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Brief & Report

2021 Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access

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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.

Brief & Report

Three HMA clinicians author naltrexone formulations in correctional settings issue brief

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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.

Brief & Report

States, Medicaid, and Economic Hard Times

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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.

Brief & Report

HMA prepares NCQA distinction in multicultural health care report

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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.

HMA consultants Michael Anderson-Nathe, Nora Leibowitz and Michele Melden completed the assessment.

Brief & Report

HMA colleagues author evidence-based programs paper

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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.

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Brief & Report

20th annual state Medicaid budget survey released

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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.

Brief & Report

COVID-19 economic impact on health insurance September 2020

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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.

Brief & Report

HMA examines current state of Medicare-Medicaid integration programs

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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.  

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

2020 Medicare Advantage Supplemental Benefit Flexibilities: Adoption of and Access to Newly Expanded Supplemental Benefits

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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.

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