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.

Show All | Podcast | Blogs | Webinars | Weekly Roundup | Videos | Case Studies | Reports | News | Solutions

Filter by topic:

Receive timely expert insights on topics you care about.

Select Topics

1806 Results found.

Webinar

Webinar Replay: Provider Network Adequacy Monitoring

Watch Now

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

Watch Now

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.

Brief & Report

HMA Releases Medicaid Managed Care White Paper

Download

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

Download

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
Webinar

Webinar Replay: Trends in State Medicaid Programs

Watch Now

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

Watch Now

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: Medicaid, Marketplace Outreach and Enrollment

Watch Now

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: FQHC Readiness for Value-Based Payments

Watch Now

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.