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

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.

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Brief & Report

HMA brief examines options for CMMI to refine approach for testing Medicare program improvements

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A recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous HMA report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.

The brief examines options for how CMMI could refine their approach to testing ideas for improving the Medicare program. HMA colleagues Jennifer Podulka, Yamini Narayan, and Lynea Holmes wrote the brief which was supported by Arnold Ventures.

HMA’s earlier brief examined the progress the Innovation Center has made in learning from Medicare-focused models during its first decade and raised questions to guide policymakers as they plan for the next phase of the Innovation Center’s work. In the new report, the team returns to those questions and offers potential answers.

The brief outlines seven pairs of competing goals and offers four recommendations that may, in part, help to balance these competing goals, as they are designed to increase the transparency of Innovation Center efforts and improve the likelihood that more models succeed in decreasing spending or improving quality. The recommendations include:

  • The Department of Health and Human Services (HHS) should establish a National Healthcare Transformation Strategy
  • CMMI should articulate a vision for how different models work together
  • CMMI should tailor models to test ideas that address the largest areas of spending growth and key areas of quality concerns, including
    • Include Part D in models
    • Include Part C in models
    • Promote primary care as a counterbalance to excessive low-value care
    • Address social determinants of health and other drivers of quality and access disparities
  • Congress and HHS should revisit the Physician-Focused Payment Model Technical Advisory Committee (PTAC)
Brief & Report

Strategic approaches to utilize ARPA funds to support older adults issue brief authored by HMA

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A new issue brief, authored by Madeline Shea and Aaron Tripp, provides an overview of key provisions of the American Rescue Plan Act (ARPA) of 2021 which offer the potential to make communities better places to grow older. ARPA provides an opportunity for states to build sustainable, person-centered systems and infrastructure for older Americans. These provisions aim to allow older Americans to age in their home and communities.

The provisions examined in the issue brief include addressing both long-standing and emerging needs of older adults for state government officials, including staff of Medicaid, aging, and housing and community development agencies; state legislators and their staff; and advisors to governors.

The ARPA funds are now available to states and local governments and will allow the development of better systems for older Americans. Key areas of opportunity outlined in the brief include

  • Building integrated data systems
  • Expanding affordable housing with services
  • Enhancing quality measurement and value-based purchasing models
  • Developing workforce recruitment and retention strategies
  • Ensuring access to internet services and assistive technology
  • Aligning Medicaid and Medicare services and payments
  • Creating ongoing structures to engage stakeholders in designing innovative and integrative approaches to meet community needs and monitoring their effectiveness over time
Brief & Report

Case study examines Georgia’s experience unbundling LARC payments from Medicaid prospective payment system

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A new case study prepared by colleagues from Health Management Associates (HMA) analyzes the Georgia Medicaid program’s experience with unbundling long-acting, reversible contraception (LARC) devices and services from the Medicaid prospective payment system (PPS) for reimbursement in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

HMA examined Medicaid claims data from 2012-2019 as well as conducted key interviews to understand whether the unbundling reimbursement policy change could have increased LARC utilization and provided analysis for policymakers and stakeholders in other states pursuing similar strategies and programs.

Additional findings and the full report are available here.

HMA’s research was supported by Medicines360 and Waxman Strategies with support from Arnold Ventures. The HMA team included Rebecca Kellenberg, Diana Rodin, and Jim McEvoy.

Brief & Report

HMA colleagues conduct environmental scan of NEMT benefit to Medicaid enrollees

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As part of a larger Medicaid and CHIP Payment and Access Commission (MACPAC) study on Medicaid non-emergency medical transportation (NEMT) in response to a request from the Senate Appropriations Committee, a team of HMA colleagues conducted a 50-state environmental scan of NEMT programs and stakeholder interviews to better understand approaches and trends in the provision of the NEMT benefit to Medicaid enrollees across the United States.

The culminating report included NEMT trends, challenges, and innovations drawn from the scan of programs and interviews with stakeholders including federal officials, Medicaid officials from six study states, NEMT brokers and providers, managed care companies, beneficiary advocates, and subject matter experts.

The key findings are outlined in the report and include information about:

  • NEMT populations and utilization
  • Various modes of transportation
  • NEMT delivery system model variations, advantages, and challenges
  • NEMT complaints, performance issues, and innovation
  • Performance improvement, oversight, and program integrity
  • Transportation network challenges and increasing role of transportation network companies
  • Coordination across federally assisted transportation services
  • Stakeholders’ view on the value and role of NEMT

In December 2020, following the completion of the interviews for this study, Congress added a requirement to the federal statute requiring states to provide NEMT to Medicaid beneficiaries who have no other means of transportation to medically necessary healthcare services.

The HMA team included Principals Sharon Silow-Carroll, MSW, MBA and Kathy Gifford, JD, Senior Consultant Carrie Rosenzweig, MPP, Consultants Anh Pham and Julie George, JD as well as retired Managing Principal Kathy Ryland.

The research underlying this report was completed with support from the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed are those of the authors and do not necessarily represent those of MACPAC.

Brief & Report

HMA briefs on Medicare-Medicaid integration

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This issue brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)[1] that meet full benefit dually eligible individuals’[2] needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.

For a succinct overview of the essential elements and policy recommendations, please access the brief fact sheet. For a full discussion of the elements and policy recommendations, please access the full brief.

The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[3]

For further information or questions, contact Sarah Barth at [email protected], Ellen Breslin at [email protected], or Samantha DiPaola at [email protected].

[1] Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.

[2] Dually Eligible Individuals: When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.

[3] Narda Ipakchi was formerly a Senior Consultant with HMA.

Brief & Report

HMA prepared issue briefs explore MLTSS impacts on state Medicaid programs

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In a recent pair of reports prepared for Arizona for Better Medicaid, HMA colleagues examined the impact of managed long-term services and supports (LTSS) in state Medicaid programs. The first report, Growth in MLTSS and Impacts on Community-Based Care, examines the historical increase in the adoption of LTSS by state Medicaid programs and how that has contributed to a shift in long-term care from institutions to the community. The second report, Managed LTSS Improves Quality of Care, describes the evidence on the impact of managed LTSS in state Medicaid programs on the quality of care.

Authors:
Principal Stephen Palmer
Senior Consultant Ashlen Strong
Senior Consultant Aaron Tripp

Brief & Report

HMA colleagues, report examines cost of stemming gun violence

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In a new report, “Cost Estimate for Federal Funding for Gun Violence Research and Data Infrastructure,” HMA colleagues were engaged by Arnold Ventures and the Joyce Foundation, to examine the cost to fund research and create a data infrastructure aimed at reducing gun violence. Each organization had previously released separate, but complimentary, reports outlining recommendations to stem gun violence in the United States.

This research and final cost estimate found the federal government would need to spend nearly $600 million over the next five years in order to close the gun violence information gap and provide sufficient resources to conduct appropriate research and collect and share comprehensive, transparent data to help policymakers and lawmakers address and solve gun violence.

HMA colleagues Catherine Guerrero, Zach Gaumer, Jay Shannon, Cindy Zeldin, and Yamini Narayan contributed to the research and final report.

During a webinar on Wednesday, July 14, a panel of experts including Dr. Shani Buggs, Zach Gaumer, and Dr. John Roman, shared their perspectives on report and discuss key issues in gun violence prevention research, data infrastructure and federal investment needed to close the current policy research gap.

Brief & Report

HMA brief examines state efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs

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Funded by UnitedHealthcare, the issue brief, State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans, outlines approaches taken by Medicaid programs seeking to coordinate Medicare and Medicaid services for dually eligible individuals without first implementing standalone Medicaid managed long-term services and supports (MLTSS) programs.

Authors are Sarah Barth, Rachel Deadmon and Julie Faulhaber.

Brief & Report

HMA authors report examining future of COVID-19 Medicare regulation changes

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A new Issue Brief, authored by Jennifer Podulka and Jon Blum, examines the many changes to Medicare regulations put in place during the COVID-19 pandemic. The brief, Which Medicare Changes Should Continue Beyond the COVID-19 Pandemic? Four Questions for Policymakers, tracks and categorizes the regulatory changes, describes the benefits and risks of the changes, and establishes a framework to support policymakers’ decisions regarding the future for the changes after the pandemic ends.

Brief & Report

Issue brief explores personal health record for children, youth, and families involved with child welfare in California

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HMA Senior Consultant Suzanne Rabideau, Principals Heidi Arthur and Eileen Moscaritolo and Consultant Anh Pham recently developed the issue brief Exploration of a Personal Health Record for Children, Youth, and Families Involved with Child Welfare in CA for California’s Medicaid CalAIM Foster Care Model of Care Workgroup. The issue brief was developed to assist the workgroup in exploring options for establishing a portable personal health record (PHR) and support the workgroup’s efforts in making long-term recommendations on this topic. The PHR would give children, youth, families, and caregivers access to the child or youth’s health information.

The issue brief also

  • Describes a PHR and it’s uses
  • Identifies ways a PHR could assist in addressing the healthcare challenges often experienced by children, youth, and families involved with child welfare
  • Identifies the federal and California-specific opportunities to facilitate access to a PHR for children and youth in foster care
  • Identifies federal and California-specific challenges to implementing a comprehensive health record for children, youth, and families
  • Shares potential options for the workgroup to consider

Authors

Suzanne Rabideau, MBA, MA, LPC, Senior Consultant
Heidi Arthur, LMSW, Principal
Eileen Moscaritolo, Principal
Anh Pham, Consultant