With a focus on the needs of young people in detention and correctional facilities, a team of Health Management Associates (HMA) colleagues completed an in-depth assessment designed to guide future planning and decision making around mental health services for youth.
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The COVID-19 pandemic highlighted nursing home safety and infection control as critical public health issues. A new report authored by HMA colleagues found compelling evidence that single rooms in nursing homes have numerous benefits for both public health and residents’ experience. The authors conclude that transitioning from multi-resident rooms to single rooms should be a component of person-centered nursing home reform. The report calls on stakeholders to come to the table to discuss options and strategies for long-term care redesign and transformation.
The report, Fundamental Nursing Home Reform: Evidence on Single-Resident Rooms to Improve Personal Experience and Public Health, was developed for a Michigan-based long-term care provider and owner of skilled nursing facilities.
HMA colleagues Sharon Silow-Carroll, MBA, MSW, Deborah Peartree, RN, MS, Susan Tucker, CPA, and Anh Pham conducted the research and analysis and prepared this report. An appendix prepared by the national accounting firm Plante Moran provides estimates of new costs and other considerations related to transitioning to single-resident rooms, based on data from two Michigan-based multi-facility long-term care organizations.
On November 20, 2020 the Trump Administration released an interim final rule with comment period (IFC) that would set reimbursement for 50 Part B drugs and biologics based on international pricing data using so-called “Most Favored Nation” (MFN) prices. At the same time, the policy would replace the current 6% add-on for affected drugs with a flat dollar add-on per dose. This memorandum provides our analysis of the policy changing add-on payments for Part B drugs under the policy.
The experts at Health Management Associates (HMA) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan’s decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
HMA further sought to understand the extent to which Medicare Advantage enrollees had access to these benefits when eligible, and the effectiveness of these benefits as a tool to contain costs, improve outcomes, and increase enrollee engagement and satisfaction.
The report outlines seven key insights and accompanying policy considerations aimed towards promoting evidence-based benefit designs; expanding Medicare Advantage organization willingness to adopt the flexible benefits; and enhancing beneficiary involvement, access, and usage of these benefits.
HMA colleagues Narda Ipakchi, Mary Hsieh, Sarah Barth, and Jonathan Blum contributed to the report which follows up on a previous report providing a snapshot of early adoption of these benefits.
This analysis was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.
HMA’s Donna Strugar-Fritsch, Shannon Robinson, MD and Scott Haga, PA-C, recently authored the issue brief, Naltrexone Formulations in Correctional Settings. This brief provides clinical, financial, and administrative information prisons and jails can use in deciding whether to keep detainees on extended release naltrexone (XR-NTX, or the brand Vivitrol) or switch them to oral naltrexone tablets in instances where detainees have been prescribed XR-NXT prior to incarceration.
Health Management Associates (HMA) and Wakely Consulting Group, Inc., collaborated to analyze, compile, and model data on Medicaid enrollment growth during the COVID-19 pandemic and develop projections under various recovery scenarios as well as analyze the potential impact of key variables on state Medicaid expenditures.
The analysis examined two key questions, how much strain will state Medicaid budgets be under over the next few years and what types of state characteristics and what types of policy options will allow states the ability address budgetary challenges.
HMA colleagues Eric Hammelman, Stephen Palmer, Matt Powers, and Kathy Gifford contributed to the report.
YESCARTATM (axicabtagene ciloleucel) – a CAR T-cell therapy (or chimeric antigen receptor T-cell therapy) for adult patients with relapsed or refractory (r/r) large B-cell lymphoma after two or more lines of systemic therapy, was approved in 2017 by the US Food and Drug Administration (FDA). While YESCARTA is considered a transformative therapy, there has been significant concern regarding access to YESCARTA and other CAR T-cell therapies. The Moran Company (TMC) was asked to use Medicare claims data to identify characteristics of the hospitals that provide, and patients who receive CAR T-cell therapy. This report presents the findings from our analysis using 2018 and 2019 Medicare claims data.
Health Management Associates (HMA) was engaged by Covered California to evaluate and make recommendations about whether the state’s Marketplace should require Qualified Health Plan (QHP) Issuers to gain National Committee for Quality Assurance (NCQA) Distinction in Multicultural Health Care.
With a mission to increase insurance coverage in California and improve quality of care while reducing costs and health disparities, Covered California sought to learn how achieving Distinction in Multicultural Health Care has helped Issuers promote meaningful change and reduce disparities to advance health equity, in order to determine whether requiring the Distinction would help the Marketplace assure QHP Issuers effectively deliver quality care and improve population health
The HMA team reviewed the Distinction’s standards and guidelines within Attachment 7, Article 3interviewed four Issuers that have earned the Distinction. They recommended Covered California update its language in Article 3.04, requiring Issuers to achieve NCQA Distinction in Multicultural Health Care and allocate resources to deliberately address disparities and health equity, increasing infrastructure and reinforcing organizational commitment to this work.
Health Management Associates (HMA), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.
The 20th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA) was released on October 14, 2020 and included two new reports: State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2020 and 2021 and Medicaid Enrollment & Spending Growth: FY 2020 & 2021.
The reports were prepared by Kathleen Gifford, Aimee Lashbrook, and Sarah Barth from HMA and by Elizabeth Hinton, Robin Rudowitz, Madeline Guth, and Lina Stolyar from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
This survey reports on trends in Medicaid spending, enrollment, and policy initiatives for FY 2020 and FY 2021, highlighting COVID-19 policy planned for implementation in FY 2021. The conclusions are based on information provided by the nation’s state Medicaid Directors.
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.
The experts at Health Management Associates (HMA) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.
Based on HMA’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.
HMA colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.
For the next phase of research, HMA will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.
The project was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.