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.
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
A highly specialized critical care, trauma and flight nurse, Trisha Bielski has deep experience in nursing leadership, military healthcare, and … Read more
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 Background
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.
RFP
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:
Improve member experience and satisfaction
Improve health outcomes by providing integrated, holistic care with a focus on the impacts of social determinants of health
Reduce healthcare disparities
Expand provider network and direct care workforce capacity and skill sets
Improve provider experience and encourage provider participation in Medicaid
Increase the use of cost-effective strategies to improve health outcomes and the service delivery system
Leverage data to promote continuous quality improvement
Timeline
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.
Current Market
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.
HMA is releasing an agency-by-agency analysis of the impacts on several key healthcare programs and services in the event of the potential federal government shutdown in the coming days. As of September 27, 2023, the U.S. Congress has not approved any of the twelve appropriations bills for FY 2024 or a continuing resolution (CR) that would maintain federal funding at the FY 2023 level for a specified period of time into FY 2024 while Congress continues negotiating. If the shutdown is not averted before the deadline, look for a LinkedIn live at 10am Monday, October 2 to discuss the ramifications on the U.S. healthcare system. Go to the HMA LinkedIn page to watch.
Child welfare services face challenges every day to prevent, treat, and reduce risk of maltreatment, neglect, trauma, housing instability, and violence in communities. These issues need to be seen as a priority for public health and community wellbeing and not just the jurisdiction and responsibility of child welfare agencies.
There are many opportunities for improvement in this area, including:
Integrating prevention services within the human services system to help support families and youth experiencing child welfare interventions
Providing technical assistance and supports to systems serving child welfare and justice-involved youth, including: policy and practice reviews, workforce and workload analyses, process re-engineering
Increasing Medicaid providers who offer more community based Evidenced Based and Informed Practices (EBP) among Community Based Organizations (CBO), Providers, and Local Government entities
Developing the workforce to enable prevention programs and building competencies to engage in meaningful interactions with children, youth, and families
Addressing disparities in both experiences and outcomes for children, youth and families, rather than focusing on responding through merely a transactional and compliance driven approach
If your organization works to help meet the needs of children, youth and families impacted by issues like mental health and substance abuse, domestic violence, child abuse and neglect, food insecurity, housing instability, incarceration, and other traumas, Health Management Associates (HMA) can help make your efforts more effective.
Together we can help you move programs upstream with strong prevention and family strengthening approaches and integrate payment models with the human services delivery system to streamline and improve resources.
HMA can help in the following ways:
Developing system integration models
Strategies to improve school-based mental health support implementation
Provide technical assistance and consulting support regarding service access and expansion of Medicaid utilization for implementation of evidence-informed programs
Workforce planning and strategy
Assist states, counties, hospitals, providers, and MCO’s address the challenges of hospital overstays and behavioral health placements
Provide technical assistance to state and local governments regarding limiting exposure to class action lawsuits or providing expert witness services
Strategic planning
Program evaluation, research and analysis including cost/benefit analysis of programs
Leadership development
Stakeholder engagement
A longtime leader in health and human services, HMA experts have front line and executive level experience providing direction to child welfare programs.
We consult with public and private sector entities who serve children and families to improve, streamline and integrate essential services. We ground our work in human-centered design, lived expertise, and change management and leadership principles in state and county program development.
