In November 2019, the Centers for Medicare & Medicaid Services (CMS) officially proposed a comprehensive regulation on Medicaid fiscal accountability. To facilitate review of the rule, HMA staff have created an overview of key elements of the proposed regulation and summary. This document is designed to give a framework to analyze the proposal and provides analysis in most sections. The HMA team can provide in-depth policy support unique and local issues may require.
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Final HMA-authored reports on reproductive care access released
A final report and series of five case studies, Beyond the Numbers: Access to Reproductive Health Care for Low-Income Women in Five Communities, have been released.
Working with the Kaiser Family Foundation (KFF), a team of HMA colleagues, Managing Principal Sharon Silow-Carroll, Consultant Carrie Rosenzweig, Senior Consultant Diana Rodin, and Principal Rebecca Kellenberg, completed the project.
Through state policy reviews, site visits, interviews with local stakeholders, and focus groups with low income women, the team examined how national, state, and local policies, as well as cultural factors, shape access to contraceptive care, sexually transmitted infection prevention and treatment, obstetrical care, and abortion services. The study focused on the on-the-ground experiences of women living in these communities and the reproductive health professionals caring for them.
The study identified themes that cut across all five “medically underserved” communities but play out in different ways depending on the local environment. The key factors influencing access include cultural and social determinants of health, healthcare coverage, provider supply and distribution, sex education, and abortion policies and environment.
In addition to an executive summary report, KFF has also published case study briefs that detail the findings in each of the five communities. The complete report is available here.
Issue brief explores child care needs of families experiencing homelessness
Recently, the HMA Community Strategies team of Managing Director Marci Eads, Principal Catherine Guerrero, Senior Associate Robyn Odendahl, Research Assistant Rathi Ramasamy and Principal Charles Robbins, contributed to a research project conducted in Los Angeles: Child Care Needs of Families Experiencing Homelessness.
Funded by the Child Care Resource Center, the study’s purpose was to understand the needs of families experiencing homelessness with children ages zero to five living in Los Angeles County Service Planning Areas 1 and 2 (San Fernando and Antelope Valleys). Through multiple sources of data including a literature review, publicly available data on homelessness in Los Angeles County, interviews with national and local experts and focus group with families experiencing homelessness, the research highlighted a need to develop and expand access to child care resources specifically designed for families experiencing homelessness.
Annual 50-state Medicaid director survey released: states report expansion and enhancement
Results of the 19th annual Medicaid Budget Survey were released Oct. 18, 2019 and examine changes taking place in Medicaid in all 50 states and the District of Columbia. The Kaiser Family Foundation (KFF) and HMA conducted the annual survey in partnership with the National Association of Medicaid Directors.
Key findings of the survey include:
- Multiple states reported expansions or enhancements to provider rates and benefits.
- Several states implemented, adopted, or continued to debate the ACA Medicaid expansion.
- A growing number of states continued to pursue work requirements and other policies promoted by the Trump administration that could restrict eligibility.
- States are implementing Medicaid initiatives to address social determinants of health, control prescription drug spending, improve birth outcomes and reduce infant mortality, and address the opioid epidemic.
The report was prepared by Kathleen Gifford and Aimee Lashbrook, Eileen Ellis and Mike Nardone, and by Elizabeth Hinton, Robin Rudowitz, Maria Diaz, and Marina Tian.
MAT issue brief addresses objections and misconceptions
A new issue brief authored by HMA Principal Donna Strugar-Fritsch, MPA, BSN, dispels myths about, and objections to, the use of medication-assisted treatments (MAT) to treat opioid addiction. The brief is a clear and concise look at MAT, how and why it works, and what its use can mean for those impacted by opioid use disorder.
The brief lays out common misconceptions about MAT and provides evidence-based responses to each, including supporting citations. It also includes objections to treating addiction in criminal justice settings and is a valuable tool for anyone working to expand access to MAT.
Objections addressed in the brief include treating a drug addiction with a drug, abuse of buprenorphine, abstinence-based treatment, methadone myths and more. It underscores the evidence basis for MAT as a key tool in reducing relapse and overdose death.
The brief was published by the California Health Care Foundation.
HMA MACPAC report, care coordination in integrated care programs serving dually eligible beneficiaries
A team of HMA colleagues including Sarah Barth, Sharon Silow-Carroll, Esther Reagan, Mary Russell and Taylor Simmons completed a study for the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to examine care coordination requirements for several Medicare-Medicaid integrated care models.
The study’s final report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches, is posted to the MACPAC website.
Engagement with community-based organizations key to achieving health equity & wellness for Medicaid populations
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.
HMA colleagues conduct impact assessments of proposals developed by California future health workforce commission
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.
White paper prepared by HMA aligns CenteringPregnancy with value-based payment models
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.
Report examines Medicaid program features, challenges, and changes in the territories
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.
Average Sales Price Reimbursement: Significant Savings from Prior Benchmark
Prior to the enactment of the Medicare Prescription Drug and Modernization Act of 2003 (MMA), the Balanced Budget Act of 1997 had set reimbursement for drugs and biologics provided incident to physician services under Part B of the Medicare Program at 95% of Average Wholesale Price (AWP). AWP as a benchmark was subject to a variety of criticisms and reports indicating that in most cases it significantly exceeded providers’ costs. As a result, the Congress created Average Sales Price (ASP) as a benchmark intended to more accurately reflect the cost to physicians and hospitals of furnishing Part B drugs. The shift from AWP based reimbursement to ASP reimbursement created significant savings for Medicare and its beneficiaries beginning January 1, 2005 and continuing under current law. The Moran Company was asked by PhRMA to analyze the impact the switch to the ASP system had on Part B medicine spending relative to the prior AWP reimbursement methodology.
Report conducted by HMA addresses alarming youth suicide trends across Colorado
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