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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.

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Webinar

Webinar Replay: Medicaid Network Adequacy

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On August 26, 2015, HMA Information Services hosted the webinar, “Medicaid Network Adequacy: A Proactive Approach to Ensuring and Demonstrating Compliance.”

Health Management Associates Principal Karen Brodsky (who previously oversaw managed care contracting for the state of New Jersey), discussed the warning signs state regulators look for when assessing the adequacy of a Medicaid managed care plan’s network. She also outlined some practical ways plans can get out in front of these potential problems – not only demonstrating compliance to regulators but also improving access and satisfaction for members.

Listen to the recording and:

  • Identify the warning signs of potential network adequacy issues and proactively fix problems before they affect member access and spark Medicaid agency inquiries.
  • Understand which provider network access triggers are directly connected to access issues and which may not be related to network problems, yet still raise network compliance concerns. 
  • Assess the viability of partnerships with community groups to satisfy demand for providers that meet the needs of members with special needs.
  • Improve communications with state agencies, providers, advocates and community-based organizations about the status of the provider network and how to work with the health plan if there is an access problem.

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

Webinar

Webinar Replay: MLTSS: Understanding the Impact of the New Medicaid Managed Care Regulations

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On July 1, 2015, HMA Information Services hosted the webinar, “Managed Long-Term Services and Supports: Understanding the Impact of the New Medicaid Managed Care Regulations.”

As part of the newly proposed Medicaid managed care regulations, CMS is seeking to codify the way in which state and federal regulators oversee MLTSS programs. It’s no surprise CMS is taking action, given the dramatic growth of MLTSS. But the proposed rules mean states, health plans, and providers will have to shoulder a wide variety of new compliance requirements in areas such as network adequacy, patient-centered planning, care coordination and quality measurement.

During this webinar, HMA Senior Consultant Lisa Shugarman and Managing Principal Susan Tucker outlined the proposed MLTSS rules and discussed the implications for states, health plans, and providers serving the long-term care market. Listen to the recording and:

  • Understand the framework for MLTSS as codified in the proposed rule.
  • Learn about CMS’ proposed definition of long-term services and supports.
  • Assess changes to network adequacy standards as well as person-centered planning and care coordination standards for MLTSS.
  • Gain insight into CMS’ quality focus for MLTSS.

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

Webinar

Webinar Replay: What New Medicaid Managed Care Regulations Mean for Health Plan Quality, Performance Measurement

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On June 17, 2015, HMA Information Services hosted the webinar, “What the New Medicaid Managed Care Regulations Mean for Health Plan Quality and Performance Measurement.”

The proposed Medicaid managed care regulations released last month by CMS include fundamental changes in the way quality and performance is measured among health plans in state-sponsored programs. The rules seek to align quality and performance measures with existing government programs like Medicare Advantage, institute a quality ratings system, support a variety of performance improvement projects, and increase the role of external quality review.

During this webinar, HMA Principal Matt Roan and Senior Consultant Lisa Shugarman outline the proposed quality rules and discuss the implication for states, Medicaid managed care plans and other stakeholders. Listen to the recording and:

  • Understand the implications of the proposed Medicaid Managed Care Quality Rating System
  • Learn how new, federal, standardized quality measures and performance improvement projects requirements will be incorporated into existing quality programs
  • Gain insight into CMS’ quality focus for Managed Long Term Services and Supports
  • Assess changes to the external quality review process as well as the role of accreditation in state review and approval of Medicaid health plans
  • Identify managed care elements of Comprehensive State Quality Strategies

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

Webinar

Webinar Replay: First Take on New Medicaid Managed Care Regulations

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On May 28, 2015, HMA Information Services hosted the webinar, “HMA’s ‘First Take’ on New Medicaid Managed Care Regulations.”

CMS just released a new set of proposed Medicaid managed care and CHIP regulations – the first major update of federal rules for health plans in state-sponsored programs in more than a decade. The changes seek to align Medicaid managed care regulations with those of other government-sponsored programs, while at the same time fostering innovation, transparency, quality and financial viability. Like all such rules, details matter. And at more than 650 pages, these proposed rules have a lot of details to digest. It will take weeks – if not months – to fully understand the ins and outs of the new regulations. However, an initial read reveals several important themes likely to dramatically impact Medicaid managed care going forward.

During this webinar, HMA experts offered a “first take,” with initial thoughts and reactions to key components of the new regulations. Topics our experts touched on include:

  • The emphasis on aligning Medicaid, Medicare and commercial regulations
  • The new Medical Loss Ratio requirements
  • The new rate setting requirements
  • Establishment of a quality rating system
  • Regulations targeted specifically at Managed Long Term Services and Supports
  • Marketing and enrollment
  • How the regulations are intended to promote flexibility of access to care for members with severe mental illness

Please note that this webinar was a panel discussion, and as such, there was only one slide used – it is the slide you see providing speaker contact information.

Webinar

Webinar Replay: Breaking Down the Armstrong Ruling and What It Means

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On April 30, 2015, HMA Information Services hosted the webinar, “Implications of the U.S. Supreme Court’s Ruling in Armstrong v. Exceptional Child Center: A Real-world Analysis.”

The U.S. Supreme Court recently limited the ability of healthcare providers to file lawsuits against state Medicaid programs over the adequacy of provider payment rates. The court’s decision in Armstrong v. Exceptional Child Center is good news for states looking to rein in Medicaid costs. But many fear it will be bad news for Medicaid beneficiaries, who may struggle to find access to quality care if providers refuse to participate in the program because of insufficient payment rates. Enforcement of Medicaid’s promise to provide high-quality health care to the poor now falls largely in the lap of CMS, whose enforcement tools may not be up to the task.

During this webinar, our presenters provided an analysis of the possible real-world implications of this decision – for providers, beneficiaries, states and Medicaid managed care plans.

Speakers included:

Meghan Linvill McNab, J.D., Krieg DeVault
Leah Mannweiler, J.D., Partner, Krieg DeVault
Kathy Gifford, J.D., Managing Principal, Health Management Associates
Catherine Rudd, J.D., Senior Consultant, Health Management Associates

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

Webinar

Webinar Replay: Medicaid in an Era of Health and Delivery System Reform

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On Nov. 7, 2014, HMA hosted the webinar, “Medicaid in an Era of Health and Delivery System Reform.”

HMA Managing Principals Vern Smith, Kathy Gifford and Eileen Ellis talked about the findings from the Kaiser Family Foundation’s (KFF) 14th annual 50-state Medicaid budget survey, which they co-authored along with KFF’s Robin Rudowitz and Laura Snyder. The survey was conducted with the cooperation of the National Association of Medicaid Directors.

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

Webinar

Webinar Replay: Managed Care and Individuals with Intellectual and Developmental Disabilities: Innovative Approaches to Care Coordination

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On Nov. 4, 2014 HMA hosted a webinar by Principal Shane Spotts, “Managed Care and Individuals with Intellectual and Developmental Disabilities: Innovative Approaches to Care Coordination.”

Shane is a leading expert on trends in managed care and I/DD. During the webinar he provided an overview of the most recent initiatives and strategies, including an assessment of what’s working and why.

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

Brief & Report

KCMU Issue Brief Profiles Newer Programs in Medicaid Health Homes

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HMA Managing Principal Mike Nardone and Julia Paradise authored the recently released issue brief, “Medicaid Health Homes: A Profile of Newer Programs” for the Kaiser Commission on Medicaid and the Uninsured (KCMU).

The Affordable Care Act (ACA) established a new state option in the Medicaid program to implement “health homes” for individuals with chronic conditions, giving states a new tool to develop models of care designed to improve care coordination and reduce costs for high-need populations. In August 2012, the KCMU issued a brief examining the first six health home programs. This update profiles health home programs in the nine states that have taken up the option in the intervening two years – Alabama, Idaho, Maine, Maryland, Ohio, South Dakota, Washington, Wisconsin, and Vermont.

States have implemented health home programs in a variety of ways, reflecting different targeting priorities, underlying delivery and payment systems, and visions of delivery system reform, as well as other state-level factors. This issue brief identified both themes and diversity in the more recent health home programs in a number areas, including geographic scope, target population, health home providers, payment, fee for service versus managed care, and HIT.

Webinar

Webinar Replay: The Value Proposition of Medicare ACOs

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On June 18, 2014 HMA’s Healthcare Transformation Institute, formally the Accountable Care Institute, presented “Medicare Accountable Care Organizations: The Value Proposition,” the third in a three-part webinar series.

HMA Principal Dr. Art Jones, MD, a pioneer in the accountable care movement, explored the financial considerations for establishing a Medicare ACO.

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

Brief & Report

Kaiser Releases Medicaid, CHIP Enrollment Snapshot Reports

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On June 3, the Kaiser Commission on Medicaid and the Uninsured released its “Medicaid Enrollment Snapshot: December 2013” issue brief.

Authored by Kaiser’s Laura Snyder and Robin Rudowitz and HMA’s Eileen Ellis and Dennis Roberts, the report indicates that as of December 2013, nearly 55.4 million people were enrolled in Medicaid. That’s an increase of 585,000 enrollees from the prior year, but the slowest growth since before the Great Recession.

The report examines changes in monthly Medicaid enrollment from December 2012 to December 2013 and the factors that influenced those changes in a variety of ways. Factors of particular note include:

  • Continued improvement in economic conditions resulted in slower Medicaid enrollment growth.
  • Early expansion of Medicaid in some states, as well as successful outreach and enrollment efforts for new Marketplaces pushed enrollment up in some states.
  • Problems implementing new enrollment systems for the Federally Facilitated Marketplace (FFM) and State Based Marketplaces (SBM) put downward pressure on Medicaid enrollment growth.

Click here to access the report.

The Commission also released its “CHIP Enrollment Snapshot: December 2013” issue brief.

Authored by HMA’s Vern Smith and Kaiser’s Laura Snyder and Robin Rudowitz, the report shows nearly 5.8 million children were enrolled in the Children’s Health Insurance Program (CHIP) in December 2013. That represents a 3.1 percent increase from 2012.

This report examines changes in monthly CHIP enrollment between December 2012 and December 2013. Some findings of interest include:

  • Continued improvement in economic conditions likely resulted in both some growth as children shifted from Medicaid to CHIP and some declines as family incomes continued to increase above CHIP eligibility levels.
  • Successful outreach and enrollment efforts for new Marketplaces likely pushed enrollment up in some states.
  • Problems implementing new enrollment systems for the Federally Facilitated Marketplace (FFM) and State Based Marketplaces (SBM) likely put downward pressure on CHIP enrollment growth.

Click here to access the report.

Webinar

Webinar Replay: ACOs and Effective Care Management

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On May 28, 2014 HMA’s Healthcare Transformation Institute, formally the Accountable Care Institute, presented “The Medicare ACO: Effective Care Management and its Anticipated Impact,” the second in a three-part webinar series.

HMA Principals Lynne Fagnani, Dr. Art Jones, MD, and Nancy Jaeckels offered lessons learned from the latest Medicare demonstrations and talked about the importance of effective care management and its return on investment. Webinar highlights include characteristics of successful programs, population management and workflow, and building blocks for care management success.

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

The third and final webinar in the series will focus on Finances of the Medicare ACO and is slated for 2 p.m. EDT June 18.

Webinar

Webinar Replay: Lessons Learned from ACA Early Implementation: Exchanges, Medicaid Expansion and System Transformation

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On April 30, 2014 HMA leveraged the vast expertise of our national consulting team to explore the early takeaways from ACA implementation and offer insights about what we can expect to see as implementation continues.

The HMA Expert Roundtable “Lessons Learned from ACA Early Implementation: Exchanges, Medicaid Expansion and System Transformation” featured:

  • Moderator Vern Smith, Managing Principal, Lansing
  • Panelist Barbara Markham Smith, Principal, Washington, D.C.
  • Panelist Kathy Gifford, Managing Principal, Indianapolis
  • Panelist Dr. Art Jones, MD, Principal, Chicago

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