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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.

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Webinar

Webinar Replay: Initiating a Successful Medicare Advantage Plan: Strategic, Operational and Planning Considerations

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This webinar was held on July 24, 2019.

If your managed care organization or health system is considering joining the growing market for Medicare Advantage (MA) plans, including Special Needs Plans (SNPs), or expanding your MA service area, now is the time to start planning for a 2021 launch.

During this webinar, HMA Managing Principal and former CMS Deputy Administrator for Medicare Jonathan (Jon) Blum is joined by HMA Managing Principal Mary Hsieh and Principal Julie Faulhaber. Together, they discussed the strategic, operational, and planning considerations every organization must address before initiating a successful Medicare Advantage plan. Our experts discussed regulatory concerns, operational readiness, benefit structure, marketing, risk management, and other key considerations.

Learning Objectives

  1. Find out what your organization needs to make a go/no go decision on the launch of a Medicare Advantage plan, including an assessment of financial feasibility, member opportunity, capital requirements, and operational capabilities.
  2. Understand the federal requirements and timelines and internal preparations involved in filing a successful application to initiate a Medicare Advantage plan.
  3. Learn why Medicare Advantage plans serve as a foundation for further efforts to initiate SNPs.
  4. Understand the key differences between SNPs and Medicare Advantage plans, including special SNP requirements such as the Model of Care.

Speakers

  • Jon Blum, Managing Principal, Washington, DC
  • Julie Faulhaber, Principal, Chicago
  • Mary Hsieh, Managing Principal, Atlanta

Who Should Listen

Executives from managed care organizations, insurers, hospitals, health systems and other entities considering the launch of a Medicare Advantage plan such as a Special Needs Plan or considering a Medicare Advantage Service Area Expansion.

Webinar

Webinar Replay: Unpacking the MassHealth One Care Procurement Databook: Key Considerations for Strengthening the Program, Advancing Health Equity

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This webinar was held on July 16, 2019. 

The Massachusetts One Care program, which went out to bid this year, is an 1115A Duals Demonstration (both a Financial Alignment Demonstration and a state demonstration) for dually eligible Medicare and Medicaid beneficiaries age 21-64 at the time of enrollment and living with disabilities. To assist potential bidders, the state released a Databook containing historical demographic, cost and utilization information for individuals who are eligible for One Care but not currently enrolled.

During this webinar, HMA experts broke down the One Care Databook and provided an eye-opening review of the data that can help regulators, health plans, providers and community-based organizations strengthen the program and advance health equity for the eligible population. Speakers also used sophisticated geo-mapping software to illustrate geographic variation in the cost and utilization of both Medicare and Medicaid services.

Learning Objectives

  • Gain insights into the eligible population and their use of Medicare and Medicaid services.
  • Consider regional variation in the cost and use of Medicare and Medicaid services.
  • Learn more about Medicare Part D service use among the eligible population.
  • Take stock of the opportunities to advance health equity gleaned from the data.

HMA Speakers

Ellen Breslin, Principal, Boston
Eric Hammelman, Principal, Chicago
Anissa Lambertino, Senior Consultant, Chicago

Who Should Listen

Federal and state regulators, Medicaid officials, and officials from the Centers for Medicare & Medicaid Services; executives of health plans, health systems, community-based organizations, and providers of long-term services and supports (LTSS).

Webinar

Webinar Replay: CMS Primary Care Initiative: Key Considerations Concerning New Value-Based Payment Options

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This webinar was held on July 11, 2019. 

The Centers for Medicare & Medicaid Services (CMS) has announced a new Primary Care Initiative, offering primary care providers (PCPs) in 26 regions nationally the opportunity to participate in new Medicare payment models beginning January 2020: Primary Care First (PCF).

During this webinar, experts from HMA described how this initiative builds on prior CMS innovation models in advancing primary care and outlined eligibility, payment models, and key considerations of the program. The PCF program includes an option to care for seriously ill patients who lack a primary care practitioner and opt to participate in this payment model option. It prioritizes the physician-patient relationship, reduces administrative burden, and financially incents improved health outcomes.

Learning Objectives

  1. Understand the eligibility requirements for the PCF programs.
  2. Describe program models including attribution and payment models.
  3. Understand the goals and quality metrics associated with PCF, including incentives aimed at reductions in hospital utilization and total cost of care.
  4. Lean how participation in this primary care initiative can help primary care practices expand their patient base, especially among high needs populations.

Speakers

  • Art Jones, MD, Principal, Chicago
  • Elizabeth Wolff, MD, MPA, Principal, New York

Who Should Listen

Physicians and executives from primacy care practices, IPAs, ACOs, hospitals, health systems, and other provider entities; health plans and other payers. Although eligibility for program participation is limited to the 26 targeted geographic areas, others may be interested in learning how CMS is progressing toward increasing primary care payment through capitation.

Webinar

Webinar Replay: Medication Assisted Treatment: Are You Ready?

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This webinar was held on June 12, 2019 and was the seventh webinar in a series about addressing the opioid crisis in America.

Medication Assisted Treatment (MAT) has been proven to successfully treat opioid use disorder and can be offered in outpatient settings alongside treatment for other chronic medical and behavioral health conditions. However, many providers are unfamiliar with the nuances of providing this treatment in their practices. What’s needed is a systematic understanding of the various operational and regulatory issues that providers will face when providing MAT.

During this webinar, HMA clinicians addressed some of the key considerations for practices looking to offer MAT. They also demonstrated how the use of a readiness assessment tool can help providers identify and work through a variety of potential problem areas, leading to implementation of a successful MAT program.

Learning Objectives

  1. Learn how to institute new workflows and manage the type of change that will come with providing access to MAT.
  2. Understand best practices for integrating MAT into an already busy practice, including the issues of staffing and scheduling.
  3. Find out how to make MAT financially sustainable, including an understanding of billing and coding rules.
  4. Learn how to ensure compliance with Drug Enforcement Administration regulations and requirements.

HMA Speakers

  • Scott Haga PA-C, Senior Consultant, Lansing
  • Jean Glossa, MD, MBA, Managing Principal for Clinical Services Washington, DC

Who Should Listen

Outpatient primary care and behavioral health providers considering adding MAT to their scope of practice, health systems interested in supporting outpatient providers, payers and health plans.

Webinar

Webinar Replay: Creating Effective Health and Law Enforcement Partnerships to Combat the Opioid Epidemic

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This webinar was held on June 5, 2019, and was the sixth webinar in a series about addressing the opioid crisis in America.

Multi-sector collaboration is a key strategy for reversing the upward trend in opioid-related deaths, and there are tremendous opportunities to develop solutions through health and law enforcement partnerships. Historically, these sectors held divergent viewpoints and practices to best address opioid use. But today, successful collaborations involving health and public safety leaders are emerging across the country in response to the opioid crisis.

During this webinar, experts from HMA and the New York City Police Department explored key elements in a multi-sector approach to address opioid use, built on a foundation of shared ownership of policies, system response, and programmatic interventions.

Learning Objectives

  1. Understand the key challenges to partnerships between health systems and law enforcement.
  2. Learn strategies for strengthening partnerships in which law enforcement, health professionals and community members work together to respond to the opioid crisis.
  3. Obtain examples of successful collaboration from around the country.
  4. Uncover current funding opportunities to support your health and law enforcement partnerships.

Speakers

  • Laquisha Grant, Senior Consultant, New York City
  • Ashley Restaino, Managing Director, Staten Island PPS
  • Theresa Tobin, Deputy Chief, New York City Police Department
  • John Volpe, Principal, New York City

Who Should Listen

Officials of state and local government, law enforcement, fire departments, emergency response, crisis hotlines and crisis centers; executives of hospitals, health systems, mobile crisis units, and affiliated community providers and payers of crisis services, including Medicaid payers.

Webinar

Webinar Replay: Advancing and Codifying Health Equity and Wellness for Medicaid Populations

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This webinar was held on June 4, 2019. 

It’s widely recognized that social determinants of health (SDOH) have a significant impact on mortality and morbidity. Community-Based Organizations (CBOs) play a significant role in addressing SDOH factors that drive health disparities and poor health outcomes. CBOs are directly connected to the populations they serve and commonly address an array of overlapping clinical and social service needs. However, CBOs face many challenges creating meaningful partnerships with health care organizations (HCOs) and health plans. Addressing these challenges is important so CBO contributions can be scaled through a more integrative and inclusive approach within the healthcare system.

During this webinar, experts from the Disability Policy Consortium (DPC) and the Arthur Ashe Institute of Urban Health (AAIUH) joined HMA to discuss the recent issue brief, published by Academy Health, which detailed lessons learned from CBOs in New York and Massachusetts.

Learning Objectives

  1. How CBOs can advance health equity and wellness goals for the individuals and communities that are the focus of Medicaid payment and care delivery system reform.
  2. How New York supported CBO engagement in its Delivery System Reform Incentive Payment (DSRIP) plan.
  3. What the challenges CBOs have experienced in healthcare reform.
  4. Why we need a National Blueprint for Advancing Health Equity by leveraging the nation’s CBOs to facilitate greater cross-sector collaboration between CBOs and HCOs.

Speakers

Dennis Heaphy, Health Policy Advocate, Disability Policy Consortium, Boston
Humberto Brown, The Arthur Ashe Institute of Urban Health (AAIUH), NYC
Ellen Breslin, HMA, Principal, Boston
Heidi Arthur, HMA, Principal, NYC

Who Should Listen

Executives of Medicaid and Medicaid-Medicare health plans; community, state and federal policy makers and program administrator; CBO and Accountable Care Organization leaders); advocates; and members of the community working to remove barriers to advance health equity and wellness for Medicaid populations.

Webinar

Webinar Replay: Pathways HUB- A Population Health Model that Activates the Community Response to Social Determinants

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This webinar was held on May 9, 2019.

One of the most successful approaches to addressing social determinants of health involves the coordination of community-based services and civic resources through a community hub funded by performance-based managed care payments.

This webinar will feature the co-developer of The Pathways Community HUB model, an approach designed to help coordinate outreach by specialized community health workers who are incentivized to engage high-need populations.

Speakers will also discuss how community hubs can be adapted to address broader community needs for an array of populations.

Learning Objectives

  1. Learn how to take local healthcare planning to the next level by identifying, activating, and financing community-based organizations through a community hub.
  2. Find out how the Pathways Community HUB can facilitate managed care payments for risk mitigation within attributed populations.
  3. Understand the value of coordinating with grassroots organizations and informal networks, such as faith-based groups, to better address social determinants of health.
  4. Find out how health systems can play a central role as the platform for community hubs, providing infrastructure, information technology, and administrative capabilities.
  5. Learn how to leverage the Pathways HUB toolkit to support the planning, development, and implementation of a community hub.

Speakers

  • Heidi Arthur, Principal, HMA
  • Mark Redding, MD, Co-Developer, Pathways Community HUB

Who Should Attend

Executives of health plans, providers, and community-based organizations; officials of state and local government, civic groups, grassroot organizations, faith-based groups, and community-based collectives.

Webinar

Webinar Replay: Activating Local Communities to Successfully Address Opioid Addiction and Recovery

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This webinar was held on April 17, 2019, and was the fifth webinar in a series about addressing the opioid crisis in America.

Local communities are organizing to battle opioid use disorder, based on the growing understanding that addiction and treatment happen at the community level. Successful efforts include tracking spikes in opioid use, effectively targeting high-burden areas, conducting community-based research on needs and resources, and deploying community-based resources in a meaningful and coordinated fashion.

During this webinar, HMA public health, prevention, and research experts explored how to activate local communities in the battle to prevent the rise of opioid use disorder and how to respond to the needs of community members for wraparound services. Speakers also addressed how the engagement of those most impacted by opioids can improve the availability and effectiveness of recovery and prevention options and solutions.

Learning Objectives

  1. Understand the importance of peers and community health workers and the roles they play in keeping local communities activated.
  2. Find out how to conduct a community gap analysis to identify the type of wraparound supports and services needed to best address opioid use disorder.
  3. Learn how to engage community members in community-based participatory research and program implementation to develop and implement effective services.
  4. Understand how to use surveillance data needed to identify and respond to neighborhoods at growing risk for opioid deaths.
  5. Find out how local communities in Delaware are organizing to prevent overdose deaths in their neighborhoods and ensure those in need have opportunities to engage in treatment.
  6. Learn why targeted Naloxone distribution makes more sense than passive distribution among the “worried well.”

HMA Speakers

  • Liddy Garcia-Bunuel, Principal, HMA Community Strategies
  • Marci Eads, PhD, Managing Director, HMA Community Strategies

Who Should Listen

State and local public health officials; behavioral health practitioners; addiction treatment providers; officials from state healthcare organizations, Medicaid agencies, community-based organizations, federally qualified health centers, and other provider organizations; and community members who have been impacted by addiction.

Webinar

Webinar Replay: Rethinking Behavioral Health Crisis Systems: Saving Lives, Saving Resources

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This webinar was held on April 16, 2019.

Across the country, police and EMS are increasingly called upon to respond to individuals experiencing behavioral health crises, without having received the training, skills and resources to effectively address those scenarios. At the same time, civilian crisis response services (e.g. crisis hotlines, mobile crisis teams) are often siloed from the public safety response, contributing to system fragmentation and inappropriate interventions. Local governments are spending considerable resources without getting the desired outcomes, and individuals frequently receive subpar care, placing them at risk for future crises and cycling in and out of emergency rooms and the criminal justice system.

During this webinar, experts from HMA explored the four key elements of a successful crisis system redesign: crisis prevention, early intervention, appropriate response, and improved post-crisis support. Speakers also addressed why system redesign is the foundational element to a new way of delivering crisis services.

Learning Objectives

  1. Understand the key components of common behavioral health crisis systems.
  2. Identify opportunities for system improvement.
  3. Learn strategies or approaches to achieve a reimagined crisis system where law enforcement, health professionals and community members work together to respond to crises.
  4. Identify funding opportunities to support your crisis system.

HMA Speakers

  • Laquisha Grant, Senior Consultant
  • John Volpe, Principal

Who Should Listen

Officials of state and local government, law enforcement, fire departments, emergency response, crisis hotlines and crisis centers; executives of hospitals, health systems, mobile crisis units, and affiliated community providers and payers of crisis services, including Medicaid payers.

Webinar

Webinar Replay: The Importance of Race and Ethnicity in Accounting for Social Risks in Medicare Value-Based Payments

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This webinar was held on April 3, 2019. 

Medicare value-based payments are increasingly considering social risk factors such as income and other elements of socioeconomic disadvantage. However, race and ethnicity are often left out of the mix, an approach that can create significant problems for providers attempting to adequately account for financial risks when entering into value-based payment arrangements.

During this webinar, experts from HMA, the National Committee for Quality Assurance and Anka Consulting discussed the importance of race and ethnicity in addressing social risks. Speakers also addressed how payers, providers and accountable care organizations can best mitigate these risks, ensuring that value-based payment arrangements are equitable, sustainable, and best serve patient needs.

Learning Objectives

  1. Understand current thinking about accounting for social risks in value-based payment arrangements and why to this point race and ethnicity have been deemphasized.
  2. Learn the key explanatory concepts for why race plays an important role in health disparities and risk, including minority stress, resilience, life course and epigenetics.
  3. Find out how to mitigate risk factors associated with race and ethnicity through flexible payment models and trauma-information approaches to care.

Speakers

  • Maddy Shea, Principal, HMA Community Strategies
  • Judy Ng, Research Scientist, National Committee for Quality Assurance
  • Kima Taylor, MD, Managing Principal, Anka Consulting, LLC

Who Should Listen

Executives and clinicians from accountable care organizations, hospitals, health systems and health plans; regulators, and others interested in value-based payments and risk adjustment.

Webinar

Webinar Replay: Overcoming Stigma of Opioid Use Disorder: Lessons for Providers, Payers, Policymakers, and the Healthcare Community at Large

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This webinar was held on March 28, 2019, and was the fourth webinar in a series about addressing the opioid crisis in America.

The stigma associated with opioid use disorder impacts not only individuals seeking treatment, it also colors the attitudes of payers and providers charged with helping those struggling with addiction. The results can be devastating, with individuals avoiding care, providers refusing to administer certain treatments – including the Medication Assisted Treatment (MAT) – and both patients and their families left with limited options.

During this webinar, HMA experts outlined the barriers to effective treatment caused by the stigma of opioid use disorder. Speakers also offered a series of concrete steps that payers and providers can take to ensure patients are seeking and receiving the best treatment options available.

Learning Objectives

  1. Learn best practices for overcoming the stigma associated with opioid use disorder and increasing patient engagement in treatment.
  2. Understand how shame influences treatment choices among patients and families impacted by opioid use disorder and how stigma impacts the availability of treatment options.
  3. Find out how to identify and address punitive attitudes that may result in barriers for individuals in need of treatments such as MAT.
  4. Learn how providers are working to overcome the stigma associated with mental healthcare, HIV/AIDS, and other conditions, and why their experiences offer important insights for opioid addiction treatment.

HMA Speakers

  • Barry Jacobs, PsyD, Principal, Philadelphia
  • Uche Uchendu, MD, Principal, Washington, DC

Who Should Listen

State and local public health and behavioral health practitioners, Medicaid, and addiction treatment providers; clinical and administrative leaders of provider organizations, health systems, correctional health facilities, Federally Qualified Health Centers, and other provider organizations; executives of Medicaid managed care organizations and behavioral health plans.

Webinar

Webinar Replay: The Role of Medicaid Managed Care Plans in Addressing the Opioid Crisis

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This webinar was held on March 14, 2019 and was the third webinar in a series about addressing the opioid crisis in America.

Medicaid managed care plans are poised to play a significant role in helping states address the opioid crisis by incentivizing utilization of effective therapies and developing policies that help stem the flow of prescription opioid drugs. Health plans are also developing models aimed at coordinating and improving treatment of opioid use disorder.

During this webinar, HMA public health and prevention experts provided an overview of current health plan opioid initiatives and offered a roadmap for future treatment and prevention strategies.

Learning Objectives

  1. Learn how health plans can help prevent the proliferation of opioid prescriptions.
  2. Find out what you need to know about the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, also known as HR-6, and what it means for health plans.
  3. Understand the role of alternate payment models and value-based reimbursements in driving the best opioid care.
  4. Learn how new controlled substance provisions aimed at expanding Medication Assisted Therapy will impact health plans.
  5. Understand where health plans are having the most success in driving opioid prevention and treatment as well as where plans are seeing challenges.

HMA Speakers

  • Craig Thiele, MD, Principal, Columbus

Who Should Listen
State and local public health and behavioral health practitioners, Medicaid, addiction treatment providers; clinical and administrative leaders of provider organizations, health systems, correctional health facilities, Federally Qualified Health Centers, and other provider organizations; executives of Medicaid managed care organizations and behavioral health plans. Attendees are encouraged to join the conversation and submit questions on Twitter using #HMAtalksOpioids.