Insights

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

HMA Insights 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 blogs, webinars, case studies, reports and more.

Show All | Blogs | Webinars | Weekly Roundup | Expert Videos | Case Studies | MI Update | Briefs & Reports | HMA News | Solutions

Filter by topic:

Receive timely expert insights on topics you care about.

Select Topics

365 Results found.

Brief & Report

The Value of Medicaid Managed Care

Download

In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

  • Planning and implementation
  • Stakeholder engagement
  • Procurement approaches
  • Outreach and enrollment
  • Contract management and monitoring
Webinar

Webinar Replay: Trends in State Medicaid Programs

Watch Now

On November 18, 2015, HMA Information Services hosted the webinar, “Trends in State Medicaid Programs: Emerging Models and Innovations.”

CCOs, RCOs, ACOs, Medicaid managed care, 1115 Waivers, 1332 Waivers, block grants, DSRIP, consumerism, integrated care, managed long-term care, patient-centered medical homes, duals demonstrations, evidence-based care. Let’s face it, there is a wide variety of economic and service delivery models emerging to serve the nation’s rapidly growing Medicaid population. While the use of Medicaid managed care continues to increase, other models are vying for relevance – and attracting interest and attention.

During this webinar, HMA Managing Principal Tina Edlund and Principals Barbara Coulter Edwards and Steve Fitton provide a high-level, strategic look at trends in state Medicaid programs – with an emphasis on how innovations in payment reform, service integration, and coordinated care models may impact the future of Medicaid. Listen to the replay and:

  • Assess the strategic implications of emerging economic and service delivery models for state Medicaid populations and weigh the strengths and weaknesses of the various approaches.
  • Understand the role that delivery system redesign can play in assuring program sustainability as states expand coverage.
  • Find out whether the shift to consumerism in health care will impact Medicaid benefit design and financial assumptions.
  • Get the latest on Medicaid financing, budget and payment reform initiatives that are at the center of virtually every attempt to address the quality, sustainability and cost of Medicaid.

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

Webinar

Webinar Replay: An Inside Look at Findings from the 15th Annual Kaiser 50-State Medicaid Budget Survey

Watch Now

On November 19, 2015, HMA Information Services hosted the webinar, “Medicaid Enrollment and Spending Trends: An Inside Look at Findings from the 15th Annual Kaiser 50-State Medicaid Budget Survey.”

Medicaid enrollment and spending both rose nearly 14 percent in fiscal year 2015 among 50 states and the District of Columbia, according to the 15th annual Medicaid budget survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU). Spending growth is expected to slow to 6.9 percent in fiscal 2016, while enrollment growth slows to 4 percent, the study projects.

What’s driving these trends, and what are states doing to improve healthcare quality while controlling costs? That’s the topic of this webinar from Health Management Associates, which works with KCMU each year to conduct the survey. HMA Managing Principals Eileen Ellis, Kathy Gifford, and Vern Smith outline key findings from the budget survey and discuss what it all means for the future of Medicaid. Listen to the replay and:

  • Assess the impact of Medicaid expansion on state budgets, including savings in areas like behavioral health, uncompensated care, and criminal justice.
  • Learn why Medicaid spending and enrollment growth will slow in 2016, and why the gap in the rate of increase between expansion and non-expansion states will narrow.
  • Identify the key drivers of Medicaid spending growth.
  • Understand the extent of major Medicaid payment and delivery system reforms among states.
  • Find out how state Medicaid directors were remarkably accurate in projecting Medicaid enrollment and spending trends in 2015 – and what that may mean for the 2016 outlook.
  • Gain insight into which states could expand Medicaid in the future and what that might mean for struggling state budgets.
  • Assess the financing of Medicaid in 2017 and beyond, when the federal matching rate for expansion enrollees begins to decline.

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

Webinar

Webinar Replay: Medicaid, Marketplace Outreach and Enrollment

Watch Now

On December 1, 2015, HMA Information Services hosted the webinar, “Outreach and Enrollment: Maximizing Medicaid and Marketplace Penetration.”

The only thing more important than offering healthcare coverage through Medicaid or an insurance exchange is making sure that people actually sign up. That’s why outreach and enrollment initiatives are vital.

  • During this webinar, HMA Principal Cathy Kaufmann reports on various efforts by states, health plans and advocacy groups to maximize their outreach and enrollment efforts. The goal: making sure that all those eligible for healthcare coverage – even the hardest to reach populations – understand their options and get signed up. Listen to the replay and:
  • Understand why wide variation in outreach and enrollment initiatives among states has a direct impact on Medicaid and exchange enrollment and penetration.
  • Overcome barriers to successful outreach and enrollment for African-American, Hispanic, Native American, and other hard-to-reach populations.
  • Evaluate alternative funding streams and partnerships with community organizations to help facilitate outreach initiatives, reduce uncompensated care, and connect people to social services, such as the Supplemental Nutrition Assistance Program (SNAP) or housing assistance.
  • Understand the importance of federally funded assisters who screen people for eligibility in Medicaid or the marketplace.
  • Reduce gaps in care, with a special focus on the population of eligibles who churn between Medicaid and the exchange.

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

Webinar

Webinar Replay: Oregon and the Future of Medicaid Managed Care

Watch Now

On November 12, 2015, HMA Information Services hosted the webinar, “Oregon and the Future of Medicaid Managed Care.”

Oregon is host to the nation’s biggest experiment in Medicaid managed care. Unlike most states, which rely on Medicaid managed care plans, Oregon has enrolled 90 percent of its Medicaid population in newly formed Coordinated Care Organizations (CCOs). These CCOs are networks of local providers who care for a population of Medicaid members under a fixed global budget – with an emphasis on care coordination, integrated care, wellness, and chronic disease management.

During this webinar, HMA Managing Principal Tina Edlund and Principals Cathy Kaufmann and Sean Kolmer provide a status report on the Oregon initiative, including key components of the model, initial quality and cost results, and the likelihood that CCOs represent the Medicaid managed care model of the future. Listen to the replay and:

  • Assess the impact of the Oregon model on total cost of care for a Medicaid population and on the ability of the state to bend the Medicaid cost curve.
  • Compare the performance of CCOs based on 17 quality measures, including substance abuse screenings, hospital readmissions, and primacy care.
  • Understand the role of the Oregon Transformation Center, which works with CCOs to support delivery systems change, improve care and reduce costs.
  • Evaluate the 1115 waiver that enabled implementation of the Oregon Medicaid model, including components that might apply to states with more traditional Medicaid managed care programs.
  • Learn how Medicaid reform can impact the broader healthcare delivery system in a state, resulting in overall improvements in quality and cost.

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

Brief & Report

HMA’s Smith Part of NAMD Panel Reviewing Medicaid at 50

Download

HMA Managing Principal Vern Smith was one of four experts who took part in the plenary panel discussion “Medicaid at 50: Past, Present and Future” at the National Association of Medicaid Directors (NAMD) fall conference Tuesday. He was joined by:

  • Thomas Betlach, NAMD President, Arizona Medicaid Director, AHCCCS
  • Deborah Bachrach, Partner, Manatt, Phelps & Phillips LLP
  • Charles Milligan, Jr., CEO, UnitedHealthcare Community & State – New Mexico

The tenures of these Medicaid agency leaders have spanned the history of Medicaid. They discussed how Medicaid has fundamentally transformed from its origins in 1965, and what the future of the program holds. Judith Moore, co-author of Medicaid Politics and Policy, and a health policy consultant, moderated the panel which followed the keynote address of Secretary Sylvia Mathews Burwell of the U.S. Department of Health and Human Services.

Click here to see the discussion as it appears in the video archive of C-Span3.

Brief & Report

HMA’s Breslin Authors Primer on Medicaid Managed Care Capitation Rates

Download

HMA Senior Consultant Ellen Breslin prepared the recently released “Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs” for the Massachusetts Medicaid Policy Institute. It includes:

  • An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
  • The overall process for setting Medicaid managed care capitation rates; and
  • The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.
Brief & Report

A Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs

Download

HMA Senior Consultant Ellen Breslin prepared this recently released primer for the Massachusetts Medicaid Policy Institute. It includes:

  • An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
  • The overall process for setting Medicaid managed care capitation rates; and
  • The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.
Brief & Report

Annual Survey Finds ACA Drove Record Annual Increases in Enrollment, Total Medicaid Spending

Download

The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015, with both rising an average of nearly 14 percent. This is just one finding in the 15th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

Released Oct. 15, this report provides an in-depth examination of the changes taking place in state Medicaid programs across the country. Health Management Associates conducted the survey of Medicaid directors across the country. The survey shows big differences across states driven largely by the states’ decisions on the Medicaid expansion and also provides an examination of state Medicaid policy and program changes across the country. 

HMA Managing Principals Vernon K. Smith, Kathleen Gifford and Eileen Ellis authored the report along with Robin Rudowitz, Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

Two additional issue briefs were developed as well:

Medicaid Enrollment & Spending Growth: FY 2015 & 2016, which provides an analysis of national trends in Medicaid enrollment and spending.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016, a collection of three case studies of Medicaid programs in Alaska, California and Tennessee.

Brief & Report

Medicaid Enrollment & Spending Growth: FY 2015 & 2016

Download

This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Vernon K. Smith and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation authored this brief.

Executive Summary

Beginning in Fiscal Year (FY) 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state FY 2015 and state FY 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described in this report.

Brief & Report

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016

Download

This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Kathleen Gifford, Principal Barbara Edwards and Senior Consultant Jenna Walls authored this brief with Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

The years 2015 and 2016 continue a period of significant change and transformation for Medicaid programs. With slow but steady improvements in the economy following the Great Recession, Medicaid programs across the country were focused on implementing a myriad of changes included in the Affordable Care Act (ACA), pursuing innovative delivery and payment system reforms with the goals of assuring access, improving quality and achieving budget certainty, and continuing to administer this increasingly complex program.

However, these changes to Medicaid policy take place in the larger context of states budgets. Unlike the Federal government, states generally have balanced budget requirements, taking into account the amount of revenue coming in from a state’s own resources as well as federal revenues. State lawmakers must balance competing priorities across budget expenditure categories. Even in years of economic growth, state lawmakers face this pressure of balancing priorities.

This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states:

  • Alaska
  • California
  • Tennessee
Brief & Report

Michigan Medicaid Managed Care Results Announced

Download

 

In previous editions of The Michigan Update (most recently in August) we have reported on the Michigan Department of Health and Human Services’ (MDHHS) release of a Request for Proposals (RFP) to re-procure its Medicaid managed care contracts. The RFP was released in early May with bidder responses due in early August. This procurement is for at least five years, with the possibility of up to three one-year extensions. The total cost of the procurement for five years is estimated to be $35 billion. On October 13, 2015 the State of Michigan announced the much anticipated results of the re-procurement.
 
Since the prices paid to the contracted HMOs are set by the state, the health plan selection was based solely on technical scores. The HMOs were required to bid on entire regions, which were configured differently than in the past. The reconfiguration required a number of the HMOs to expand their service areas to meet the “entire region” requirement. The new regional configuration appears in the map below:
Note: Region 2 and Region 3 were required to be bid together.

The RFP included a proposed number of HMOs that would be awarded contracts for each of these regions. To minimize disruptions for Medicaid enrollees, in each region (other than the Upper Peninsula) the number of plans selected was one more than the proposed maximum number of awards for that region. Proposals from the HMOs were evaluated based on demonstrated competencies and also statements of their proposed approaches to many new initiatives related to population health, care management, behavioral health integration, patient-centered medical homes, health information technology and payment reform.

Not every HMO was successful in each region for which it submitted a bid. Two plans were not successful in any region. One is Sparrow PHP, which is an incumbent plan in Region 7. The other is MI Complete Health (Centene/Fidelis SecureCare) which is not currently a Medicaid plan in any part of the state but does have an Integrated Care Organization contract to serve dual Medicare/Medicaid enrollees in Macomb and Wayne counties as part of Michigan’s dual eligible demonstration.

The following table indicates the regions for which each bidding HMO was and was not successful. In addition, the numerical values show the rank of that plan based on their evaluation scores among the successful bidders for each region. If an HMO is a current contractor for all counties in a region, their result is shaded green. If the HMO is a current contractor for some but not all counties in a region, their result is shaded yellow. The number of Medicaid enrollees currently served in each of the regions, eligible through both “traditional” Medicaid and the Healthy Michigan Plan, appear in the bottom row on the table; across all regions, this is more than 1.6 million Medicaid enrollees.

Technical Evaluation Results

<td style="background: #ffff66; padding: 0in 5.4pt; border: 1pt solid windowtext; b

 
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Aetna Better Health
(CoventryCares)
 
 
 
 
No
 
 
Yes – 4
Yes – 4
Yes – 7
Blue Cross Complete
 
 
 
Yes – 3
 
Yes – 5
Yes – 3
 
Yes – 3
Yes – 5
HAP Midwest Health Plan
 
 
 
 
 
Yes – 6
 
 
No
No
Harbor Health
Plan
 
 
 
 
 
 
 
 
 
Yes – 8
McLaren Health
Plan
 
Yes – 3
Yes – 3
Yes – 4
Yes – 3
Yes – 3
Yes – 2
Yes – 3
Yes – 6
Yes – 4
Meridian Health Plan of MI
 
Yes – 1
Yes – 4
Yes – 5
Yes – 2
Yes – 4
No
Yes – 5
Yes – 5
Yes – 3
MI Complete Health
(Centene/Fidelis)
 
 
 
 
 
 
 
 
No
No
Molina Healthcare
of MI
 
Yes – 4
Yes – 1
Yes – 1
Yes – 1
Yes – 2
Yes – 1
Yes – 1
Yes – 1
Yes – 2
Priority Health Choice
 
No
No