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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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
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

Blog

Florida releases procurement for statewide Medicaid prepaid dental program

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This week, our In Focus section reviews the Florida Statewide Medicaid Prepaid Dental Program invitation to negotiate (ITN) released October 6, 2023, by the Florida Agency for Health Care Administration (AHCA). Contracts will serve 4.4 million Statewide Medicaid Managed Care (SMMC) members.

Background

The Florida Statewide Medicaid Prepaid Dental Program is a full-risk capitated dental program, which began rolling out by groups of regions in December 2018. The incumbent statewide Medicaid dental plans are DentaQuest, Liberty, and MCNA Dental.

Florida also is reprocuring its traditional managed medical assistance (MMA) program and managed long-term care program under SMMC. Awards for Medicaid managed care organizations (MCOs) are expected in February 2024.

ITN

Florida intends to award contracts to at least two plans. One of AHCA’s goals is to contract with plans that will support the HOPE Florida: Pathways to Prosperity initiative, which focuses on community collaboration between the private sector, faith-based community, not-for-profits, and government entities to break down traditional community silos. Through this program, AHCA seeks to:

  • Improve oral health outcomes by implementing a quality continuum
  • Enable personalized oral healthcare, particularly for people with special needs
  • Strengthen the network of dental providers
  • Integrate medical and dental care

In addition to the services currently provided, dental plans will cover authorized hospital outpatient and ambulatory surgery center (ASC) services as part of the new contracts. Plans will cover ancillary medical services provided secondarily to dental care in an ASC or outpatient hospital setting when medically necessary.

Dental plans will continue to operate statewide across all regions. Capitation rates for Medicaid and dually eligible members, however, are set regionally. Rates for medically necessary procedures are set at a statewide level. The new contracts will consolidate the 11 regions into nine as shown in the table below.

Timeline

Responses are due January 5, 2024, and notification of intent to award is anticipated to be released on March 29, 2024. Contracts will run from the execution date in 2024 through 2030.

Evaluation

Technical proposals will be scored using a total weighted score of 6,600, as shown in the table below.

Link to RFP

Solutions

Consumer Assessment of Healthcare Providers Systems (CAHPS): Improving Member Experience

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Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and should, work to improve their Consumer Assessment of Healthcare Providers Systems (CAHPS) scores.

The CAHPS annual survey measures member experience with providers and Medicare and Medicaid health insurance plans. It has also become a critical metric used by the Centers for Medicare and Medicaid Services (CMS).

Plans can work to improve CAHPS scores by developing a comprehensive improvement plan involving a holistic year-around approach that involves monitoring the member experience from enrollment through disenrollment. With score improvement comes incentive payments tied to high quality performance.

CAHPS SCORES ARE USED BY:

The National Committee for Quality Assurance (NCQA) to STAR rate health plans in accreditation scoring

Potential members to compare plan scores against one another on the NCQA website

Several state Medicaid programs that require plans to report these surveys and use scores as part of their incentive programs

CMS, which has increased its STAR rating, CAHPS-related measure from double weighted to quadruple weighted in contract year 2021

Medicare Advantage Prescription Drug (MAPD) plans, which use CAHPS to calculate 32% of the overall aggregate score

CAHPS COHORTS THAT ARE MEDICARE STAR MEASURES

PART C CAHPS MEASURES (WEIGHTS)

Getting needed care (4)

Getting appointment and care quickly (4)

Customer service (4)

Rating of healthcare quality (4)

Rating of health plan (4)

Care coordination (4)

Annual flu vaccine (1)

PART D CAHPS MEASURES (WEIGHTS)

Rating of drug plan (4)

Getting needed prescription drugs (4)

ADDITIONAL STAR MEASURES AND ACTIVITIES THAT RELATE TO MEMBER EXPERIENCE

PART C MEASURES (WEIGHTS)

Complaints about the health plan (2)

Member choosing to leave the plan (2)

Plan makes timely appeals decisions (2)

Reviewing appeal decisions (2)

Call center, language interpreter and TTY availability (2)

Health plan quality improvement (5)

PART D MEASURES (WEIGHTS)

Call center, language interpreter and TTY availability (2)

Complaints about the drug plan (2)

Member choosing to leave the drug plan (2)

Drug plan quality improvement (5)

Health Management Associates’ expert colleagues can help plans outline an organizational assessment of member experience and customize interventions and solutions to increase scores.

Our team of quality and accreditation experts can help organizations improve customer service and scores by:

Establishing a year-around effort

Using an organizational effort to break down department silos and improve cooperation between departments

Assessing core functions within the plan and contractors that contribute to member experience including marketing, enrollment, disenrollment, UM, QI, member service, grievances, appeals, etc.

Identifying and addressing patient frustrations with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Recognizing social determinants of health (SDOH) are often overlooked in access to care-related issues, such as lack of transportation or lack of funds for co-payments

Outlining techniques for obtaining point-of-service feedback to help address potential member experience issues before they arise

Contact our experts:

Sarah Owens

Sarah M. Owens

Principal

A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
David Wedemeyer

David Wedemeyer

Principal

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
Solutions

Star Rating: We Can Help You Navigate to a Higher Level

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What is the VALUE of a Star in your plan(s)?

What initiatives have you introduced to prepare for the changes in the Star Rating that may impact your overall Star Rating results?

What are you doing for health equity focus? What data are you collecting for health equity?

What do you think are your organization’s financial implications when Star Rating requirements change?

What are your Star Rating strategies for increasing your organization’s market share and viability?

What sort of interventions, data sources, analytics and reporting have you found to be successful to improving your Star Rating?

WE CAN HELP YOU BY:

Establishing a year-around effort to improve Star Rating performance

Assessing core functions within the plan and contractors that contribute to understanding members

Identifying and addressing customer concerns with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Working on health equity issues including sharing techniques for obtaining data

Leveraging all data and intervention efforts (such as risk and quality) to drive decision and focus

Contact our experts:

Sarah Owens

Sarah M. Owens

Principal

A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
David Wedemeyer

David Wedemeyer

Principal

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
Solutions

HMA Can Help You Prepare for The Joint Commission (TJC) Accreditation and Certification

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HMA’s team of experts have completed accreditation requirements with our clients as well as in our formal executive and operational leadership roles in the health care setting.  We work closely with our clients and with TJC and other accreditation programs with a focus on improving healthcare quality and favorable outcomes. Our team of seasoned healthcare executive consultants bring more than 100 years of experience in clinical, quality, and operations, with proven results. HMA offers a full continuum of accreditation services for hospitals, ambulatory surgical centers (ASCs), Federally Qualified Health Centers (FQHCs) and behavioral health (BH) care settings. We work closely with FQHCs to provide assistance for certifications and advanced certifications in health equity (HE). HMA can offer onsite or virtual mock survey and gap analysis preparation for TJC accreditation, as well as tactical and advisory support to prepare our client leadership teams for a winning accreditation survey results and supporting the development of a sustainable plan to achieve year over year success!

Our experts can help you by:

Assessing core functions supporting the implementation of the latest TJC standards and interpretation of the standards

Building the business case for TJC accreditation

Guiding your team through the new HE standards

Creating quality and assessment improvement plan (QAPI) to lead to a successful survey

Continuous survey readiness support via a sustainable plan

And so much more across the continuum

Contact us at [email protected]

Contact our experts:

Trisha Bielski

Trisha Bielski

Senior Consultant

A highly specialized critical care, trauma and flight nurse, Trisha Bielski has deep experience in nursing leadership, military healthcare, and … Read more
Ruth Danielzuk

Ruth Danielzuk

Senior Consultant

Driven by collaboration across the healthcare landscape, Ruth Danielzuk is a seasoned quality and innovation expert with experience managing programs … Read more
Matthew Sandoval

Matthew Sandoval

Principal

Matthew Sandoval is an accomplished leader in healthcare with a proven track record of managing the administration, operations, and quality … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more