Insights

HMA Insights: Your source for healthcare news, ideas and analysis.

HMA Insights—including briefs, webinars, and our podcast—gives you easy access to HMA’s deep expertise, helping you stay current on the latest healthcare trends and topics. Search for a topic of interest or browse the latest insights below.

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Brief & Report

HMA examines current state of Medicare-Medicaid integration programs

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The experts at Health Management Associates (HMA) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.

Based on HMA’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.

HMA colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.

For the next phase of research, HMA will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.

The project was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.  

Blog

Regulatory changes to Medicare in response to COVID-19

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This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.  As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.

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Brief & Report

HMA releases COVID-19 Medicare regulation tracking tool

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The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, HMA, commissioned by The Commonwealth Fund and The SCAN Foundation, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.

HMA Senior Consultant Jennifer Podulka and Managing Principal Jon Blum led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief Regulatory Changes to Medicare in Response to COVID-19 and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.

The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.

Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.

These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.

Webinar

Webinar Replay: Exploring Medicare Advantage Plans as a New Business Strategy

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This webinar was held on August 6, 2020.

The COVID-19 pandemic shined a spotlight on funding pressures on providers and systems that rely largely on fee-for-service payment. This, along with additional stressors brought on by the pandemic, has led many health systems and providers to consider revenue diversification and service expansion strategies. During this webinar, HMA Medicare Advantage experts addressed the option of using Medicare Advantage as a strategy to better manage care of patients and provide a steady stream of predictable revenues.

Learning Objectives:

  • Evaluate the benefits and risks of exploring a Medicare Advantage business strategy.
  • Understand the evolving national Medicare Advantage policy landscapes and competitive marketplace.
  • Assess various Medicaid Advantage plan options and strategic business considerations.
  • Find out about the unique market opportunities of Medicare Advantage Special Needs Plans.
  • Learn what needs to be done for a successful Medicare Advantage launch or expansion in 2022.

HMA Speakers

Jon Blum, Managing Principal, Washington, DC
Mary Hsieh, Managing Principal, Atlanta, GA

Blog

HMA announces cancellation of 2020 annual conference

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Health Management Associates has made the decision to cancel its October 2020 conference on Trends in Publicly Sponsored Healthcare, given continuing developments concerning COVID-19 and out of an abundance of caution for the safety of attendees, speakers, and staff. Full refunds will be made to registered attendees and sponsors.

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Webinar

Webinar Replay: Nursing Home Revenue Diversification and Care Options Series: Exploring Medicare Advantage as an Alternative Revenue Source for Post-Acute Providers

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This webinar was held on July 17, 2020.

Even before COVID-19, post-acute providers such as nursing homes struggled with inadequate reimbursement rates and declining occupancy rates. This, along with additional stressors brought on by the pandemic, has led many nursing homes to consider revenue diversification and service expansion strategies. During this webinar (the first in a series), HMA Medicare Advantage and long-term care experts addressed two such options for nursing homes: Medicare Advantage Institutional Special Needs Plans (I-SNP) and Institutional-Equivalent Special Needs Plans (IE-SNP).

Learning Objectives

  • Understand Medicare Advantage, its significance and its growth
  • Identify types of Medicare Advantage options for residents and community-based beneficiaries
  • Explore how Medicare Advantage can serve as a potential revenue diversification strategy
  • Learn about the benefits and risks of   Medicare Advantage, in particular for I-SNPs
  • Identify how to assess if an I-SNP or an IE-SNP is the right opportunity for your organization

HMA Speakers

Mary Hsieh, Managing Principal, Atlanta, GA
Susan Tucker, Principal, Tallahassee, FL

Blog

CMS updates Medicare Advantage and Section 1876 cost plan network adequacy

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This week, our In Focus section examines new guidance issued by the Centers for Medicare & Medicaid Services (CMS) regarding Medicare Advantage (MA) plan network adequacy requirements. On June 17, 2020, CMS released updated Medicare Advantage and 1876 Cost Plan Network Adequacy Guidance for Medicare Advantage (MA) health plans to use now for Contract Year 2021 network submission. 

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Blog

Impact of COVID-19 federal policy on Medicare Advantage

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This week, our In Focus section examines the operational impacts of federal Medicare Advantage policy changes in response to the COVID-19 pandemic. On January 31, 2020, the Secretary of Health and Human Services declared a public health emergency. This was followed by a national emergency declared by President Trump on March 13, 2020. These declarations provide the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) authority to waive certain Medicare and Medicaid regulatory requirements to help health plans, providers, and other stakeholders respond to immediate needs of their members and communities. These waiver flexibilities, when combined with other legislative and regulatory changes issued by Congress and CMS have resulted in over 200 policy changes to Medicare alone. Many of these affect Medicare Advantage sponsors and have direct implications to current and future operations of plan responsibilities. We examine eight categories of requirements and flexibilities that have significant business relevance and exposure for Medicare Advantage plan sponsors:

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Webinar

Webinar Replay: Federal COVID-19 Response: Medicare Advantage Policy Changes and Impacts

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This webinar was held on June 11, 2020.

In response to the rapid spread of the COVID-19 virus, Congress and the Centers for Medicare & Medicaid Services (CMS) have made significant policy changes to Medicare Advantage regulations, allowing for expanded benefits and other flexibilities designed to better serve the Medicare population.

During this webinar, HMA experts addressed the impact of these changes, including a look at policies affecting cost sharing, telehealth, Star Ratings, prescription drugs, provider funding, appeals, and Special Needs Plans (SNP). Speakers also addressed the likelihood that these policies remain in place even after the COVID-19 emergency ends.

Learning Objectives: 

  • Learn about changes in federal Medicare Advantage policies in response to COVID-19.
  • Understand how Medicare Advantage plans, including Special Needs Plans, are adjusting to the new rules, including the impact on benefit design, care delivery, payment models, and quality.
  • Identify operational implications of Medicare Advantage policy changes to ensure continued delivery of high-quality care to beneficiaries.

HMA Speakers:

  • Julie Faulhaber, MBA, Principal, Chicago
  • Mary Hsieh, PharmD, MPH, Managing Principal, Atlanta
  • Narda Ipakchi, MBA, Senior Consultant, Washington, DC
  • Sarah Owens, Principal, Philadelphia
  • Danielle Pavliv, MPH, PMP, Senior Consultant, Atlanta
Brief & Report

2020 Medicare Advantage Supplemental Benefit Flexibilities: Adoption of and Access to Newly Expanded Supplemental Benefits

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An HMA-authored issue brief examines beneficiary access to, and plan adoption of, newly expanded Medicare Advantage (MA) supplemental benefit flexibilities and raises questions regarding the expected impacts of new supplemental benefit offerings on beneficiary satisfaction, outcomes, and total cost of care.

The new flexibilities for MA plans include innovative supplemental benefits offered through expansion of primarily health-related benefits, benefits offered non-uniformly, Value-Based Insurance Design (VBID), and Special Supplemental Benefits for the Chronically Ill (SSBCI).

The brief’s key finding is that enrollment in plans offering these flexibilities is relatively low and varies across geographic areas with 19% of all MA enrollees enrolled in a plan that offered at least one expanded supplemental benefit.  HMA will conduct additional analyses including interviews with key stakeholders to inform the policy community on the opportunities and challenges with the adoption and implementation of new supplemental benefits.

This brief was produced by HMA Managing Principals Jonathan Blum and Mary Hsieh, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi under a grant from Arnold Ventures.

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