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Brief & Report

Issue brief proposes local option for uninsured


Examining the more than 3 million non-elderly poor adults in states without Medicaid expansion, the HMA team of Matt Powers and former HMA colleagues Nora Leibowitz and Jack Meyer, have authored an issue brief proposing a local health insurance option to fill gaps for these individuals who frequently lack access to meaningful healthcare.

The brief, Considerations for a Local Health Insurance Option in Medicaid Non-expansion States, published by the Milbank Memorial Fund, recognizes the critical role local entities and providers play in providing care and proposes a Local Choice Option, could:

  • Provide a comprehensive insurance product that promotes appropriate access to healthcare and better health outcomes
  • Repurpose funding now used only for direct care to provide healthcare more efficiently
  • Support local customization and create an alternative to an open-ended entitlement program in states where that is not currently politically tenable

The brief concludes a Local Choice Option would be a sound investment with the potential for quick implementation and benefits of health insurance not currently available to people living in poverty in non-expansion states.


CMS Will 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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Iowa releases Health Link Medicaid managed care RFP

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This week, our In Focus section reviews the Iowa Health Link request for proposals (RFP) for Medicaid managed care organizations (MCOs) to serve the state’s traditional Medicaid program, the Children’s Health Insurance Program (CHIP) known as Healthy and Well Kids in Iowa (Hawki), and the Iowa Health and Wellness Plan (IHAWP). The RFP was released by the Iowa Department of Human Services on February 17, 2022. Contracts are set to begin July 1, 2023, and are worth approximately $6.5 billion annually.

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Brief & Report

Report examines the value of community behavioral health providers and their networks


A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.

An HMA team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, The Value of Community Behavioral Health Providers & Their Networks with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).

Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.

New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:

  • Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
  • Warehouse and including data sharing requirements in future managed care contracts.
  • Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
  • Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.

California releases Medi-Cal RFP for Two-Plan, GMC, Regional Models

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This week, our In Focus section reviews the California Medicaid (Medi-Cal) managed care request for proposals (RFP) released by the California Department of Health Care Services (DHCS) on February 9, 2022. DHCS is procuring contracts for commercial plans for three of the Medi-Cal managed care plan models in 21 counties, serving approximately 3 million beneficiaries. Contracts will be awarded to one managed care organization (MCO) in each of the Two-Plan model counties, two MCOs in each of the geographic managed care (GMC) model counties, and two MCOs in each of the Regional model counties. This procurement is the largest released by California, rebidding contracts for commercial plans statewide.

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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

Case Study

Expanding access to CenteringPregnancy group care through telehealth


Poor birth outcomes, especially for communities of color, are a persistent health issue for our country. While there is no “cure” for preterm birth, the leading contributor to poor birth outcomes, group prenatal care is an evidence-based practice to reduce pre-term birth, especially for urban African American communities.

Group prenatal care provides a host of other benefits including improved breastfeeding rates, enhanced parental knowledge, and better pregnancy spacing. In addition, decreasing preterm birth provides tremendous cost savings.

The Centering Health Institute (CHI) has developed a successful model of group prenatal care called CenteringPregnancy™. CenteringPregnancy empowers patients, strengthens patient-provider relationships, and builds communities through three main components of health assessment, community building, and interactive learning delivered as a series of group visits with pregnant individuals at similar gestational age.

While more prenatal providers are offering Centering as a model of care, not every pregnant individual has access to this model. Maternity care in rural America is facing a crisis in access, and the COVID-19 pandemic required organizations to shift to care delivered through telehealth.

Download to read the approach and results.

Case Study

Strengthening MAT processes and OUD care in emergency departments


The prevalence of opioid use disorder (OUD) and the resultant harms from this disorder continue to escalate in the United States. The CDC’s National Center for Health Statistics released a report noting that in 2020, drug overdose deaths in the United States increased by nearly 30% over the previous year, reaching an all-time high of more than 100,000. The majority of these deaths are attributable to opioids.

Download the read the approach and results.


CMS payment notice signals shift in COVID-19 policies for Medicare Advantage, Part D

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This week our In Focus section reviews the Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies issued by the Centers for Medicare & Medicaid Services (CMS) on February 1, 2022. The Advance Notice includes proposed updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2023. It also shows CMS’ updates to Part D benefit parameters. Comments are due by 6:00 PM EST on March 4, 2022. The final Rate Announcement will be published by April 4, 2022.

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