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Brief & Report

HMA releases COVID-19 Medicare regulation tracking tool

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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.

Brief & Report

Inland Empire Health Plan releases health homes program year one implementation report

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A new report has been released outlining Inland Empire Health Plan’s (IEHP) efforts to establish 50 care teams to support the delivery of core Health Homes Program services for IEHP’s most vulnerable members with complex health conditions.

HMA contributed to the new report and has supported implementation of IEHP’s Health Homes Program since 2018, providing consultation in the development and implementation of a clinical model of care, the design and deployment of a population health management tool, the creation and delivery of a multi-modal training program, and the provision of practice coaching to over 50 care teams.

HMA colleagues Liz Arjun, Marc Avery, Emily Brandenfels, Leslie Brooks, Nancy Jaeckels Kamp, and Jeffrey Ring contribute to this project, which is led by Betsy Jones. Former HMA colleagues Lynn Dierker and Michael Mabanglo also contributed.

Brief & Report

Issue brief outlines Medicare Advantage supplemental benefit flexibilities

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An HMA-authored issue brief examines beneficiary access to, and plan adoption of, newly expanded Medicare Advantage (MA) supplemental benefit flexibilities and raises questions regarding the expected impacts of new supplemental benefit offerings on beneficiary satisfaction, outcomes, and total cost of care.

The new flexibilities for MA plans include innovative supplemental benefits offered through expansion of primarily health-related benefits, benefits offered non-uniformly, Value-Based Insurance Design (VBID), and Special Supplemental Benefits for the Chronically Ill (SSBCI).

The brief’s key finding is that enrollment in plans offering these flexibilities is relatively low and varies across geographic areas with 19% of all MA enrollees enrolled in a plan that offered at least one expanded supplemental benefit.  HMA will conduct additional analyses including interviews with key stakeholders to inform the policy community on the opportunities and challenges with the adoption and implementation of new supplemental benefits

This brief was produced by HMA Managing Principals Jonathan Blum and Mary Hsieh, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi under a grant from Arnold Ventures.

Brief & Report

HMA report examines COVID-19 toll on Pennsylvania hospitals

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A report completed by HMA colleagues estimated the potential financial impact on hospitals and health systems of the current COVID-19 pandemic in the Commonwealth of Pennsylvania.

The analysis, completed in mid-April, concluded that Pennsylvania hospitals and health systems are likely to experience losses in excess of $7 billion for the final 10 months of 2020 after accounting for federal disaster relief payments, based on emergency relief legislation that had been passed at the time. HMA Principal Tom Marks and Senior Consultant Mary Goddeeris completed the report, Analysis of the Financial Impact of COVID-19 on Pennsylvania Hospitals, on behalf of the Hospital and Healthsystem Association of Pennsylvania (HAP). HMA conducted interviews and collected data from finance officials at a sample of health systems and projected the findings across the population of Pennsylvania hospitals and health systems. The interviews and analysis were completed in mid-April, well before the full effect of the pandemic could be measured. Financial leaders consistently reported enormous declines in patient service from mid-March to mid-April due to the cancellation and deferral of non-emergency services. While there are varying assumptions about the return of pre-pandemic patient service volumes, all leaders projected a bleak forecast for the second quarter and continued negative impact of service disruption for the rest of 2020.

Learn more about HMA’s multi-faceted COVID-19 response.

Brief & Report

HMA experts publish 50-state Medicaid pharmacy study with Kaiser Family Foundation

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In conjunction with the Kaiser Family Foundation (KFF), a team of HMA experts have published survey results and analysis examining administration of the Medicaid pharmacy benefit. HMA contributing colleagues were Kathleen Gifford, Anne Winter and Linda Wiant. Rachel Dolan, Marina Tian, and Rachel Garfield  from KFF also contributed.

The report, How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020, summarized the survey conducted in all 50 states and the District of Columbia.

The survey outlines Medicaid pharmacy policy areas and key issues to watch based on feedback from the states in several categories including pharmacy benefit administration, cost-containment and utilization controls, payment and rebates, 340B management and long-term priorities.

Brief & Report

Medicare-Medicaid integration: integrated model enrollment rates show majority of Medicare-Medicaid dual eligible population not enrolled

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Working in conjunction with Arnold Ventures, a team of HMA consultants has written an issue brief, Medicare-Medicaid Integration: Integrated Model Enrollment Rates Show Majority of Medicare-Medicaid Dual Eligible Population Not Enrolled. This brief presents key findings on their examination of the availability of integrated programs in states, the growth in enrollment rates, and differences in enrollment and programs across the country.

The HMA team cited several reasons why Medicare-Medicaid integrated program options are not equally available nationwide and why enrollment is limited in places where programs exist. The result is that millions of people are not enrolled in whole-person, integrated program options – a reality that is inefficient, and worse yet, inequitable.

The HMA team, led by Managing Principal Jon Blum and Principal Sarah Barth, includes Narda Ipakchi, Ellen Breslin, Mindy Cohen, Sharon Silow-Carroll and other HMA subject matter experts.

Brief & Report

HMA experts author LA city and county studies

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HMA Community Strategies (HMACS) experts have released a pair of evaluation reports commissioned by the City of Los Angeles and the County of Los Angeles.

HMACS worked with the Los Angeles Housing + Community Investment Department (HCIDLA) to facilitate the inaugural, interactive Los Angeles Poverty Prevention Summit and produced a report and policy recommendations.

The report, Breaking the Cycle of Poverty, Defining Innovative and Equitable Strategies, summarized ideas and input from the summit and provides analysis and recommendations to move forward by harnessing existing resources and leveraging them with other efforts to alleviate poverty in the county.

A second report, prepared for the Los Angeles County Chief Executive Office, evaluated strategies to combat homelessness put forth by the Office of Homeless Initiatives (HI). The evaluation of HI’s strategies is summarized in the report, Evaluating the Effectiveness of Los Angeles County’s Strategies to Expand and Enhance Interim Housing and Emergency Shelter Services. The report focuses on analyzing existing strategies and how they are preforming and goes on to identify best practices and areas of needed improvement.

HMACS is involved in continued work to address homelessness, poverty and other social determinants of health in Los Angeles County and beyond with the goal of improving health and wellbeing, particularly for at-risk patients and families.

The HMACS teams, led by Principal Charles Robbins, also included Catherine Guerrero, Nayely Chavez, and Rathi Ramasamy as well as Michael Stiffler and Kara Riehman.

Brief & Report

HMA explores potential issues for individuals with end-stage renal disease enrolling in Medicare Advantage

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Starting in 2021, Medicare beneficiaries with End-Stage Renal Disease (ESRD) will be able to enroll in any Medicare Advantage (MA) plan. The Anthem Public Policy Institute asked HMA to explore some of the potential issues associated with how MA plans are currently paid by the Centers for Medicare & Medicaid Services (CMS) for individuals with ESRD, and identify any possible modifications that CMS or Congress could make to more closely align payment with costs.

This white paper was prepared for Anthem Public Policy Institute by HMA Managing Principal Jon Blum, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi.

Brief & Report

HMA prepares report detailing economic implications of a Medicaid expansion in Missouri

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On January 30, 2020, the Missouri Hospital Association issued a press release outlining a report prepared by Health Management Associates. View the official press release here.

The report, Medicaid Expansion in Missouri – Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, was prepared by HMA MMS Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Jack Meyer. They conducted interviews with leaders directly involved with expansion in Arkansas, Indiana, and Ohio to evaluate the policy and operational adjustments they undertook to design a budget-conscious program while maximizing state value. Those interviews allowed clarification of many of the questions raised about state-level costs and budget savings of a potential Missouri expansion.

The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the healthcare community.

Brief & Report

Report maps out strategies, recommendations for preventing poverty

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In order to stimulate new thinking around addressing the crisis of poverty, Councilmember Mitch O’Farrell and the Los Angeles Housing + Community Investment Department (HCIDLA) convened the inaugural Los Angeles Poverty Prevention Summit. HMA Community Strategies worked with HCIDLA to facilitate the interactive event and produce a policy recommendations report.

“Breaking the cycle: Defining innovative & equitable strategies” is a summary, which synthesizes the ideas generated from the summit into recommendations aimed at reducing poverty in Los Angeles.

HMA Community Strategies colleagues Nayely Chavez, Catherine Guerrero, Rathi Ramasamy, and Charles Robbins conducted research for this report.