Using Virtual Research Data Center (VRDC) Data to Answer Big Questions

Using Virtual Research Data Center (VRDC) Data to Answer Big Questions

Health Management Associates (HMA) is utilizing Virtual Research Data Center (VRDC) data to do what HMA does best: solve publicly funded healthcare’s most challenging problems. The combination of our deep analytics expertise and our nationally renowned subject matter experts can help you solve your toughest challenges.

We are committed to helping clients meet their needs through:

Market Analysis

Want to know how many psychologists are treating Medicaid patients in a county? Or how many duals got NEMT in a year? We can tell you that. How many folks on Medicare got drugs for Memory Loss last year? We can tell you that too. The VRDC allows us to examine the Medicaid and Medicare populations with significant precision to inform your decisions.

Consulting Services

We love hard questions. Carefully designed smaller queries can add up to answer big questions like “Does access to Non-Emergency Medical Transportation help patients managing challenging chronic medical conditions?” or, “Are services critical to patient success being delivered equitably to patient populations?” HMA can help you answer your hardest questions by breaking them into smaller questions that add up to big results. Outcomes Survey (HOS) specific to BH, and align data performance to quality improvement efforts.

Quality Improvement and KPI Benchmarking

HMA’s team of quality experts can help you identify metrics that matter internally to your organization as well as to your payers and providers. We can run metrics against these Medicaid and Medicare data to prepare you to manage risk through deep data analysis and creation of benchmarks that help manage access, cost, quality, and utilization.

HMA’s access to VRDC data through this agreement include:

Data representative of 100 percent of Medicare and Medicaid beneficiaries and their medical experience expressed as claims

Data representative of 100 percent of Part D Drug Event (PDE) data

Detailed Long-Term Care data for all Medicare and Medicaid beneficiaries through the MDS dataset

We can help organizations including:

State and municipal departments of health and public health

Health plans

Provider organizations

Analytics and technology vendors

Private equity

Correctional health

Contact our experts:

Jim McEvoy

Data Analytics Resources Director

Jim McEvoy is accomplished in architecting robust technology solutions for state agencies, health plans and service providers. Jim understands the … Read more

Eric Pfeifer

Data Analytics Resources Director

Leading ideas and solutions for long-term services and supports

Dedicated to supporting the effectiveness of publicly financed healthcare programs, Health Management Associates (HMA) is committed to promoting the design, financing and operation of effective models of person-centered long-term services and supports (LTSS) which:

Support an individual’s ability to receive services in the most integrated setting

Promote successful community living

Improve integration of LTSS with quality physical and behavioral healthcare

Support Medicare and Medicaid integration and coordination

Address the social determinants of health for people with support needs

Support direct care workforce initiatives for states, managed care organizations and long-term care providers

Support strategic planning focused on long-term care

Support managed care readiness initiatives

What we offer

With deep expertise in the field, our colleagues and the work we do help to shape current system trends. In addition, we support improved outcomes for beneficiaries and successful participation for the wide range of LTSS providers including managed care organizations, states offering critical services, and purchasers through:

LTSS Models of Care

Developing and promoting person-centered integrated, and holistic LTSS models of care

LTSS Quality Standards

Supporting the development of LTSS quality standards and metrics, including technical assistance for NCQA and other accreditation and credentialing

LTSS Regulatory Compliance

Facilitating readiness and compliance with federal and state regulations, including home and community-based settings of care, Medicaid managed care, the Fair Labor Standards Act, and the Americans with Disabilities Act

LTSS Integration

Implementing care management and service delivery models that promote integration of services across physical, behavioral, and LTSS providers and between Medicare and Medicaid including those developed under PACE, managed LTSS, and managed fee-for-service

LTSS Stakeholder Engagement

Supporting effective community engagement by public policy makers, and empowering advocacy organizations and other stakeholders in understanding, shaping, and responding to change

LTSS Delivery and Payment Models

Assisting organizations and providers to prepare and respond to payment and structural changes in LTSS (e.g., managed care, accountable care, value-based purchasing)

LTSS and Social Determinants Design

Designing innovative approaches to addressing the social determinants of health, including improved strategies for affordable and accessible housing, competitive employment for persons with disabilities, access to technology, and social equity-based care delivery models

LTSS Market Analysis

Providing expert market analysis for investors relating to LTSS providers, managed care organizations, service vendors, or emerging trends in the LTSS landscape

LTSS Research and Evaluation

Enabling the use of data to uncover opportunities for improvement and to demonstrate value to ACOs, hospital systems, payers, and funders

Our wide-ranging expertise includes:

Medicaid LTSS waiver and state plan authority options

Operation and oversight of managed LTSS

Public procurements

LTSS provider operations

Federal and state compliance

Care management and care coordination

Workforce development

Strategic planning and practice redesign

LTSS policy analysis

Value-based purchasing

Quality monitoring, evaluation and research

Community capacity and network adequacy

Readiness reviews

Our Clients Include:

Federal, state and local governments

For-profit, not-for-profit and public health plans

Institutional and home and community-based services providers and their associations

National, state and local advocacy organizations

National and regional foundations

Direct care workforce representatives

Investment services entities

Contact our experts:

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Sharon Lewis


Sharon Lewis is a nationally lauded expert in federal and state disability policy, including home and community-based services (HCBS), education, … Read more

Susan McGeehan

Associate Principal

Susan McGeehan is a multi-faceted healthcare leader with extensive experience in dual eligible programs, long-term services and supports (LTSS), Medicaid … Read more

Rural Health and Challenges with Health Equity

There are 47 to 60 million people residing in rural areas in the U.S. Many rural residents must navigate healthcare system challenges people living in urban and suburban areas generally do not face. While workforce shortages, lack of consumer choice in health plans and providers, travel distance, transportation issues, social isolation, and increased inequity for people in marginalized communities do impact urban and suburban healthcare services, these issues are exacerbated in most rural communities. Developing and supporting rural health programs requires understanding the unique characteristics of rural settings and how these dynamics influence healthcare policy, providers, payers, consumers, and health equity.

Health Management Associates (HMA) brings together industry-leading policy, program, financial, community, and clinical experts to provide comprehensive solutions that make healthcare and human services work better for people living in rural and frontier areas across the country. We offer a full suite of professional health and human services consulting services to clients serving rural and frontier communities. This includes state agencies, county health departments, critical access and rural hospitals, federally qualified health centers (FQHCs) and rural health clinics, skilled nursing facilities, home and community-based service providers, behavioral health providers, oral health providers, and pharmacies/pharmacists. We also work with human services organizations and public health agencies, supporting their direct services, as well as assisting them in connecting with healthcare systems and providers. Our national, multisector, multisystem experience in healthcare and human services enhances our ability to support rural clients in making sustainable, positive impacts in their local communities.


Health Equity & Access for Rural Dually Eligible Individuals (HEARD) Toolkit

With funding from Arnold Ventures, HMA created the HEARD Toolkit, a robust discussion of the access challenges facing dually eligible individuals in rural areas and a portfolio of actionable solutions to address these challenges. Dually eligible individuals in rural areas reside at the intersection of a major public health crisis and a fragmented Medicaid and Medicare delivery system. They experience poor access to services and to integrated care programs (ICPs) to address their whole person needs.

HMA designed this Toolkit to help policymakers address access issue dually eligible individuals in rural areas have to navigate every day. For example, addressing access must encompass getting to a comprehensive Medicaid and Medicare services continuum that includes home- and community-based services (HBCS), as well as ICPs. A primary focus on equity can help states, local communities, payers, and providers begin to address issues of access for these very vulnerable individuals in rural communities. The Toolkit provides examples and ideas for rural providers and communities to address equity and improve services and supports for dually eligible individuals.

Learn More

For example, HMA can assist rural communities and the organizations that support their needs with:

Rural-specific workforce solutions

Programs addressing Social Determinants of Health/Health-related Social Needs

Payment system reforms

Development of integrated care programs for Dual Eligibles

Substance Use Disorder/Opioid Use Disorder prevention, treatment, and recovery services

Behavioral health services and supports

Justice-involved carceral healthcare and transitions

Long-term services and supports and home and community-based services

HMA understands the multilevel challenges for delivery of quality health care and social services to rural populations. From workforce and care access issues to transportation difficulties and technology barriers, to socio-economic differences, we can help rural providers and organizations overcome challenges and achieve their goals to serve and support their communities’ needs.

Other Rural Health Project Examples:

HMA is supporting review and reform of the primary care payment environment in New Mexico working under a contract with Mercer. New Mexico’s Medicaid program had identified multiple challenges the primary care providers faced across the state, including rural sustainability and fiscal soundness. HMA’s approach includes coupling data analysis with stakeholder engagement. Our work to date includes designing, testing, and evaluating new primary care alternative payment models (APMs); fiscal, policy, and/or programmatic implementation recommendations related to the multi-payor roll-out of a primary care APM; and supporting primary care practitioners related to NM Medicaid APM implementation. Additional project work will include more provider specific analysis, recruitment for pilot testing and provide education, analysis and training for providers, health plans and state regulators.

HMA is working with the Colorado Department of Health Care Policy and Financing (HCPF) to perform a dynamic heat mapping as the first phase of a three-phase project that includes an environmental scan of home and community-based services (HCBS)/Medicaid. HMA is creating a tool that HCPF can leverage to update and track progress to close provider gaps. In subsequent work HMA will identify potential geographic regions which would benefit from reimbursement structure changes, including geographic adjustment factors to apply to preexisting fee-for-service rates or other mechanisms to effectively address identified care gaps. Based on these results, HMA will recommend strategies and best practices to expand the provider network in rural areas to avoid care deserts and assure access to services for all Medicaid members.

Over the past six years, HMA has supported tribal communities in Montana with an array of data and evaluation expertise specific to behavioral health system assessments and evaluation activities. To date, we have conducted feasibility assessments for tribes considering options to 638 their behavioral health services, evaluated high-fidelity wraparound services in tribal communities through the Montana Systems of Care program, supported efforts to discern a concept design for a joint tribally operated Substance Use Disorder (SUD) Continuum of Care, and assisted tribally operated clinics in best practices in opioid prescribing and addiction treatment.

The Georgia Health Policy Center provides technical assistance for grantees of HRSA’s Rural Health Programs. HMA created a primer and additional tools, including a webinar, designed to inform and support rural provider leadership on Value-Based Care. The primer serves as a self-paced guide helping organizations consider national trends and experiences, assess their current state and readiness, understand benefits and barriers of Value-Based Care. The primer and tools are used by the technical assistance team and rural health grantees.

HMA has worked with HSHS for over 10 years, providing a wide range of services including:

Grant surveillance related to strategic plans, project management, grant program development, and narrative writing for multiple state and federal grants including USDA, HRSA, and SAMHSA. 

Expanding access to medication assisted treatment (MAT) in emergency departments by activating a team of HMA experts to implement a global assessment of readiness to adopt MAT, create a comprehensive training curriculum, assist with development of policies, workflows and standardized orders; and provide technical assistance required to address stigma and implement change. HMA also aided in writing the successful proposal for state funding for this project.

Stakeholder engagement for a hub-and-spoke model of telehealth network, assessed strategic priorities across multiple diverse stakeholders, and developed a strategic plan for HSHS’ Wisconsin rural healthcare provider telehealth network.

Development of the Illinois Telehealth network composed of 21 rural healthcare providers across Illinois. HMA provided technical expertise on the adoption of telehealth services and the development of clinical protocols and led strategic planning efforts. The network now functions to support the members in disseminating best practices, implementing telehealth service lines, sharing clinical protocols, removing barriers, and promoting evaluation.

HMA is currently assisting HSHS’ rural behavioral health team in devising new models of community-based withdrawal management processes consistent with recent changes in Wisconsin’s regulations. HMA experts on residential substance use disorder and integrated care provide technical assistance, training, and evidence-based policy development.

HMA supported the Texas Department of Agriculture, State Office of Rural Health (SORH) by leading SORH’s three-year strategic plan and design future programs. For the needs assessment, HMA conducted a systematic assessment that included an environmental scan of rural health key issues and trends, online survey of rural Critical Access Hospitals (CAHs) and prospective payment systems (PPS) hospitals in Texas identify needs and gaps, and an analysis of publicly available data to identify health needs and differences between rural and urban residents. Informed by this assessment and close collaboration with SORH staff, HMA developed a strategic plan to guide the next three years of SORH’s programming, as well as created work and evaluation plans for the SORH and Flex grant programs. Other tasks included assessment of Texas rural hospital telemedicine readiness, recommendations for value-based payment models for rural hospitals, and opportunities to support rural hospitals in reducing health disparities.

Contact our experts:

Ellen Breslin headshot

Ellen Breslin


A seasoned consultant, Ellen Breslin draws upon her nearly 30 years of experience and expertise in health policy, with a … Read more

Stephanie P. Denning


Stephanie Denning has worked in healthcare and human services for more than 25 years. Her experience spans the public, non-profit, … Read more
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Rebecca Kellenberg


Rebecca Kellenberg specializes in assisting public and private health care organizations with Medicaid and CHIP policy analysis and implementation. With … Read more

Jill Kemper

Senior Consultant

Jill Kemper has extensive experience improving access to care and care delivery, especially for vulnerable or complex patient populations and … Read more

Health Equity and Equity-Centered Strategic Approaches 

There is significant and increasing demand across health and human services to address health inequities and eliminate disparities in service delivery and positive health outcomes. Organizations are asked to provide healthcare in holistic ways that recognize both individual and population-level needs.

Three areas of activity in this space include:

Diversity, Equity, and Inclusion (DEI) work to address inequities within organizations

Equitable access to care and service delivery to improve outcomes and eliminate health disparities

Community wellness and population health outcome improvement

Recent changes in federal and state policy and financing are driving equity advancement, chiefly: Executive Order 13985 to Advance Racial Equity and Support for Underserved Communities Through the Federal Government, which paves the way for the nation’s first racial equity blueprint for federal agencies; and the Centers for Medicare and Medicaid Services’ (CMS) strategic pillar on health equity, including an equity framework for payment policy through 2032.  In addition, current and pending 1115 waivers from several states pay significant attention to equity by addressing social determinants of health and health related social needs. 

Illustration from the CMS framework for health equity

HMA can help organizations across the health and human service spectrum operationalize health and racial equity.

We acknowledge that to improve health and social service outcomes at individual and community levels, we need to work across sectors and enterprises. We believe embedding equity practices and strategies throughout health and human services will deliver results and develop new innovative partnerships.


Assess organizational climate, policies, practices, and impacts

Establish equity as a critical foundation of your organizational culture in a way that is apparent and transparent to staff and clients

Identify priorities to infuse equity throughout the organization

Create plans for ongoing feedback and organizational action responsive to staff and client needs

Apply population health management approaches to delivery system redesign grounded in addressing social determinants of health and health-related social needs

Strategic planning


Technical assistance


Ongoing guidance

Align organizational strategy with an actionable equity agenda

Work with leadership and staff to ensure that your organization’s activities are designed and implemented in a way that supports an equity agenda for both staff and clients

Facilitate equity workshops and build organizational capacity

Design and facilitate equity workshops to build organizational competencies, including: Equity principles and fundamentals, Equitable practice strategies, metrics, and continuous quality improvement, Cultural humility and community engagement approaches

Plan, convene, and facilitate forums for large and small groups within a workplace or system ensuring buy-in from involved parties and leadership

Establish a framework for mutual support and information sharing while integrating insights through continued learning and dialogue.

Our Services

Assessment, mitigation, and remediation

Community engagement

Equitable access and service delivery design

Stakeholder engagement and facilitation

Organizational assessment

Change management

Strategic planning and implementation

Training and technical assistance


A Health Equity Impact Assessment (HEIA) can help organizations understand the potential impact, positive and/or negative, that a change to the delivery system may have on a facility’s existing patients and the health and wellbeing of the surrounding community.

Pivotal to any HEIA is meaningful stakeholder engagement, the format of which may vary depending on the project, and high‐quality data analysis.

HMA colleagues routinely:

Design and program online surveys

Conduct key informant interviews

Facilitate focus groups and public deliberations

Synthesize stakeholder feedback

Conduct community health needs assessments

Analyze health indicators and incidence rates in populations

Contact our experts:

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Uma Ahluwalia

Managing Principal

Uma S. Ahluwalia is a respected healthcare and human services professional with extensive experience leading key growth initiatives in demanding … Read more

Leticia Reyes-Nash


Leticia Reyes-Nash is an accomplished, innovative executive leader with 20 years of experience leading policy advocacy, projects, and community engagement, … Read more
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Charles Robbins


Charles Robbins has been transforming communities for the past three decades. His extensive community-based organization career spans healthcare, child welfare, … Read more

Madeleine (Maddy) Shea


Maddy Shea has a passion for health equity and the federal, state and local cross-sectoral expertise to guide community health … Read more
Doris Tolliver

Doris Tolliver


Doris Tolliver is a strategic thinker specializing in racial and ethnic equity, organizational effectiveness, change management, and business strategy development. She … Read more

HMA Can Help You Prepare for The Joint Commission (TJC) Accreditation and Certification

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

And so much more across the continuum

Contact us at [email protected]

Contact our experts:

Trisha Bielski

Senior Consultant

A highly specialized critical care, trauma and flight nurse, Trisha Bielski has deep experience in nursing leadership, military healthcare, and … Read more

Ruth Danielzuk

Senior Consultant

Driven by collaboration across the healthcare landscape, Ruth Danielzuk is a seasoned quality and innovation expert with experience managing programs … Read more

Matthew Sandoval


Matthew Sandoval is an accomplished leader in healthcare with a proven track record of managing the administration, operations, and quality … Read more

Mary Walter

Managing Director, Quality and Accreditation

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more

Consumer Assessment of Healthcare Providers Systems (CAHPS): Improving Member Experience

Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and should, work to improve their Consumer Assessment of Healthcare Providers Systems (CAHPS) scores.

The CAHPS annual survey measures member experience with providers and Medicare and Medicaid health insurance plans. It has also become a critical metric used by the Centers for Medicare and Medicaid Services (CMS).

Plans can work to improve CAHPS scores by developing a comprehensive improvement plan involving a holistic year-around approach that involves monitoring the member experience from enrollment through disenrollment. With score improvement comes incentive payments tied to high quality performance.


The National Committee for Quality Assurance (NCQA) to STAR rate health plans in accreditation scoring

Potential members to compare plan scores against one another on the NCQA website

Several state Medicaid programs that require plans to report these surveys and use scores as part of their incentive programs

CMS, which has increased its STAR rating, CAHPS-related measure from double weighted to quadruple weighted in contract year 2021

Medicare Advantage Prescription Drug (MAPD) plans, which use CAHPS to calculate 32% of the overall aggregate score



Getting needed care (4)

Getting appointment and care quickly (4)

Customer service (4)

Rating of healthcare quality (4)

Rating of health plan (4)

Care coordination (4)

Annual flu vaccine (1)


Rating of drug plan (4)

Getting needed prescription drugs (4)



Complaints about the health plan (2)

Member choosing to leave the plan (2)

Plan makes timely appeals decisions (2)

Reviewing appeal decisions (2)

Call center, language interpreter and TTY availability (2)

Health plan quality improvement (5)


Call center, language interpreter and TTY availability (2)

Appeals auto forwarded (2)

Appeals upheld (2)

Complaints about the drug plan (2)

Member choosing to leave the drug plan (2)

Drug plan quality improvement (5)

Health Management Associates’ expert colleagues can help plans outline an organizational assessment of member experience and customize interventions and solutions to increase scores.

Our team of quality and accreditation experts can help organizations improve customer service and scores by:

Establishing a year-around effort

Using an organizational effort to break down department silos and improve cooperation between departments

Assessing core functions within the plan and contractors that contribute to member experience including marketing, enrollment, disenrollment, UM, QI, member service, grievances, appeals, etc.

Identifying and addressing patient frustrations with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Recognizing social determinants of health (SDOH) are often overlooked in access to care-related issues, such as lack of transportation or lack of funds for co-payments

Outlining techniques for obtaining point-of-service feedback to help address potential member experience issues before they arise

Contact our experts:

Sarah M. Owens


A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more

Mary Walter

Managing Director, Quality and Accreditation

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more

David Wedemeyer


David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more

Star Rating: We Can Help You Navigate to a Higher Level

What is the VALUE of a Star in your plan(s)?

What initiatives have you introduced to prepare for the changes in the Star Rating that may impact your overall Star Rating results?

What are you doing for health equity focus? What data are you collecting for health equity?

What do you think are your organization’s financial implications when Star Rating requirements change?

What are your Star Rating strategies for increasing your organization’s market share and viability?

What sort of interventions, data sources, analytics and reporting have you found to be successful to improving your Star Rating?


Establishing a year-around effort to improve Star Rating performance

Assessing core functions within the plan and contractors that contribute to understanding members

Identifying and addressing customer concerns with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Working on health equity issues including sharing techniques for obtaining data

Leveraging data to drive decisions

Contact our experts:

Sarah M. Owens


A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more

Mary Walter

Managing Director, Quality and Accreditation

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more

David Wedemeyer


David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more