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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: Medicaid Network Adequacy

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On August 26, 2015, HMA Information Services hosted the webinar, “Medicaid Network Adequacy: A Proactive Approach to Ensuring and Demonstrating Compliance.”

Health Management Associates Principal Karen Brodsky (who previously oversaw managed care contracting for the state of New Jersey), discussed the warning signs state regulators look for when assessing the adequacy of a Medicaid managed care plan’s network. She also outlined some practical ways plans can get out in front of these potential problems – not only demonstrating compliance to regulators but also improving access and satisfaction for members.

Listen to the recording and:

  • Identify the warning signs of potential network adequacy issues and proactively fix problems before they affect member access and spark Medicaid agency inquiries.
  • Understand which provider network access triggers are directly connected to access issues and which may not be related to network problems, yet still raise network compliance concerns. 
  • Assess the viability of partnerships with community groups to satisfy demand for providers that meet the needs of members with special needs.
  • Improve communications with state agencies, providers, advocates and community-based organizations about the status of the provider network and how to work with the health plan if there is an access problem.

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

Webinar

Webinar Replay: MLTSS: Understanding the Impact of the New Medicaid Managed Care Regulations

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On July 1, 2015, HMA Information Services hosted the webinar, “Managed Long-Term Services and Supports: Understanding the Impact of the New Medicaid Managed Care Regulations.”

As part of the newly proposed Medicaid managed care regulations, CMS is seeking to codify the way in which state and federal regulators oversee MLTSS programs. It’s no surprise CMS is taking action, given the dramatic growth of MLTSS. But the proposed rules mean states, health plans, and providers will have to shoulder a wide variety of new compliance requirements in areas such as network adequacy, patient-centered planning, care coordination and quality measurement.

During this webinar, HMA Senior Consultant Lisa Shugarman and Managing Principal Susan Tucker outlined the proposed MLTSS rules and discussed the implications for states, health plans, and providers serving the long-term care market. Listen to the recording and:

  • Understand the framework for MLTSS as codified in the proposed rule.
  • Learn about CMS’ proposed definition of long-term services and supports.
  • Assess changes to network adequacy standards as well as person-centered planning and care coordination standards for MLTSS.
  • Gain insight into CMS’ quality focus for MLTSS.

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

Webinar

Webinar Replay: What New Medicaid Managed Care Regulations Mean for Health Plan Quality, Performance Measurement

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On June 17, 2015, HMA Information Services hosted the webinar, “What the New Medicaid Managed Care Regulations Mean for Health Plan Quality and Performance Measurement.”

The proposed Medicaid managed care regulations released last month by CMS include fundamental changes in the way quality and performance is measured among health plans in state-sponsored programs. The rules seek to align quality and performance measures with existing government programs like Medicare Advantage, institute a quality ratings system, support a variety of performance improvement projects, and increase the role of external quality review.

During this webinar, HMA Principal Matt Roan and Senior Consultant Lisa Shugarman outline the proposed quality rules and discuss the implication for states, Medicaid managed care plans and other stakeholders. Listen to the recording and:

  • Understand the implications of the proposed Medicaid Managed Care Quality Rating System
  • Learn how new, federal, standardized quality measures and performance improvement projects requirements will be incorporated into existing quality programs
  • Gain insight into CMS’ quality focus for Managed Long Term Services and Supports
  • Assess changes to the external quality review process as well as the role of accreditation in state review and approval of Medicaid health plans
  • Identify managed care elements of Comprehensive State Quality Strategies

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

Webinar

Webinar Replay: Minimum MLRs and Rate Setting Requirements

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On June 16, 2015, HMA Information Services hosted the webinar, “Minimum MLRs and Rate Setting Requirements: Implications of the Proposed Medicaid Managed Care Regulations.”

Health Management Associates Managing Principal Eileen Ellis and Steve Schramm, managing director of Optumas, talked about the proposed changes to the rate setting process and the implications for states, Medicaid managed care plans and other stakeholders. Listen to the recording and:

  • Understand how the 85% MLR requirement may impact the financial flexibility of Medicaid managed care plans.
  • Assess how the shift to actuarial certification of specific rate cells will impact the competitive environment for Medicaid managed care plans.
  • Learn how the new rules may provide Medicaid managed care plans with additional risk-sharing opportunities.
  • Find out how the proposed 85% MLR rules for Medicaid managed care align with existing state and NAIC regulations.
  • Explore the additional documentation requirements from the perspectives of states as well as managed care organizations.

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

Webinar

Webinar Replay: New York State’s Ambitious DSRIP Program: A Case Study

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On May 28, 2015, HMA Information Services hosted the webinar, “New York State’s Ambitious DSRIP Program: A Case Study.”

New York has by far the most ambitious Delivery System Reform Incentive Payment (DSRIP) Program in the nation. The program has a clear focus on full health system transformation and payment reform. The state will invest $6.4 billion to incentivize collaboration among health care providers, social service providers, and community-based organizations to dramatically alter the way health care is delivered to Medicaid recipients. The primary goal: a 25% reduction in avoidable hospital use over five years. Getting there will require huge investments in community-based care, improvements in key quality metrics like hospital readmissions, and the continued shift from traditional fee-for-service payment models to value-based care.

Health Management Associates Principal Denise Soffel, PhD, has been on the front lines in helping New York plan, develop, and implement its DSRIP initiative. She provided an in-depth look at the initiative, including how the New York program will inform the thinking of other states considering applying for waivers, and why New York’s clear focus on health system transformation and payment reform signals the future direction of DSRIP nationwide.

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

Webinar

Webinar Replay: First Take on New Medicaid Managed Care Regulations

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On May 28, 2015, HMA Information Services hosted the webinar, “HMA’s ‘First Take’ on New Medicaid Managed Care Regulations.”

CMS just released a new set of proposed Medicaid managed care and CHIP regulations – the first major update of federal rules for health plans in state-sponsored programs in more than a decade. The changes seek to align Medicaid managed care regulations with those of other government-sponsored programs, while at the same time fostering innovation, transparency, quality and financial viability. Like all such rules, details matter. And at more than 650 pages, these proposed rules have a lot of details to digest. It will take weeks – if not months – to fully understand the ins and outs of the new regulations. However, an initial read reveals several important themes likely to dramatically impact Medicaid managed care going forward.

During this webinar, HMA experts offered a “first take,” with initial thoughts and reactions to key components of the new regulations. Topics our experts touched on include:

  • The emphasis on aligning Medicaid, Medicare and commercial regulations
  • The new Medical Loss Ratio requirements
  • The new rate setting requirements
  • Establishment of a quality rating system
  • Regulations targeted specifically at Managed Long Term Services and Supports
  • Marketing and enrollment
  • How the regulations are intended to promote flexibility of access to care for members with severe mental illness

Please note that this webinar was a panel discussion, and as such, there was only one slide used – it is the slide you see providing speaker contact information.

Webinar

Webinar Replay: Breaking Down the Armstrong Ruling and What It Means

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On April 30, 2015, HMA Information Services hosted the webinar, “Implications of the U.S. Supreme Court’s Ruling in Armstrong v. Exceptional Child Center: A Real-world Analysis.”

The U.S. Supreme Court recently limited the ability of healthcare providers to file lawsuits against state Medicaid programs over the adequacy of provider payment rates. The court’s decision in Armstrong v. Exceptional Child Center is good news for states looking to rein in Medicaid costs. But many fear it will be bad news for Medicaid beneficiaries, who may struggle to find access to quality care if providers refuse to participate in the program because of insufficient payment rates. Enforcement of Medicaid’s promise to provide high-quality health care to the poor now falls largely in the lap of CMS, whose enforcement tools may not be up to the task.

During this webinar, our presenters provided an analysis of the possible real-world implications of this decision – for providers, beneficiaries, states and Medicaid managed care plans.

Speakers included:

Meghan Linvill McNab, J.D., Krieg DeVault
Leah Mannweiler, J.D., Partner, Krieg DeVault
Kathy Gifford, J.D., Managing Principal, Health Management Associates
Catherine Rudd, J.D., Senior Consultant, Health Management Associates

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

Webinar

Webinar Replay: Culturally Responsive Health Care and CLAS Standards

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On March 12, 2015, HMA Information Services hosted the webinar, “Do the Right Thing: Culturally Responsive Health Care and the Federally Mandated CLAS Standards.”

Not only is culturally responsive health care the right thing to do, but key elements are mandated by the federal CLAS standards (Culturally and Linguistically Appropriate Services). There is also a strong business case for culturally responsive health care; it drives patient satisfaction, helps improve outcomes, and brings a degree of economic viability to what is essentially an unfunded mandate. Unfortunately, many healthcare organizations find themselves either unfamiliar with the standards or lagging in the development and implementation of strategies for full compliance.

During this webinar, HMA Principal Dr. Jeff Ring makes the case for culturally responsive health care and illustrates how to make culturally responsive health care work for patients and the organizations serving them.

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

Webinar

Webinar Replay: A Guide to Planning Integrated Care for Underserved Populations

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On Jan. 28, 2015, HMA Information Services (HMAIS) hosted the webinar, “Shoulder to Shoulder: A Guide to Planning Integrated Care for Underserved Populations.”

Just in time for those planning to apply for SAMHSA’s $1.6 million Primary and Behavioral Health Care Integration (PBHCI) opportunity, the webinar featured our integration experts discussing key factors for successfully planning, coordinating, and delivering integrated healthcare to high need, vulnerable populations in any setting.

HMA speakers included:

  • Heidi Arthur, Principal
  • Terry Conway, M.D., Managing Principal
  • Pat Dennehy, DNP, Principal
  • Gina Lasky, Ph.D, HMA Community Strategies Project Manager
  • Jeffrey Ring, Ph.D, Principal

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

Be sure to check out all that HMAIS, the ultimate source of Medicaid data, has to offer at https://hmais.healthmanagement.com/.

Webinar

Webinar Replay: The Missing Link: Stable Housing as a Key Determinant of Health in Medicaid Populations

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On Dec. 12, 2014, HMA hosted the webinar, “The Missing Link: Stable Housing as a Key Determinant of Health in Medicaid Populations.”

This webinar featured healthcare and housing experts on the front lines of ground-breaking work that tackles housing as part of a strategy to improve health and health outcomes.

John Lovelace of UMPC for You offered a case study of his organization’s growing, three-year-old Shelter Care Plus program for the homeless. William C. Kelly, Jr. of Stewards of Affordable Housing for the Future (SAHF) discussed the Medicaid business case for housing as a platform to serve the health needs of other low-income populations. And HMA’s Mike Nardone talked about the link between housing and Medicaid-financed health care.

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

Webinar

Webinar Replay: The Republican Midterm Victory and the Potential Impact on Healthcare Reform

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On Nov. 25, 2014, HMA hosted the webinar, “The Republican Midterm Victory and the Potential Impact on Healthcare Reform.”

During this webinar, Kaiser News Network and former NPR correspondent Julie Rovner assessed the likely impact of this important election on key components of the Affordable Care Act, including Marketplace enrollment, Medicaid expansion, delivery system reform, and the political environment that has proponents and opponents of the law in bitter conflict. The session was moderated by Jack Meyer, a managing principal in HMA’s Washington, DC, office.

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

Webinar

Webinar Replay: Public Health Departments in the Era of Delivery System Reform

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On Nov. 19, 2014, the HMA Healthcare Transformation Institute, formerly the Accountable Care Institute, hosted the webinar, “Public Health Departments in the Era of Delivery System Reform.”

This webinar explored the importance of local and state health department involvement and leadership in the discussions and decision-making processes related to health care delivery and finance reforms. It featured officials from three public health departments who have experience as leaders in community-wide health reform initiatives.

Speakers

Jillian Jacobellis, PhD, Deputy Advisor, Colorado Department of Public Health and Environment

Patricia Harrison, Deputy County Executive for Human Services, Fairfax County

Leticia Reyes-Nash, Division Chief, Illinois Department of Public Health

HMA Moderators

Pat Terrell, Managing Principal, Chicago
Joan Henneberry, Managing Principal, Denver
Dr. Margaret Kirkegaard, Principal, Chicago

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

Visit the Healthcare Transformation Institute at www.accountablecareinstitute.com. You can find the HTI’s accompanying paper, “The Critical Role of Public Health Departments in Health Care Delivery and System Reform” by clicking here.