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Brief & Report

KCMU Issue Brief Profiles Newer Programs in Medicaid Health Homes


HMA Managing Principal Mike Nardone and Julia Paradise authored the recently released issue brief, “Medicaid Health Homes: A Profile of Newer Programs” for the Kaiser Commission on Medicaid and the Uninsured (KCMU).

The Affordable Care Act (ACA) established a new state option in the Medicaid program to implement “health homes” for individuals with chronic conditions, giving states a new tool to develop models of care designed to improve care coordination and reduce costs for high-need populations. In August 2012, the KCMU issued a brief examining the first six health home programs. This update profiles health home programs in the nine states that have taken up the option in the intervening two years – Alabama, Idaho, Maine, Maryland, Ohio, South Dakota, Washington, Wisconsin, and Vermont.

States have implemented health home programs in a variety of ways, reflecting different targeting priorities, underlying delivery and payment systems, and visions of delivery system reform, as well as other state-level factors. This issue brief identified both themes and diversity in the more recent health home programs in a number areas, including geographic scope, target population, health home providers, payment, fee for service versus managed care, and HIT.

Brief & Report

Kaiser Releases Medicaid, CHIP Enrollment Snapshot Reports


On June 3, the Kaiser Commission on Medicaid and the Uninsured released its “Medicaid Enrollment Snapshot: December 2013” issue brief.

Authored by Kaiser’s Laura Snyder and Robin Rudowitz and HMA’s Eileen Ellis and Dennis Roberts, the report indicates that as of December 2013, nearly 55.4 million people were enrolled in Medicaid. That’s an increase of 585,000 enrollees from the prior year, but the slowest growth since before the Great Recession.

The report examines changes in monthly Medicaid enrollment from December 2012 to December 2013 and the factors that influenced those changes in a variety of ways. Factors of particular note include:

  • Continued improvement in economic conditions resulted in slower Medicaid enrollment growth.
  • Early expansion of Medicaid in some states, as well as successful outreach and enrollment efforts for new Marketplaces pushed enrollment up in some states.
  • Problems implementing new enrollment systems for the Federally Facilitated Marketplace (FFM) and State Based Marketplaces (SBM) put downward pressure on Medicaid enrollment growth.

Click here to access the report.

The Commission also released its “CHIP Enrollment Snapshot: December 2013” issue brief.

Authored by HMA’s Vern Smith and Kaiser’s Laura Snyder and Robin Rudowitz, the report shows nearly 5.8 million children were enrolled in the Children’s Health Insurance Program (CHIP) in December 2013. That represents a 3.1 percent increase from 2012.

This report examines changes in monthly CHIP enrollment between December 2012 and December 2013. Some findings of interest include:

  • Continued improvement in economic conditions likely resulted in both some growth as children shifted from Medicaid to CHIP and some declines as family incomes continued to increase above CHIP eligibility levels.
  • Successful outreach and enrollment efforts for new Marketplaces likely pushed enrollment up in some states.
  • Problems implementing new enrollment systems for the Federally Facilitated Marketplace (FFM) and State Based Marketplaces (SBM) likely put downward pressure on CHIP enrollment growth.

Click here to access the report.

Brief & Report

Issue Brief Explores Clinical Management Apps


HMA partnered with The Commonwealth Fund to develop an issue brief examining consumer mobile health applications, or apps. HMA Managing Principal Sharon Silow-Carroll and Principal Barbara Markham Smith explore the use of these apps in “Clinical Management Apps: Creating Partnerships Between Providers and Patients.”

The market for health and wellness apps for use on smart phones, tablets, and other mobile devices is still in its infancy, but is expected to double by the end of 2013. The brief explores current apps on the market, and focuses on those that connect patients with their clinicians and help them manage chronic conditions. It reports patient views about clinical management apps, and how these tools are impacting health outcomes. The brief also takes a look at the challenges to develop and spread the use of clinical management apps and what the future might hold for these tools, particularly for reaching vulnerable populations.

Brief & Report

HMA-authored report for SAMHSA-HRSA looks at health homes


The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) engaged Health Management Associates (HMA) to outline key areas of a recently enacted provision of the Affordable Care Act that permits Medicaid coverage of health homes, a service delivery model supporting care coordination and related supports for individuals with chronic conditions, including those with mental and substance use conditions.

HMA’s team of Managing Principal Jennifer N. Edwards and Principals Katharine V. Lyon, Juan Montanez, and Alicia D. Smith created “Financing and Policy Considerations for Medicaid Health Homes for Individuals with Behavioral Health Conditions: A Discussion of Selected States’ Approaches.”

This report has three purposes:

  • To describe the overarching policy considerations for states and potential providers of health home services
  • To discuss the roles of quality measurement and health information technology (HIT)
  • To explore options and considerations for developing reimbursement methodologies and establishing payment rates.

The report provides an overview of health home service design and Medicaid State Plan Amendment development. It outlines the processes that may be necessary for state governments to work with SAMHSA and CMS in order to receive consultation and obtain approval for Medicaid health home services. HMA authors also offer observations and recommendations for states interested in implementing the benefit.

Released this week, the report was developed for the SAMHSA-HRSA Center for Integrated Health Solutions with funds under grant number 1UR1SMO60319-01 from SAMHSA-HRSA, U.S. Department of Health and Human Services. The CIHS promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.

Brief & Report

New report highlights need to address long-term care demands


Health Management Associates (HMA) partnered with AARP Public Policy Institute and the National Association of States United for Aging and Disabilities (NASUAD) to issue a new report highlighting the challenges facing states in providing long-term services and supports (LTSS).

HMA Senior Consultant Jenna Walls is one of the authors of “At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint.” Released July 16, the report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms under way and trends across the country.

Brief & Report

Issue brief examines Medicaid outreach, enrollment strategies


A continuum of coverage options take effect under the Affordable Care Act (ACA) in 2014. In advance of this milestone, the Kaiser Family Foundation is offering a series of issue briefs that profile Medicaid outreach and enrollment strategies to inform efforts to implement the ACA.

HMA Principal Jennifer Edwards and Consultant Diana Rodin worked with Samantha Artiga, of the  Kaiser Family Foundation, to produce the recently released “Profiles of Medicaid Outreach and Enrollment Strategies: Helping Families Maintain Coverage in Michigan.” It is the second installment in the “Gearing up for 2014” series which highlights lessons learned from Medicaid and CHIP outreach and enrollment strategies . This brief profiles a new initiative of the Michigan Primary Care Association (MPCA) to facilitate coverage renewals through a systematic, technology-based reminder system coupled with one-on-one assistance.

The inaugural issue brief profiled a successful initiative among health centers in Utah to provide one-on-one Medicaid enrollment assistance.

Brief & Report

Report looks at Managed Care Organizations’ outreach efforts


The Commonwealth Fund

As state Medicaid programs are increasingly shifting beneficiaries into managed care organizations (MCOs), some MCOs are expanding their traditional role to better meet the needs of their vulnerable members and communities.

In a new Commonwealth Fund report, Health Management Associates Managing Principal Sharon Silow-Carroll and Consultant Diana Rodin, report on the efforts of four managed care organizations (MCOs) that are forging community partnerships to meet the needs of vulnerable Medicaid patients and others in their communities.

They developed four case studies:

These case studies describe the “how” and the “why” when it comes to MCOs addressing barriers and changing the way care is delivered, including internal and state policy drivers, leveraging partnerships and key take-aways.


Brief & Report

New report details state dual integration efforts


In the fall of 2012, Health Management Associates Senior Consultant Jenna Walls and colleagues from the AARP Public Policy Institute, and the National Association of States United for Aging and Disabilities (NASUAD) surveyed all 50 states and the District of Columbia to develop a comprehensive picture of emerging dual integration initiatives for older adults and adults with physical disabilities.

The research shows that two-thirds of all states will integrate Medicaid and Medicare services for dual eligibles over the next two years, most with statewide initiatives designed to target all full-benefit duals and span most types of long-term care services and supports. In addition, the report discovered that most states are turning to risk-based managed care models to deliver these integrated services to duals.


Brief & Report

Hospital Charges and Reimbursement for Drugs: 2019 Update Analysis of Markups Relative to Acquisition Cost


Analyses of prescription drug spending trends may not always include the role various parts of the pharmaceutical supply chain play in those trends. We estimate, based on publicly available data, how much hospitals paid, on average, to acquire a drug from its manufacturer. We then calculate the amount by which hospital charges and commercial insurers’ payment to hospitals for those drugs exceeded their acquisition cost. The tables that follow analyze hospital mark-ups and margins by site of service for 20 individual drugs for commercial payers.