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HMA Insights: Your source for healthcare news, ideas and analysis.

HMA Insights 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 blogs, webinars, case studies, reports and more.

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Webinar

Webinar Replay: Building Population-Based Integrated Delivery Systems for Vulnerable Populations

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On December 10, 2015, HMA Information Services hosted the webinar, “Building Population-Based Integrated Delivery Systems for Vulnerable Populations.”

Designing and implementing population-based integrated delivery systems, particularly those involving multiple medical, behavioral health, dental and social service providers, has become a focus of states, health plans and providers themselves. This focus is growing to include people covered by Medicaid and other government programs, in addition to Medicare. New models are emerging and lessons being learned about effective approaches.

During this webinar you’ll hear from HMA Principals Art Jones, MD, Jeanene Smith, MD, MPH, and Vice President Pat Terrell and about some of these approaches, as well as experiences to build upon. Listen to the replay and:

  • Understand the key elements of and best approaches to the design and implementation of multiple provider integrated delivery systems serving primarily Medicaid and uninsured populations.
  • Learn how Oregon’s experience with the Coordinated Care Model is shaping both care delivery in that state as well as influencing other similar approaches across the country.
  • Learn about a model in Chicago, the Medical Home Network, which is now fully operating as an integrated delivery system for a significant Medicaid membership.
  • Hear discussion about barriers and challenges (and strategies to overcome them) as well as the emerging benefits to providers, payers and patients alike.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: Total Cost of Care Benchmarks and Physician Practices

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On December 9, 2015, HMA Information Services hosted the webinar, “Total Cost of Care Benchmarks and Physician Practices: An Early Stage Evaluation of Five Regional Healthcare Improvement Collaboratives Funded by the Robert Wood Johnson Foundation.”   

The Total Cost of Care and Resource Use framework developed by HealthPartners is at the center of a pilot program funded by the Robert Wood Johnson Foundation (RWJF) to identify and address healthcare overuse and inefficiency in five areas of the country. RWJF funded (NRHI) – along with five regional healthcare improvement collaboratives (RHICs) – to implement the first phase of the pilot, which involves the use of multi-payer commercial claims data to produce and share total cost of care benchmarks with physicians and practices. 

During this webinar, representatives of NRHI, the Oregon Health Care Quality Corp., MN Community Measurement, and Health Management Associates (HMA) share findings from an evaluation of this first phase of the pilot. The results of the evaluation, conducted by HMA, illustrate both the challenges and promises of using cost transparency initiatives to drive delivery system change. Listen to the replay and:

  • Understand how each RHIC’s specific approaches and progress vary according to pre-existing data collection infrastructures, stakeholder dynamics and the local healthcare environment.
  • Learn how RHICs are dealing with concerns over the measurements and public reporting, and how they are incorporating technical assistance and checklists to improve data quality.
  • Understand the importance of seeking physician input and feedback as early as possible to help design and plan the project and to ensure that total cost of care reporting is actionable. 
  • Find out how efforts among RHICs to work collaboratively and share lessons learned helped accelerate progress toward the development and dissemination of total cost of care reporting in their communities.
  • Learn how the early experiences of RHICs can be applied to other regionally based healthcare transparency and reform initiatives.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: Transforming Care: From Volume to Value

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On December 9, 2015, HMA and IBM Watson Health presented a webinar, “Transforming Care: From Volume to Value.”  

As the federal government, state governments, payers, and health care providers across the country move from traditional fee-for-service payment models toward value-based care models,  initiatives such as Medicaid Health Homes, Medicare Accountable Care Organizations and Delivery System Reform Incentive Payment (DSRIP) programs are dramatically changing the way health care services are delivered, managed and paid for.

During this webinar, experts discussed the principles and goals of value-based care that underpin state and national reform efforts, the role that information technology (IT) will play in support of these goals, and examples of how IT has enabled provider and payer organizations to pursue value-based care initiatives.

HMA:

  • The principles and goals of value-based care (Tony D. Rodgers, HMA Principal)
  • The implications of value-based care for physicians and other health care providers (Jean Glossa, MD, HMA Principal)
  • The role of health care IT in moving the U.S. health care system from volume to value (Lynn Dierker, HMA Principal)

IBM Watson Health:

  • The technology innovations that exist to enhance, scale and accelerate human expertise to help individuals live healthier and more productive lives (Eric Fichtel, Care Management Director at IBM Watson Health)

The HMA and IBM Watson Health slide decks for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

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Webinar

Webinar Replay: Provider Network Adequacy Monitoring

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On December 8, 2015, HMA Information Services hosted the webinar, “Provider Network Adequacy Monitoring: Findings and Recommendations from the 2015 Robert Wood Johnson Foundation-Funded Survey of States and Health Plans.”

Invest in network standards. Monitor program-wide provider capacity. Increase after-hours access. Deploy data analytics. Increase states’ role in network oversight. These are some of the key findings and recommendations from the Robert Wood Johnson Foundation-funded survey of health plans and state regulators concerning provider network adequacy compliance and monitoring standards. The survey, conducted by Health Management Associates (HMA), was designed to identify important trends and potential challenges in provider access monitoring and compliance given the dramatic increase in health insurance coverage under the Affordable Care Act.

During this webinar, HMA Principals Karen Brodsky and Barbara Markham Smith outline nearly a dozen findings and recommendations, providing a roadmap for both states and health plans seeking more effective and efficient ways of ensuring adequate provider access for members. Listen to the replay and:

  • Identify key differences in network adequacy compliance and monitoring standards among states and learn why a push for more standardization of methods and metrics is necessary.
  • Understand the need to track provider overlap among competing health plan networks to get a true read on provider capacity in a state or region.
  • Learn why health plans are increasingly including essential community providers in Medicaid, commercial and exchange networks.
  • Understand health plan reports regarding where they exceed state network requirements in order to ensure better provider access.
  • Find out how after-hours access is being addressed for primary care service access.
  • Understand the importance of data analytics in identifying network access problems, especially the type of problems that result in increased use of emergency room and out-of-network care.
  • Assess the role of state insurance regulators and the likelihood they will need to step up their involvement in monitoring network adequacy among health plans.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: Care Management Essentials

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On December 2, 2015, HMA Information Services hosted the webinar, “Care Management Essentials: Practical Approaches to Implementing a Successful Care Management Program.”

Care management is growing in importance as healthcare providers taking on risk seek effective ways of improving patient outcomes while controlling costs. The most successful care management programs offer practical methods for identifying members in need of interventions, effective care plans, face-to-face consultation, and reliable methodologies for tracking results.

During this webinar, HMA Principal Nancy Jaeckels Kamp provides the key steps for designing and implementing a successful care management program – including the type of infrastructure and workflow redesign needed to ensure your organization’s care management efforts deliver measureable results. Listen to the replay and:

  • Understand the key elements of a successful care management program.
  • Learn practical approaches to identifying eligible patients for appropriate care management interventions.
  • Identify infrastructure needs, workflows and processes that support care management.
  • Find out how care management initiatives aimed at complex medical conditions can dovetail with similar efforts targeting depression and other mental health issues.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: Trends in State Medicaid Programs

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On November 18, 2015, HMA Information Services hosted the webinar, “Trends in State Medicaid Programs: Emerging Models and Innovations.”

CCOs, RCOs, ACOs, Medicaid managed care, 1115 Waivers, 1332 Waivers, block grants, DSRIP, consumerism, integrated care, managed long-term care, patient-centered medical homes, duals demonstrations, evidence-based care. Let’s face it, there is a wide variety of economic and service delivery models emerging to serve the nation’s rapidly growing Medicaid population. While the use of Medicaid managed care continues to increase, other models are vying for relevance – and attracting interest and attention.

During this webinar, HMA Managing Principal Tina Edlund and Principals Barbara Coulter Edwards and Steve Fitton provide a high-level, strategic look at trends in state Medicaid programs – with an emphasis on how innovations in payment reform, service integration, and coordinated care models may impact the future of Medicaid. Listen to the replay and:

  • Assess the strategic implications of emerging economic and service delivery models for state Medicaid populations and weigh the strengths and weaknesses of the various approaches.
  • Understand the role that delivery system redesign can play in assuring program sustainability as states expand coverage.
  • Find out whether the shift to consumerism in health care will impact Medicaid benefit design and financial assumptions.
  • Get the latest on Medicaid financing, budget and payment reform initiatives that are at the center of virtually every attempt to address the quality, sustainability and cost of Medicaid.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: Medicaid, Marketplace Outreach and Enrollment

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On December 1, 2015, HMA Information Services hosted the webinar, “Outreach and Enrollment: Maximizing Medicaid and Marketplace Penetration.”

The only thing more important than offering healthcare coverage through Medicaid or an insurance exchange is making sure that people actually sign up. That’s why outreach and enrollment initiatives are vital.

  • During this webinar, HMA Principal Cathy Kaufmann reports on various efforts by states, health plans and advocacy groups to maximize their outreach and enrollment efforts. The goal: making sure that all those eligible for healthcare coverage – even the hardest to reach populations – understand their options and get signed up. Listen to the replay and:
  • Understand why wide variation in outreach and enrollment initiatives among states has a direct impact on Medicaid and exchange enrollment and penetration.
  • Overcome barriers to successful outreach and enrollment for African-American, Hispanic, Native American, and other hard-to-reach populations.
  • Evaluate alternative funding streams and partnerships with community organizations to help facilitate outreach initiatives, reduce uncompensated care, and connect people to social services, such as the Supplemental Nutrition Assistance Program (SNAP) or housing assistance.
  • Understand the importance of federally funded assisters who screen people for eligibility in Medicaid or the marketplace.
  • Reduce gaps in care, with a special focus on the population of eligibles who churn between Medicaid and the exchange.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: An Inside Look at Findings from the 15th Annual Kaiser 50-State Medicaid Budget Survey

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On November 19, 2015, HMA Information Services hosted the webinar, “Medicaid Enrollment and Spending Trends: An Inside Look at Findings from the 15th Annual Kaiser 50-State Medicaid Budget Survey.”   

Medicaid enrollment and spending both rose nearly 14 percent in fiscal year 2015 among 50 states and the District of Columbia, according to the 15th annual Medicaid budget survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU). Spending growth is expected to slow to 6.9 percent in fiscal 2016, while enrollment growth slows to 4 percent, the study projects. 

What’s driving these trends, and what are states doing to improve healthcare quality while controlling costs? That’s the topic of this webinar from Health Management Associates, which works with KCMU each year to conduct the survey. HMA Managing Principals Eileen Ellis, Kathy Gifford, and Vern Smith outline key findings from the budget survey and discuss what it all means for the future of Medicaid. Listen to the replay and:

  • Assess the impact of Medicaid expansion on state budgets, including savings in areas like behavioral health, uncompensated care, and criminal justice.
  • Learn why Medicaid spending and enrollment growth will slow in 2016, and why the gap in the rate of increase between expansion and non-expansion states will narrow.
  • Identify the key drivers of Medicaid spending growth.
  • Understand the extent of major Medicaid payment and delivery system reforms among states.
  • Find out how state Medicaid directors were remarkably accurate in projecting Medicaid enrollment and spending trends in 2015 – and what that may mean for the 2016 outlook.
  • Gain insight into which states could expand Medicaid in the future and what that might mean for struggling state budgets.
  • Assess the financing of Medicaid in 2017 and beyond, when the federal matching rate for expansion enrollees begins to decline.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: FQHC Readiness for Value-Based Payments

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On November 17, 2015, HMA Information Services hosted the webinar, “FQHC Readiness for Value-Based Payments: Priorities for Success.”

Federally Qualified Health Centers (FQHCs) continue to struggle with dramatic changes in the way in which healthcare is financed in a post-ACA world. The shift to value-based payments is the latest test. The question is whether FQHCs are equipped to accept value-based payments while remaining financially sustainable.

During this webinar, HMA Principal Art Jones, MD, Managing Principal Gaylee Morgan, Senior Consultant Rob Werner, and Principal Deborah Zahn outline a step-by-step readiness assessment that FQHCs can implement to measure their ability to successfully take on risk under a value-based payment model. The webinar also provides case studies of FQHCs that have successfully entered into a variety of risk-sharing arrangements, providing important lessons about how FQHCs are adapting to new funding mechanisms. Listen to the replay and:

  • Understand key trends driving the need for FQHCs to shift to value-based payments and explore new partnerships and collaborations.
  • Understand key components of population health management, including how to understand and stratify risk, implement targeted interventions, and consistently deliver and manage care.
  • Learn how FQHCs are playing an important role in accountable care organizations, with an emphasis on reducing the global cost of care while improving patient outcomes.
  • Find out how FQHCs are joining forces to create their own independent practice associations and ACOs, driven by a desire to shift from a fee-for-service model to value-based payments.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: Oregon and the Future of Medicaid Managed Care

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On November 12, 2015, HMA Information Services hosted the webinar, “Oregon and the Future of Medicaid Managed Care.”

Oregon is host to the nation’s biggest experiment in Medicaid managed care. Unlike most states, which rely on Medicaid managed care plans, Oregon has enrolled 90 percent of its Medicaid population in newly formed Coordinated Care Organizations (CCOs). These CCOs are networks of local providers who care for a population of Medicaid members under a fixed global budget – with an emphasis on care coordination, integrated care, wellness, and chronic disease management.

During this webinar, HMA Managing Principal Tina Edlund and Principals Cathy Kaufmann and Sean Kolmer provide a status report on the Oregon initiative, including key components of the model, initial quality and cost results, and the likelihood that CCOs represent the Medicaid managed care model of the future. Listen to the replay and:

  • Assess the impact of the Oregon model on total cost of care for a Medicaid population and on the ability of the state to bend the Medicaid cost curve.
  • Compare the performance of CCOs based on 17 quality measures, including substance abuse screenings, hospital readmissions, and primacy care.
  • Understand the role of the Oregon Transformation Center, which works with CCOs to support delivery systems change, improve care and reduce costs.
  • Evaluate the 1115 waiver that enabled implementation of the Oregon Medicaid model, including components that might apply to states with more traditional Medicaid managed care programs.
  • Learn how Medicaid reform can impact the broader healthcare delivery system in a state, resulting in overall improvements in quality and cost.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: The Age Wave in Social Programs

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On November 11, 2015, HMA Information Services hosted the webinar, “Are You Ready for the Age Wave in Social Programs?”

America is aging. By 2030, approximately one in five Americans will be 65 or older. This age wave will have dramatic implications for the financing and delivery of government-sponsored social programs, including Medicaid and Medicare-Medicaid dual eligibles.

During this webinar, HMA Vice President Joan Henneberry and Senior Consultant Lisa Shugarman outline the challenges that an aging population poses for Medicaid health plans, state Medicaid programs, and dual eligibles initiatives. They also provide a roadmap to the type of innovative partnerships required among payers, providers and policy makers to better serve this population. Listen to the replay and:

  • Understand the importance of building relationships at the community level to best meet the needs of an aging population.
  • Obtain case studies of the types of partnerships and reimbursement models that have successfully incentivized payers and providers to serve members with complex needs.
  • Learn what health plans can expect as states begin to move Long-Term Services and Supports into a managed care environment.
  • Find out how to leverage home and community-based services to broaden the reach of preventive care and proactively assess an individual’s health needs.

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.

Webinar

Webinar Replay: The Future of Community Behavioral Health

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On November 10, 2015, HMA Information Services hosted the webinar, “The Future of Community Behavioral Health: Leveraging the Transformation to Value-Based Health Care.”   

Community behavioral health has never been more relevant. Not only have the costs of caring for those with behavioral health needs become a focal point of delivery system reform, but the medical system has also come to value the type of person-centered health care and social supports that the community behavioral health sector provides.

Leading healthcare organizations are already taking advantage of the significant opportunities for advancing behavioral health within delivery system redesign. Their success is instructive in an array of areas, including managing organizational change, strategically building out the continuum of care, and pursuing the partnerships, mergers and acquisitions that provide scale, capacity and leverage. 

During this webinar, HMA Principals Heidi Arthur, Josh Rubin, and Meggan Schilkie highlight the opportunities available to community behavioral health providers and offer a roadmap for success. Listen to the replay and:

  • Take advantage of new and innovative payment mechanisms and successfully navigate the transition to value-based payments.
  • Learn how the behavioral health community is addressing the social determinants of health by providing supportive housing and using peer support to complement clinical care.
  • Recognize partnerships, mergers, and acquisitions as important potential vehicles for expanding service lines and building critical mass. 
  • Understand the organizational and clinical advantages to becoming a Certified Community Behavioral Health Center.
  • Assess infrastructure readiness for important functions like data warehousing, continuous quality improvement, compliance, prospective financial modeling, cost-of-care reporting, value-based payments, and managed care.
  • Develop an approach to change management that accommodates rapid transition, promotes stability, and fosters buy-in during expansion and enhancement. 

The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.