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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Webinar

Webinar Replay: 21st Century LTSS – A Roadmap

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On September 23, 2015, HMA Information Services hosted the webinar, “21st Century LTSS – A Roadmap to Improved Outcomes, Lower Costs and Better Lives for Individuals with Complex Healthcare Needs.”

There is an urgent need for health plans, accountable care organizations, and providers to integrate LTSS into their overall concept of person-centered care for individuals with complex needs. Being responsive to the needs of consumers in an effective manner requires a fresh conceptualization of LTSS, one that will provide the flexibility needed to deliver person-centered care in a manner that improves overall quality of life while bending the cost curve through reduction of unnecessary hospital use. This means leveraging LTSS touch points at the community level, proactively identifying member needs, and linking individuals to appropriate community-based care before an emergency room visit or hospitalization is necessary.

During this webinar, HMA Senior Consultant Ellen Breslin, and Dennis Heaphy, policy expert with Disability Policy Consortium and chairman of the Massachusetts One Care Implementation Council, explore how payers and providers can work together to create financial incentives and protocols that drive 21st Century LTSS.

Listen to the recording and:

  • Understand how to leverage LTSS to build a robust primary care prevention strategy by relying on community health workers to help identify the healthcare needs of individuals with complex conditions.
  • Learn how to align provider incentives with patient needs by pursuing a value-based purchasing strategy that creates a direct link between payments and consumer-defined outcomes.
  • Find out how risk adjustment models for LTSS can help fine-tune provider reimbursements and improve payment accuracy.
  • Identify strategies to improve the overall integration of LTSS into the delivery of person-centered care, including granting providers greater authority to streamline the authorization process.

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

Webinar

Webinar Replay: A Step-by-Step Guide to Integrating Behavioral Health into the Primary Care Setting

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On September 22, 2015, HMA Information Services hosted the webinar, “Evidence-based Integration: A Step-by-Step Guide to Integrating Behavioral Health into the Primary Care Setting.”

There is a clear and growing body of evidence that supports the integration of behavioral health into the primary care setting. Numerous trials show that integration delivers upon the triple aim, generating a measurable return on investment over time, improving outcomes for patients, and resulting in a high quality experience for patients. Furthermore, health plans, state and national demonstrations, and accrediting bodies are moving in this direction. During this webinar, HMA experts Lori Raney, MD, and Nancy Jaeckels Kamp provided a step-by-step guide to integration, including key structural and organizational investments, process improvements, and the type of training required to make integration work.

Listen to the recording and:

  • Identify four key structural changes required for successful integration, including implementation of screening tools, a registry or tracking system, step-care protocols, and a team approach to care coordination.
  • Understand the role that integrated care managers and consulting psychiatrists play in extending and maximizing psychiatric resources.
  • Assess various trials and case studies that demonstrate a return on investment for integrating behavioral health into primary care.
  • Avoid pitfalls by clearly defining the roles of care managers in the primary care setting and training the primary care team to identify and understand behavioral health issues.

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

Webinar

Webinar Replay: Sustainable Funding for Asthma-Related Home Interventions

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On September 15, 2015, HMA Information Services hosted the webinar, “Sustainable Funding for Asthma-Related Home Interventions.”

Home interventions aimed at eliminating key drivers of asthma attacks like mold, dust, pests and tobacco smoke can improve the lives of those with asthma and dramatically reduce the cost of this chronic disease. Unfortunately, not all asthma-related home interventions are reimbursed by payers, despite the well-documented return on investment. During this webinar, HMA Managing Principals Jack Meyer and Mike Nardone, and Ruth Ann Norton, president and CEO, Green & Healthy Homes Initiative, outlined how to make the business case for asthma-related home interventions and build a sustainable stream of funding for those initiatives.

Listen to the recording and:

  • Learn how to obtain coverage of asthma-related home interventions by working with Medicaid through a variety of mechanisms, including targeted case management, state plan amendments, innovation grants and 1115 waivers.
  • Assess the cost savings potential of asthma home visits, including reductions in emergency care, hospitalizations and school and work absenteeism.
  • Understand the various payment models and how they might be leveraged to fund asthma-related home interventions, including fee-for-service, fixed fee per visit and bundled payments.
  • Find out how to make the business case for asthma-related home interventions to Medicaid managed care plans, with an emphasis on improving outcomes and lowering the cost of chronic disease.
  • Understand the importance of in-depth community needs assessments in making the business case for asthma-related home interventions.

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

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/.