Jennifer Podulka penned a blog post for The Commonwealth Fund in conjunction with The SCAN Foundation, highlighting the legislative and regulatory changes made to Medicare in response to the COVID-19 pandemic. She was part of the HMA team who authored an Issue Brief and policy tracker earlier this year.
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In this week’s In Focus section, Health Management Associates (HMA) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA. This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance. While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models. As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?
In April 2020, HMA released COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, by State. Our experts assessed COVID-19’s potential impact on health insurance coverage for each state and forecasts Medicaid enrollment could increase by 11 to 23 million across all states over the next several months.
The May 2020 updated analysis, HMA Updated Estimates of COVID Impact on Health Insurance Coverage, projects the potential impact of the COVID-19 pandemic on health insurance coverage and cost by state through 2022. The analysis provides deeper insights into how health insurance coverage is estimated to take years to more closely resemble pre-COVID-19 coverage levels.
The September 2020 summary update on the estimated impact of COVID-19 on the economic downturn looks at the uncertainty surrounding the economic pace of recovery, estimated Medicaid enrollment, and the estimated growth in individual coverage.
This webinar was held on September 18, 2020.
As the COVID-19 pandemic continues to sweep across the country and new “hotspots” emerge daily, multiple research labs are working at an extraordinary pace to develop a viable vaccine. However, prior to the release of a vaccine, or more likely multiple vaccines, the public health and health care delivery systems must be ready. We need protocols for vaccine storage and handling for different vaccine types, as well as measured plans for rapid and efficient vaccine distribution and administration. Myriad factors must be considered to ensure safe and effective transport, storage, management, distribution, and tracking of millions of vaccine doses. Many states, cities, counties, and local communities are struggling to keep up with current public health needs, including contact tracing, preparation for a seasonal flu campaign and ensuring that school-aged children do not fall behind on important immunizations.
In this webinar, HMA experts presented practical guidelines and tools to help public health professionals, health plans, community organizations, and others plan for effectively distributing and managing COVID-19 vaccine(s) in their jurisdictions. Presenters also touched on issues ranging from physical infrastructure needs for vaccine storage and distribution to meeting tracking requirements, and the importance of using an equity lens across all aspects of vaccine campaign planning.
- Gain a comprehensive understanding of what is needed to prepare for managing a COVID-19 vaccine from acquisition to distribution.
- Explore tools designed to help identify the number of vaccinators needed and the costs to meet desired coverage levels.
- Learn practical insights for planning and preparing for a mass vaccination event on a local level
- Understand how to ensure an equity lens is used when determining priority populations for distribution
- Identify the roles of various stakeholders participating in vaccine delivery
Michelle Parra, PhD, Principal, Los Angeles, and former director of the Vaccine Preventable Disease Control Program for the Los Angeles County Department of Public Health
Greg Vachon, MD, MPH, Principal, Chicago, Board Certified in Internal Medicine with expertise in digital health solutions and information technology for integration and population health management
Margaret Kirkegaard, MD, MPH, Principal, Chicago, Board Certified in Family Medicine with expertise in practice transformation and population-based health care delivery for vulnerable and underserved groups.
Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the firm’s acquisition of Burns & Associates, Inc., an Arizona-based health policy consulting firm that specializes in innovative approaches to the financing and delivery of health care and human services.
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.
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.
Data collection and analysis for the policy tracker was conducted by HMA colleagues Jennifer Podulka, Narda Ipakchi, Zach Gaumer, Yamini Narayan, and Elaine Henry. This project was supported by grants from The SCAN Foundation and The Commonwealth Fund.
This webinar was held on July 13, 2020.
Aggressive COVID-19 contact tracing is key to state reopening strategies. During this webinar, HMA community health experts addressed how community health workers can play a critical role in contact tracing, leveraging their trusted position in local communities and simultaneously furthering efforts to assist patients with multiple needs, including housing instability, food insecurity and co-morbidity. HMA experts also outlined best practices for establishing a contact tracing infrastructure and discuss how community health workers are positioned to emerge as the vanguard for COVID-19 vaccination efforts.
- Learn how to apply creative workforce strategies to address contact tracing, isolation support, co-morbid disease management, and immunization efforts.
- Obtain creative financing and sustainability strategies for staffing and infrastructure.
- Understand how community health workers and paraprofessionals can play an expanded role in the post-COVID-19 delivery system of the future.
Kathleen Nolan, Vice President, Washington, DC
Pat Casanova, Principal, Indianapolis, IN
Uma Ahluwalia, Principal, Washington, DC
A recording of the first webinar and supporting materials are now available here.
This webinar was held on June 30, 2020.
In the midst of the COVID-19 pandemic, state and local governments and safety net providers are faced with a clear indication of disparities in population health outcomes and looming budgetary challenges across the nation. These entities are committed to their residents and are looking for creative strategies to mitigate health risks and deliver responsive health and human services despite budgetary challenges. As such, the role of the community health worker or the navigator rises to the top. Engaging and integrating trusted community health workers and other paraprofessionals is a promising, cost-effective and trust-building practice that can support the seamless dissemination of these essential services in these unprecedented times.
This webinar was the first in HMA’s Community Health Worker Series. During this webinar, HMA experts put forth a value proposition for the timely engagement and integration of community health workers/navigators/peer support specialists in the delivery of health and human services. Presenters provided several compelling case studies and three successful implementation models for integrating paraprofessionals into the delivery system. Participants learned how community health workers are poised to support the unique needs of residents in urban, suburban, rural, and public health and human services settings. Finally, respondents reflected on the paraprofessional role from a social determinants of health standpoint and from the perspective of minority populations and their communities.
- Understand the role community health workers and other paraprofessionals can play in the health and human services workforce in the COVID-19 era.
- Learn how select states explored the certification, education, financing and roles of community health workers and other paraprofessionals when integrated into specific health and human services.
- Find out how to build trust in minority communities, incorporating social determinants of health in the COVID-19 recovery response at the crossroads of health disparities and racial inequities.
Uma Ahluwalia, Principal, Washington, DC
Heidi Arthur, Principal, New York, NY
Stephanie Denning, Principal, Denver, CO
Julia Elitzer, Senior Consultant, San Francisco, CA
Iliana Gilman, Principal, Austin, TX
Catherine Guerrero, Principal, Denver, CO
Lori Weiselberg, Managing Principal, Chicago, IL
The National Academy of State Health Policy (NASHP) has a great website of state CHW models: https://www.nashp.org/state-community-health-worker-models/
The Association of State and Territorial Health Officials (ASTHO) features tools and information about CHWs at: https://www.astho.org/Community-Health-Workers/
There is also a helpful image describing the ever-changing picture of state approaches to CHW certification as well: https://www.astho.org/Programs/Clinical-to-Community-Connections/Documents/Map-of-State-Approaches-to-CHW-Certification/
Multnomah County training: https://multco.us/health/community-health/community-health-worker-training
SAMHSA has great resources: https://www.samhsa.gov/brss-tacs/recovery-support-tools/youth-young-adults
The VT interview is the March 4, 2020 podcast. https://www.aha.org/advocacy/small-or-rural/rural-report-podcast-series