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Brief & Report

Engagement with community-based organizations key to achieving health equity & wellness for Medicaid populations

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A new issue brief from AcademyHealth, in partnership with Health Management Associates (HMA) and the Disability Policy Consortium (DPC), showcases the vital role that community-based organizations (CBOs) can play in advancing health equity and wellness for individuals and communities in Medicaid payment and care delivery system reform.

The brief provides five key lessons from CBOs in New York City and reactions to those lessons from CBOs in Massachusetts. Together, these perspectives provide a compelling case to elevate the role of CBOs in reform.

The authors, including HMA’s Ellen Breslin and Heidi Arthur, call for the development of a National Blueprint for Advancing Health Equity Through Community-Based Organizations to facilitate greater cross-sector collaboration between CBOs and HCOs.

Read the full brief here or on the AcademyHealth website.

Brief & Report

HMA colleagues conduct impact assessments of proposals developed by California future health workforce commission

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A team of HMA colleagues, including Carrie Cochran, Helen DuPlessis, Kelly Krinn, Nora Leibowitz and Ryan Mooney, along with Healthforce Center at the University of California, San Francisco conducted impact assessments on recommendations developed by the California Future Health Workforce Commission.

The assessments were provided to the commission and used to help determine which of more than 30 proposals would be part of the commission’s final report. In addition, Nora Leibowitz summarized commissioner dissents with the draft recommendations and organized the outstanding issues for the report.

The final report, which identifies a doctor shortage in California and mechanisms for addressing the problems, included the supporting work by HMA.

Download the impact assessments below.

Brief & Report

White paper prepared by HMA aligns CenteringPregnancy with value-based payment models

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In, “Aligning Value-Based Payment with the CenteringPregnancy Group Prenatal Care Model: Strategies to Sustain a Successful Model of Prenatal Care,” HMA authors Diana Rodin, MPH, and Margaret Kirkegaard, MD, MPH, review new opportunities to promote improved outcomes and lower costs in maternity care though value-based payment strategies. Prepared for the Centering Healthcare Institute, it demonstrates specifically how CenteringPregnancy can be an effective, financially sustainable model of maternity care, that meets the goals of value-based payment contracts.

The report examines:

  • Value-based payment in Medicaid maternity care
  • Alternating payment models in maternity care across states
  • CenteringPregnancy as a model of prenatal group care – outcomes, evidence, cost and savings
  • CenteringPregnancy alignment with value-based payment framework

The complete white paper can be downloaded below.

Brief & Report

Report examines Medicaid program features, challenges, and changes in the territories

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Medicaid was designed to serve low-income and vulnerable individuals, but it operates differently in the U.S. territories than it does in the states. While the federal share varies based on per capita income for each state, federal funding for Medicaid in the territories is subject to a statutory cap and a fixed federal matching rate. Following recent hurricanes, typhoons and the North Korean missile crisis, which have damaged infrastructure and limited tourism, the fiscal issues for territories have been exacerbated. This is in addition to the larger share of people living in poverty that are in fair or poor health in the territories.

In a recently published issue brief, Kaiser Family Foundation’s Program on Medicaid and the Uninsured Policy Analyst Cornelia Hall and Associate Director Robin Rudowitz, along with HMA Principal Kathy Gifford, surveyed and interviewed territory Medicaid officials to identify the key issues and trends in the programs for the territories.

Key findings include:

  • The reliance on Affordable Care Act funds for Medicaid programs, which are set to expire in September.
  • Enrollment increases due to recent hurricanes.
  • Benefits and delivery systems differ in the territories.
  • Provider shortages.

View below for the full issue brief.

Brief & Report

Report conducted by HMA addresses alarming youth suicide trends across Colorado

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On January 3, 2019, Colorado Attorney General Cynthia H. Coffman released the study, Community Conversations to Inform Youth Suicide Prevention. The multi-layered study, conducted by HMA, focused on the four Colorado counties with the highest youth suicide rate.

HMA designed a multi-pronged strategy to the study with the goal of learning about opportunities and approaches to youth suicide prevention in each of the four counties, and across Colorado. The team conducted 42 stakeholder interviews and also facilitated 34 focus groups with adults and youth from various communities and sectors. For comparison, focus groups were also conducted with school staff and parents in two counties, where youth suicide rates were lower and/or there had not been recent suicide clusters.

HMA also reviewed information about current suicide prevention activities and resources, traditional and social media coverage related to suicide, and publicly available information on school policies and procedures related to suicide prevention and postvention in the aftermath of a student suicide or suicide attempt.

Key findings:

Risk factors attributing to youth suicide:

  • Pressure and anxiety about failing
  • Social media and cyber bullying
  • Lack of pro-social activities
  • Lack of connection to a caring adult
  • Judgement and lack of acceptance in the community.
  • Substance use, mental health disorders and trauma history
  • Adult suicides in the community

Barriers to suicide prevention:

  • Not enough resources to effectively implement youth suicide prevention, intervention and postvention activities
  • Each county faces lack of resources and funding for public health and social services programs
  • Lack of equitable distribution of resources across agencies
  • Lack of mental health providers in these communities who accept Medicaid
  • Communities with more mental health resources have few providers who are trained to work with youth or the providers only accept adults
  • Stigma associated with seeking help
  • Stigma against LGBTQ+ individuals limits the places and resources from which those individuals seek help
Brief & Report

50-state Medicaid director survey released: states focus on quality and outcomes amid waiver changes

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Results of the 18th annual Medicaid Budget Survey were released Oct. 24, 2018 and examine changes taking place in Medicaid in all 50 states and the District of Columbia. The Kaiser Family Foundation (KFF) and HMA conduct the survey in partnership with the National Association of Medicaid Directors.

Key findings of the study include:

  • A growing number of states are implementing or planning to implement Section 1115 waivers
  • Risk-based managed care continues to be the predominant deliver system for Medicaid services
  • States are working to address social determinants of health
  • Expansion of people served in in-home and community-based settings
  • States are planning provider rate increases, increase in benefits for mental health and substance use disorder treatment and efforts to address rising prescription drug costs and management strategies to address the opioid crisis.

The report was prepared by Kathleen Giff­ord, Eileen Ellis, Barbara Coulter Edwards, and Aimee Lashbrook from HMA, and by Elizabeth Hinton, Larisa Antonisse, and Robin Rudowitz from the Kaiser Family Foundation.

Brief & Report

HMA Denver office evaluates jail-based behavioral health services program in Colorado

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HMA partnered with the Colorado Office of Behavioral Health and Correctional Treatment Board to conduct a statewide program evaluation report for The Jail Based Behavioral Health Services (JBBS) program. The JBBS program is administered by the Office of Behavioral Health and is funded through Colorado House Bill 10-1352 and was expanded through Colorado Senate Bill 12-163 creating the Correctional Treatment Cash Fund.  The JBBS program provides resources for the county jails to address the needs of individuals with substance use disorders and co-occurring mental health disorders. Initiated in 2011 with twenty- four counties, the program is in its seventh year and has grown to 46 counties across the State.  This initial JBBS program evaluation examined both process elements of how the program is implemented across the counties as well as the outcomes and impact of the services provided.

Brief & Report

MACPAC contracted with HMA to better understand how states develop their hospital payment policies

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Health Management Associates was contracted by MACPAC to better understand how states develop their hospital payment policies. State, hospital, and managed care representatives from five states that vary in their use of supplemental payments and financing approaches (Arizona, Louisiana, Michigan, Mississippi, and Virginia) were interviewed. The three key findings from the study include:

  1. The availability of financing for the non-federal share of Medicaid payments has affected states’ use of base and supplemental payments;
  2. The use of Medicaid managed care has not substantially affected Medicaid payments to hospitals; and,
  3. The adoption of prospective payment systems and value-based payment models is slow.

MACPAC presented this information at its September 2018 Commission meeting.

Brief & Report

HMA reviews state assisted living licensing regulations and statutes for 2018 NCAL state regulatory review

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From March 2017 through April 2017, HMA reviewed each state and the District of Columbia’s assisted living licensing regulations and statutes, relying on the resources published on state licensure agency web pages.  According to the NCAL’s 2018 edition of “Assisted Living State Regulatory Review,” assisted living regulations, statutes, and policies in 29 states were updated between June 2017 and June 2018. The report found that the most common changes to state regulations were in the area of staffing, such as additional training requirements and expanded background check requirements.

Brief & Report

HMA Report Examines Needs Assessment for Denver Residents with Intellectual and Developmental Disabilities

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The City and County of Denver’s Department of Human Services (DHS) contracted with HMA, between March and August 2018, to conduct a needs assessment of services and supports for individuals with intellectual and/or developmental disabilities (IDD). Denver will use findings from this assessment to inform decisions regarding the governance and distribution of a Denver property tax (mill levy) dedicated to funding services for residents with IDD.

The primary goals of the needs assessment were:

  1. Inventory current services for Denver County residents with IDD and the existing capacity in and around Denver to provide these services.
  2. Identify service gaps and potential ways to address these gaps by engaging stakeholders ‐ including clients, families, caregivers, service providers, city and state agencies, employers, and the public, with the intent to form the basis of how dedicated mill levy funding is programmed going forward.
  3. Research possible governance models for determining/overseeing the disbursement of dedicated revenue, gathering stakeholder feedback on the governance models, and evaluating pros and cons of preferred models to form the basis of the process through which dedicated funding is allocated going forward.

The report summarizes the findings in the three areas identified above, including recommendations on the most pressing service gaps to address and features of the governance model.

Brief & Report

HMA Contributes to CPEHN Report on California’s Mental Health Equity Act

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Principal Jeff Ring and Senior Consultant Helena Whitney recently coordinated and facilitated an advisory committee which provided recommendations for the implementation of California’s Mental Health Equity Act (AB 470, 2017). Using the Advisory Committee recommendations, they developed the California Pan-Ethnic Health Network (CPEHN) report, “Measuring Mental Health Disparities.”

AB 470 was proposed to mandate the Department of Health Care Services (DHCS) update the performance and outcome reporting system on mental health outcomes and utilization for beneficiaries receiving Specialist Mental Health Services in order to focus the Performance Outcomes System (POS) on disparities. Following the passage of the statute, CPEHN created an Advisory Committee of behavioral health and healthcare experts to develop recommendations for the DHCS to consider during its stakeholder engagement process.

After reviewing DHCS’ existing data and quality measures, the Advisory Committee identified data elements that the state performance outcome reporting system on mental health should include to further the work of tracking mental health disparities and achieving health equality.

Also considered was information obtained through interviews with selected subject matter experts who directed the Advisory Committee to additional performance measures and datasets, such as those currently in use by health plans that are participating in state and national pilot programs such as the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program, the Health Homes for Patients with Complex Needs Initiative, and the Whole Person Care Program.

Special consideration was given to measures that were (1) developed by nationally-recognized organizations such as the National Committee for Quality Assurance and the Consumer Assessment of Healthcare Providers and Systems Consortium, (2) are endorsed by the National Quality Forum, (3) are widely used by other states, (4) and/or are cited in the literature as “disparity-sensitive,” meaning that the measurements help identify inequities in health outcomes and access to services.

Per the requirements of the statute, the Advisory Committee organized its measure recommendations into two phases:

  1. Those that are currently available from county mental health plans or the state and should be included in the initial POS reports (“Phase I”).
  2. Those that could be added to county reporting systems and/or may be available from Medi-Cal managed care plans and should be included in future POS reports (“Phase II”).
Brief & Report

Report Examines the Models and Issues of Behavioral Heath Crisis Services

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In a report prepared for the Michigan Health Endowment Fund, HMA Principal Steve Fitton and Senior Consultant Esther Reagan examine the models and issues of behavioral health crisis services.

Many people with behavioral health (mental illness and/or substance use disorder [SUD]) issues are arriving in hospital emergency departments (EDs) and not being well served in that setting. The ED is the wrong place at the wrong time for many patients – and for many reasons. These include being discharged prematurely, long waits in noisy EDs may exacerbate symptoms, the EDs may not have the professional staff best suited to provide services, and the ED itself is an expensive setting and can result in unnecessary and costly admissions for public and private insurers.

A number of models have been developed with the goal of improving the behavioral health emergency response environment. This report explores several models, including mobile crisis teams, co-located and dedicated behavioral health crisis emergency services units, behavioral health staffing in hospital EDs, and standalone behavioral health crisis centers. Strategies for moving forward, including addressing challenges in multiple areas are outlined as well.