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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Webinar

Webinar Replay – Health Performance Accelerator Webinar Series: How States Are Rethinking Medicaid Managed Care Performance Management

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This webinar was held on September 8, 2020.

State Medicaid agencies (SMAs) are actively exploring improved approaches to managing the performance of Medicaid managed care organizations (MCOs) and accountable care organizations (ACOs), emphasizing tailored quality measures, new incentive models, more effective use of information technology, and revised contract requirements.

During this webinar, experts from HMA and HealthEC outlined potential improvements to MCO/ACO performance management and showcased ways in which information technology can be deployed to enable these improvements.

Learning Objectives:    

  • Learn about ways in which the number and mix of measures, the design of business processes and use of information systems should change to achieve improvements in MCO/ACO performance management.
  • Learn how HMA can work with SMAs on performance management initiatives.
  • Find out how IT solutions such as HealthEC’s can dramatically improve SMA processes such as data aggregation, synthesis, transformation, validation, and comparative analysis in support of performance management system improvements.

Speakers

Steve Soto, Principal, HMA
Sita Kapoor, HealthEC, Chief Information Officer

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

Hawaii Releases Quest Integration Reprocurement RFI

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This week, our In Focus section reviews the Hawaii request for information (RFI) regarding reprocurement of the state’s QUEST Integration (QI) Medicaid managed care program, released on July 21, 2020. QI covers approximately 360,000 individuals, including pregnant women, children, parents/caretakers, adults, and individuals who are aged, blind, or disabled (ABD). The state had awarded contracts earlier this year, however, the contracts were rescinded as the state focused on their response to COVID-19.

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Blog

Oklahoma releases Medicaid managed care request for public feedback

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This week, our In Focus section reviews the Oklahoma request for public feedback in the SoonerCare program design, released on June 18, 2020. The Oklahoma Health Care Authority (OHCA) and Governor Kevin Stitt are seeking stakeholder input for the state’s Medicaid managed care program design before finalizing a request for proposals (RFP). The RFP, which is currently in development, is scheduled to drop in the fall and has an implementation date of October 2021. Individuals, program participants, providers, trade associations, companies, and other organizations are encouraged to submit responses by August 17, 2020.

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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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Blog

Medicaid and exchange enrollment update – March 2020

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This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “March 2020 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,” published on June 22, 2020. Additionally, we review 2020 Exchange enrollment data from the “Health Insurance Exchanges 2020 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 2, 2020. Combined, these reports present a picture of Medicaid and Exchange enrollment in early 2020, leading up to the COVID-19 pandemic and representing 70.9 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees. Medicaid/CHIP and Exchange enrollment is expected to rise in 2020 according to a team of HMA Medicaid experts, health economists, and data analysts. Read the previous In Focus on HMA’s forecast model.

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Blog

GAO 50-state Medicaid survey on federal policy challenges

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This week our In Focus section summarizes the United States Government Accountability Office (GAO) Medicaid report, State Views on Program Administration Challenges, released earlier this year. GAO conducted interviews with Medicaid officials from 50 states and the District of Columbia to identify challenges related to federal Medicaid policies.  

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Blog

Medicaid Managed Care Spending in 2019

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This week, our In Focus section reviews Medicaid managed care spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), we have received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2019. We expect the final version of the report will be completed by the end of 2020 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2019 exceeded $594 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.5 billion, bringing total program expenditures to $623.5 billion.

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Brief & Report

HMA experts publish 50-state Medicaid pharmacy study with Kaiser Family Foundation

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In conjunction with the Kaiser Family Foundation (KFF), a team of HMA experts have published survey results and analysis examining administration of the Medicaid pharmacy benefit. HMA contributing colleagues were Kathleen Gifford, Anne Winter and Linda Wiant. Rachel Dolan, Marina Tian, and Rachel Garfield from KFF also contributed.

The report, How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020, summarized the survey conducted in all 50 states and the District of Columbia.

The survey outlines Medicaid pharmacy policy areas and key issues to watch based on feedback from the states in several categories including pharmacy benefit administration, cost-containment and utilization controls, payment and rebates, 340B management and long-term priorities.

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