HMA Insights – including our new podcast – 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 podcast, blogs, webinars, case studies, reports and more.
HMA is pleased to welcome new experts to our family of companies in August 2023.
Dianne Bisacky is a seasoned professional with C-Level executive experience and a strategic mindset dedicated to driving growth and implementing innovative solutions.
Sheila Wilson is a registered nurse with over 35 years of experience in both the clinical and managed care environments.
This week, our In Focus section reviews the Florida Statewide Medicaid Prepaid Dental Program invitation to negotiate (ITN) released October 6, 2023, by the Florida Agency for Health Care Administration (AHCA). Contracts will serve 4.4 million Statewide Medicaid Managed Care (SMMC) members.
The Florida Statewide Medicaid Prepaid Dental Program is a full-risk capitated dental program, which began rolling out by groups of regions in December 2018. The incumbent statewide Medicaid dental plans are DentaQuest, Liberty, and MCNA Dental.
Florida also is reprocuring its traditional managed medical assistance (MMA) program and managed long-term care program under SMMC. Awards for Medicaid managed care organizations (MCOs) are expected in February 2024.
Florida intends to award contracts to at least two plans. One of AHCA’s goals is to contract with plans that will support the HOPE Florida: Pathways to Prosperity initiative, which focuses on community collaboration between the private sector, faith-based community, not-for-profits, and government entities to break down traditional community silos. Through this program, AHCA seeks to:
In addition to the services currently provided, dental plans will cover authorized hospital outpatient and ambulatory surgery center (ASC) services as part of the new contracts. Plans will cover ancillary medical services provided secondarily to dental care in an ASC or outpatient hospital setting when medically necessary.
Dental plans will continue to operate statewide across all regions. Capitation rates for Medicaid and dually eligible members, however, are set regionally. Rates for medically necessary procedures are set at a statewide level. The new contracts will consolidate the 11 regions into nine as shown in the table below.
Responses are due January 5, 2024, and notification of intent to award is anticipated to be released on March 29, 2024. Contracts will run from the execution date in 2024 through 2030.
Technical proposals will be scored using a total weighted score of 6,600, as shown in the table below.
Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and should, work to improve their Consumer Assessment of Healthcare Providers Systems (CAHPS) scores.
The CAHPS annual survey measures member experience with providers and Medicare and Medicaid health insurance plans. It has also become a critical metric used by the Centers for Medicare and Medicaid Services (CMS).
Plans can work to improve CAHPS scores by developing a comprehensive improvement plan involving a holistic year-around approach that involves monitoring the member experience from enrollment through disenrollment. With score improvement comes incentive payments tied to high quality performance.
CAHPS SCORES ARE USED BY:
The National Committee for Quality Assurance (NCQA) to STAR rate health plans in accreditation scoring
Potential members to compare plan scores against one another on the NCQA website
Several state Medicaid programs that require plans to report these surveys and use scores as part of their incentive programs
CMS, which has increased its STAR rating, CAHPS-related measure from double weighted to quadruple weighted in contract year 2021
Medicare Advantage Prescription Drug (MAPD) plans, which use CAHPS to calculate 32% of the overall aggregate score
CAHPS COHORTS THAT ARE MEDICARE STAR MEASURES
PART C CAHPS MEASURES (WEIGHTS)
Getting needed care (4)
Getting appointment and care quickly (4)
Customer service (4)
Rating of healthcare quality (4)
Rating of health plan (4)
Care coordination (4)
Annual flu vaccine (1)
PART D CAHPS MEASURES (WEIGHTS)
Rating of drug plan (4)
Getting needed prescription drugs (4)
ADDITIONAL STAR MEASURES AND ACTIVITIES THAT RELATE TO MEMBER EXPERIENCE
PART C MEASURES (WEIGHTS)
Complaints about the health plan (2)
Member choosing to leave the plan (2)
Plan makes timely appeals decisions (2)
Reviewing appeal decisions (2)
Call center, language interpreter and TTY availability (2)
Health plan quality improvement (5)
PART D MEASURES (WEIGHTS)
Call center, language interpreter and TTY availability (2)
Complaints about the drug plan (2)
Member choosing to leave the drug plan (2)
Drug plan quality improvement (5)
Health Management Associates’ expert colleagues can help plans outline an organizational assessment of member experience and customize interventions and solutions to increase scores.
Our team of quality and accreditation experts can help organizations improve customer service and scores by:
Establishing a year-around effort
Using an organizational effort to break down department silos and improve cooperation between departments
Assessing core functions within the plan and contractors that contribute to member experience including marketing, enrollment, disenrollment, UM, QI, member service, grievances, appeals, etc.
Identifying and addressing patient frustrations with providers and plans before they become problematic
Leveraging information technology to make websites more user friendly
Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year
Recognizing social determinants of health (SDOH) are often overlooked in access to care-related issues, such as lack of transportation or lack of funds for co-payments
Outlining techniques for obtaining point-of-service feedback to help address potential member experience issues before they arise
Contact our experts:
What is the VALUE of a Star in your plan(s)?
What initiatives have you introduced to prepare for the changes in the Star Rating that may impact your overall Star Rating results?
What are you doing for health equity focus? What data are you collecting for health equity?
What do you think are your organization’s financial implications when Star Rating requirements change?
What are your Star Rating strategies for increasing your organization’s market share and viability?
What sort of interventions, data sources, analytics and reporting have you found to be successful to improving your Star Rating?
WE CAN HELP YOU BY:
Establishing a year-around effort to improve Star Rating performance
Assessing core functions within the plan and contractors that contribute to understanding members
Identifying and addressing customer concerns with providers and plans before they become problematic
Leveraging information technology to make websites more user friendly
Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year
Working on health equity issues including sharing techniques for obtaining data
Leveraging all data and intervention efforts (such as risk and quality) to drive decision and focus
Contact our experts:
HMA’s team of experts have completed accreditation requirements with our clients as well as in our formal executive and operational leadership roles in the health care setting. We work closely with our clients and with TJC and other accreditation programs with a focus on improving healthcare quality and favorable outcomes. Our team of seasoned healthcare executive consultants bring more than 100 years of experience in clinical, quality, and operations, with proven results. HMA offers a full continuum of accreditation services for hospitals, ambulatory surgical centers (ASCs), Federally Qualified Health Centers (FQHCs) and behavioral health (BH) care settings. We work closely with FQHCs to provide assistance for certifications and advanced certifications in health equity (HE). HMA can offer onsite or virtual mock survey and gap analysis preparation for TJC accreditation, as well as tactical and advisory support to prepare our client leadership teams for a winning accreditation survey results and supporting the development of a sustainable plan to achieve year over year success!
Our experts can help you by:
Assessing core functions supporting the implementation of the latest TJC standards and interpretation of the standards
Building the business case for TJC accreditation
Guiding your team through the new HE standards
Creating quality and assessment improvement plan (QAPI) to lead to a successful survey
Continuous survey readiness support via a sustainable plan
And so much more across the continuum
Contact our experts:
Florida Releases Procurement for Statewide Medicaid Prepaid Dental Program
This week, our In Focus section reviews the KanCare Medicaid capitated managed care request for proposals (RFP), released October 2, 2023, by the Kansas Department of Health and Environment and Department for Aging and Disability Services. The program covers approximately 520,000 beneficiaries and is worth $4.1 billion. New contracts would begin January 2025.
KanCare is the state’s Medicaid managed care program, covering both traditional Medicaid and Children’s Health Insurance Program (CHIP) members. In all, KanCare covers approximately 320,000 children, 79,000 parents and pregnant women, 59,000 individuals with disabilities, and 54,000 individuals ages 65 and older.
Managed care organizations (MCOs) provide statewide integrated physical health, behavioral health, and long-term services and supports. Covered services include nursing facility care and home and community-based services, as well as Medicaid-funded inpatient and outpatient mental health and substance use disorder services and seven Section 1915(c) HCBS waiver programs.
Kansas is not currently an expansion state. While the governor’s 2024 budget plan called for Medicaid expansion, lawmakers rejected the proposal during the last legislative session.
In 2022, the state legislature delayed the procurement until 2023 to ensure that it occurred after the gubernatorial election and extended current MCO contracts through 2024.
Kansas expects to select three MCOs. The RFP includes a renewed focus on integrated, whole-person care, workforce retention, and accountability measures for the MCOs. The state lists the main goals for the KanCare procurement as:
A mandatory pre-bid conference will take place on October 16, 2023. Proposals are due January 4, 2024, with awards expected April 12, 2024. Contracts will be effective January 1, 2025, through December 31, 2027, with up to two one-year renewal options. Following is the timeline leading up to implementation.
Incumbents are Centene, CVS/Aetna, and UnitedHealthcare. A breakdown of market share by enrollment as of June 2023 can be seen in the table below. Other insurers have already cited their interest in bidding for the new contracts.
Kansas Releases KanCare, CHIP Medicaid Managed Care RFP
