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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Blog

Staying ahead of the star rating curve: insights from HMA and Wakely’s Medicare Summit

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This week, our In Focus section highlights a presentation from HMA and Wakely, an HMA company, titled “Staying Ahead of the Star Rating Curve – A Case Study,which was given at the 12th Medicare Stars, HEDIS, Quality Assurance, & Risk Adjustment Summit on June 15, 2022.

The presentation provided an overview of major changes in the Medicare stars program, which will result in both higher ratings and significantly higher revenues for many Medicare Advantage plans in 2023.  However, the presentation indicated the higher ratings reflect temporary changes and not necessarily improvements in quality, adding that Medicare Advantage plans should be cautious about enhancing future benefits based on additional 2023 revenues.

Click here to view the presentation.

For questions, please contact our experts below.

Blog

Behavioral health crises drive bipartisan action in Congress

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Agreement about the severity of the nation’s mental health and substance use disorder crises is rising above the partisan politics in Congress. In fact, these are among a handful of issues driving work on bipartisan legislation across all the key House and Senate committees with jurisdiction over behavioral health programs and policies this year.

On May 18, the U.S. House of Representatives Energy and Commerce Committee unanimously approved the “Restoring Hope for Mental Health and Well-Being Act of 2022” (H.R. 7666). This legislation incorporates a collection of bipartisan bills to update and reauthorize over 30 Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) programs addressing the mental health and substance use disorder (SUD) crisis. The bill also advances initiatives to strengthen the 9-8-8 National Suicide Prevention Lifeline implementation efforts, invest in the crisis response continuum of care, and support strategic opioid crisis response plans among numerous other policies. Energy and Commerce is one of several House committees planning to advance behavioral health bills this year.

U.S. Senate committee leaders have been similarly engaged in developing bipartisan proposals to address mental health and substance use disorders. Senate Health, Education, Labor and Pensions (HELP) and Finance committee leaders are expected to reveal their proposals as soon as this summer. The Finance Committee’s proposal will focus on Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) policies and could reflect findings from the committee’s report, “Mental Health Care in the United States: The Case for Federal Action.” Similarly, HELP members Sens. Chris Murphy (D-CT) and Bill Cassidy (R-LA) introduced the Mental Health Reform Reauthorization Act to extend several expiring mental health programs, which could be incorporated in that Committee’s comprehensive proposal. Across committees, there has been an interest in strengthening parity, supporting integration of primary and behavioral health care, increasing access to youth mental health screenings, scheduling fentanyl analogues, and easing requirements for prescribing Medication Assisted Treatment.

What To Expect

Congressional leaders have consistently expressed their desire to advance bipartisan legislation to address the urgent needs and gaps in the mental health and SUD care delivery systems, as well as support education and research.  While these are key areas to watch, the diminishing number of legislative days on the congressional calendar and climate surrounding November’s mid-term elections create uncertainty for the timing and scope of Congress’ work. It remains to be seen whether a package of health care proposals, such as reauthorization of the U.S. Food and Drug Administration’s user fee programs, the Cures 2.0 legislation to advance biomedical research, mental health and substance use disorder legislation, and the PREVENT Act could be sent to President Biden’s desk before the end of September.

HMA companies are supporting clients impacted by the policy changes being discussed and the program funding addressed in these legislative proposals. Understanding the landscape for federal change allows state and local governments and stakeholders to plan for and shape these opportunities. For more information, please contact our experts below.

Blog

CMS hospital inpatient rule proposes novel methods for calculating 2023 payment rates

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This week, our In Focus section reviews the policy changes included in the Centers for Medicare & Medicaid Services’ (CMS) Fiscal Year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (CMS-1771-P). This year’s IPPS Proposed Rule includes several important policy changes that will alter hospital margins and change administrative procedures, beginning as soon as October 1, 2022.

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Blog

HMA conference on “The New Normal for Medicaid, Medicare, and Other Publicly Sponsored Programs” to feature insights from health plan leaders, state Medicaid directors, and providers

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Pre-Conference Workshop: October 9, 2022
Conference: October 10-11, 2022
Location: Fairmont Chicago, Millennium Park

HMA Conference on the New Normal for Medicaid, Medicare, and Other Publicly Sponsored Programs to Feature Insights from Health Plan Leaders, State Medicaid Directors, Providers

Early Bird registration is now open for HMA’s fifth national conference on trends in publicly sponsored healthcare. Early Bird Registration Ends July 11th.

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Blog

President’s budget recommends significant investments in unity agenda issues

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This week, our In Focus section reviews President Biden’s budget proposal for federal fiscal year 2023, released on March 28, 2022. The President’s proposal kicks off the Congressional budget process and negotiations on the annual spending bills for the federal fiscal year that starts October 1, 2022. The budget proposal highlights the Administration’s program initiatives and recommended legislative and regulatory changes. The President’s budget is merely a request of Congress, who drafts the actual budget resolution that will go into effect if passed.

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Brief & Report

Learning from COVID-19-related flexibilities: moving toward more person-centered Medicare and Medicaid programs

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A new person-centered assessment framework and issue brief, authored by HMA experts in conjunction with Manatt Health, examine the temporary regulatory Medicare and Medicaid flexibilities implemented during the COVID-19 public health emergency (PHE) and aimed at ensuring access to care for older adults and people with chronic conditions and disabilities.

As these temporary flexibilities are currently set to expire in April 2022, the report provides insight and guidance for policymakers as they assess the impact these regulatory policy changes are having on advancing person- and community-centered care and consider possible permanence of these changes.

The framework is designed to help facilitate these conversations and decisions and assess the potential for continuation of the regulatory flexibilities to advance person- and community-centered care, facilitate access to care in the least intensive or least restrictive setting, and better align Medicare and Medicaid program rules.

HMA colleagues Jennifer Podulka, Yamini Narayan, and Keyan Javadi contributed to the framework and research.

Brief & Report

Issue brief examines greater flexibility for primary care models

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An issue brief released today outlines new Medicare payment models that offer greater flexibility and aim to shift more care to primary care models, moves that can improve quality and reduce costs. HMA authors, Jennifer Podulka, Yamini Narayan, and Lynea Holmes found the two newest primary care payment models, Global and Professional Direct Contracting (which will be re-branded as Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) beginning January 1, 2023) and Primary Care First offer more flexibility than previously released approaches and represent a promising step forward for primary care.

The report, Increasing Medicare’s Investment in Primary Care, also notes that to increase the likelihood that models achieve overall cost savings and/or quality improvement, one option for the Center for Medicare and Medicaid Innovation is to test approaches that place greater value on primary care and give primary care providers greater flexibility to tailor care for people outside of a fee-for-service system. These changes could improve people’s access to care, the quality of care received, and quality of life.

Blog

CMS to accept applications for new Medicare ACO REACH model

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This week our In Focus section reviews the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center’s newly announced model – Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH). CMS will accept applications from organizations interested in participating and is particularly interested in partnering with provider-led organizations and similar groups with direct patient care experience and a strong track record serving underserved populations that focus on primary care to better manage Medicare beneficiaries’ health. Applications are due by April 22, 2022.

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Webinar

Webinar replay: summary and implications of the 2023 Medicare Advantage advance notice

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This webinar was held on February 22, 2022. 

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which proposes important changes in plan payments, risk adjustment, Star Ratings, and other key financial and regulatory requirements for 2023.

During this webinar, consultants from Wakely Consulting Group, an HMA Company, provided an overview of the proposed changes, with an emphasis on the likely impact that the new rates and policies will have on Medicare Advantage bids, membership growth, quality, and strategy. Speakers also touched on other recent public statements from federal regulators that could point to additional future changes for Medicare Advantage plans.

Learning Objectives 

  • Understand how the proposals in the Advance Notice will impact Medicare Advantage payment rates in 2023.
  • Learn about updates to payment models and risk-adjustment methodologies, including a new effort to engage Medicare Advantage plans in value-based models that transform care.
  • Find out how new initiatives to account for how well plans address equity and social determinants of health will impact Star Ratings.
  • Understand the growth prospects for Medicare Advantage, including a look at how COVID-19 continues to affect plan membership growth, financial risk, and profitability.

HMA Speakers

Thomas Grivakis, Senior Consulting Actuary, Wakely

Rachel Stewart, Consulting Actuary, Wakely

Ready to talk?