new experts to our family of companies in August 2023.

Dianne Bisacky – Principal
HMA

Dianne Bisacky is a seasoned professional with C-Level executive experience and a strategic mindset dedicated to driving growth and implementing innovative solutions.

Sheila Wilson – Principal
HMA

Sheila Wilson is a registered nurse with over 35 years of experience in both the clinical and managed care environments.

Read more about our new HMA colleagues

Sheila Wilson

Sheila Wilson

Principal