Children’s Behavioral Health Consulting

Children’s Behavioral Health Consulting

HMA Solutions

Children’s Behavioral Health Consulting

Cross‑System Solutions for Schools, Health Systems, and State & Local Agencies

The US children’s behavioral health system is facing significant strains. Workforce shortages, fragmented funding and accountability, and rising demand are converging in the places where children spend time and receive care. Healthcare systems are seeing the impact in emergency departments and inpatient units, schools are expected to respond to student needs without sufficient capacity, and state and local agencies face pressure to align policy, financing, and programs across behavioral health, Medicaid, child welfare, and education.

How HMA Can Help

HMA partners with child-serving systems to translate urgency into practical, financeable, implementable improvements, strengthening the continuum from prevention and early intervention to crisis response and recovery. Examples of services we provide include:

Landscape assessments and needs analyses (qualitative and quantitative)

Stakeholder engagement and facilitated convenings (including family, youth, community, and cross-agency partners)

Gap analysis and service continuum design (school-, community-, and facility-based)

System and model redesign, including governance, referral pathways, and care coordination across settings

Strategic planning and implementation support (operational roadmaps, change management)

Regulatory and policy analysis to support compliant, scalable program models

Workforce strategy and provider training to build sustainable capacity

Financial modeling, including fiscal pro formas and revenue cycle considerations

Site assessments and facility studies to support service expansion and optimization

Who We Serve

We support providers, health systems, children’s hospitals, schools, school-based entities (including local education agencies [LEAs]), state and local government agencies and community-based partners working to improve children’s behavioral health.

Common Challenges

Fragmentation across child-serving systems,

Workforce shortages and training needs,

Misaligned financing and accountability, and

The operational challenge of coordinating care across school, community, and clinical settings.

Where We Help

Hospitals and Health Systems
Strengthen pediatric behavioral health strategy and operations—improving crisis pathways, clarifying roles across ED/inpatient/outpatient settings, and connecting clinical services to community and school-based partners

Schools, LEAs, and School-Based Entities
Build sustainable school mental health approaches—right-sizing service tiers, strengthening referral and care coordination, and aligning school-based services with Medicaid, community providers, and crisis systems

State and Local Government, Child-Serving Agencies, and Community-Based Partners
Advance cross-system solutions—aligning policy, financing, and accountability across behavioral health, Medicaid, child welfare, and education, while building implementable continuums of care that improve access and equity. 

HMA Differentiators

Cross-setting expertise. We work across schools, community-based systems, and healthcare delivery settings, helping partners design handoffs and shared accountability rather than isolated programs.

Implementation and financing. We connect strategy to operations and the realities of financing, reimbursement, and sustainability so plans can move toward successful implementation and delivery.

Multidisciplinary team. Our team includes clinicians, program administrators, researchers, and former state and local leaders with deep knowledge of children’s behavioral health ecosystems. Many of us are parents and grandparents ourselves who are passionate about and personally invested in this work.

Partnership-first approach. We bring a collaborative, community-grounded process that centers children, youth, and families and builds durable cross-sector relationships.

Local context, national perspective. We tailor solutions to market dynamics, resources, and policy environments while bringing lessons learned from diverse geographies and client types.

Let’s strengthen children’s behavioral health—together.

Whether you’re leading in a hospital or healthcare system, a school or LEA, or a state or local agency, we can help you align partners and build an implementable plan across the continuum of care.

Contact us to discuss your priorities and identify next steps.

Connected Crisis Care: Generating Collaborative Solutions for 988 and Beyond

HMA Solutions

Connected Crisis Care: Generating Collaborative Solutions for 988 and Beyond

Health Management Associates, Inc. (HMA), is a national leader in crisis system design, known for developing innovative, collaborative, data-driven solutions that help states and communities build effective, person-centered crisis response systems. We help strengthen crisis response systems through skill-building and collaboration strategies. Our model creates lasting crisis response system connections, fosters trust, and enhances the overall quality of care across the crisis response continuum.

Is your state, region, or county ready to enhance and sustain its crisis response?

Has your state recently launched 988, mobile crisis teams, or crisis stabilization units and is now exploring next steps to strengthen the system? 

Are you seeking practical, engaging training, and convening strategies to deepen collaboration and elevate your crisis response across all partners? 

Our Approach:

Coordinated Crisis Response Through Skill-Building and System Integration

Our team uses a two-prong approach to bring together a diverse group of providers, partners, and stakeholders to expand system capacity and build trust and collaboration across the crisis response continuum. Through a series of cross-system trainings and convenings, we lay the foundation for better communication, coordination, and collaboration. This approach ensures that individuals in crisis experience more seamless, coordinated, and compassionate care across every point of the response continuum.

Skill-Building:

Monthly Training Programs Tailored to Every Role in Crisis Response

"This training helped cross-train coping strategies for working with clients, reminded us that there is always a path through stress, and helped us focus on meeting individuals where they are in their journey." -Crisis care provider

We collaborate with our clients to determine the best approach for training that meets the needs of your organization. Our monthly virtual training courses are designed to meet crisis response providers where they are—across all levels of readiness and roles. Using diverse learning methods, such as didactic instruction, interactive problem-solving, and peer-to-peer collaboration, we ensure content is practical, engaging, accessible and grounded in best practice frameworks and protocols. Topics include culturally responsive mobile crisis response, trauma-informed care, suicide risk assessments, and working with diverse populations including youth, older adults, and individuals with intellectual/developmental disabilities. Each session builds real-world skills that can be applied immediately in the field. In addition, these courses can be set up to be taken on demand.

System Integration:

Systemwide Convenings to Build Trust and Drive Collaboration

"I appreciate having a variety of divisions and departments (i.e., HR) participating in these monthly convenings. Thank you for this opportunity and collaboration." - Crisis convening attendee

Through structured, facilitated convenings, led by HMA’s crisis response experts, we bring together a diverse network of crisis providers, partners, and stakeholders to strengthen coordination across the full crisis continuum. We use Liberating Structures and other learning techniques to enhance engagement, foster relational trust, share knowledge, and sustain collaboration. Convening topics can be aligned with the monthly training topics to reinforce learning and provide opportunities to operationalize new skills and understanding across the crisis continuum. Convenings often highlight local exemplars as a way to share local best practices and encourage locality-specific collaboration and problem-solving.

Ready to Build Trust and Capacity in Your Crisis System?

We are excited to partner with your crisis care system to help you create a transformative response model based on collaboration, trust, and ongoing professional development. In addition to this suite of offerings, the HMA team has expertise in helping communities develop and implement strategic roadmaps for next-phase crisis system improvement.

Who We Help

911/call centers/emergency management services (EMS)

Associations and foundations

Behavioral health care providers

Coalitions and advocates

Criminal justice stakeholders and facilities

Crisis care systems and providers

Educational settings and academic institutions

Federal, state, and local government agencies

Health plans

Hospitals and health systems

Investors

Law enforcement

Public health departments

Project Spotlight:

What Makes HMA Different?

Many of our team members are former executives and clinical leaders from the behavioral health sector. They bring decades of experience in leading behavioral health care in inpatient, outpatient and emergency department settings, and have been instrumental in establishing the 988 program. HMA provides the depth, agility, and collaborative approach to address today’s most urgent behavioral health challenges. We know the challenges faced by states and organizations, and support strategic planning and implementation, large scale crisis system redesigns, crisis needs assessments, and relationship building with stakeholders.

Contact our experts:

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Angela Bergefurd

Senior Principal

A seasoned behavioral health leader with more than 25 years of government healthcare experience, Angela Bergefurd has a deep understanding … Read more
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Allie Franklin

Managing Director

Allie Franklin is a licensed clinical social worker with decades of experience in public, private, and non-profit behavioral health, healthcare, … Read more
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Jennifer Hodgson

Principal

Jennifer Hodgson is a licensed marriage and family therapist who maintained a private practice and taught in higher education for … Read more
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Monica Johnson

Managing Director

A skilled state and federal government executive, Monica Johnson has over 25 years of experience in the behavioral health field. … Read more
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Kim Williams

Principal

Kim Williams is an experienced executive, policy leader and social worker with a record of transformational growth, accomplishment, and innovation … Read more

Solutions for behavioral health workforce shortages

HMA Solutions

Solutions for behavioral health workforce shortages

Growing demand and need for BH services is outpacing workforce capacity nationally.
 
In 2024, 43 of the 44 states responding to an NRI survey reported a behavioral health workforce shortage[1]. States, Health Plans and Provider Associations are all struggling with how to manage the problem.
 
A standardized approach to assessing BH workforce shortages can help states and organizations better design sustainable workforce solutions, especially considering challenges federal funding changes and the need for diverse care needs across rural and urban areas across the US. Recommendations are grounded in lived experience, policy fluency, and practical feasibility.

[1] Source: https://www.nri-inc.org/media/tghpz5uu/smha-workforce-shortages-2023.pdf

Design and Implementation

Support infrastructure and policy alignment grounded in community partnerships

Expert Analysis

Interpret data using specialized tools, knowledge, experience, and context

Strategic Planning

Define goals, align resources, and guide decisions

A Standardized Approach

HMA’s framework helps states, health plans, and provider associations and organizations design sustainable workforce solutions, especially considering challenges like the need for diverse care needs and regionally appropriate strategies. Our work delivers measurable, generalizable, lasting improvements, and provides a window into obvious partnership opportunities for workforce development projects in both rural and urban communities. The recommendations are grounded in lived experience, policy fluency, and practical feasibility.​

Our Services

With a deep understanding of current and emerging shifts in care and policy, our BH workforce consultants are well equipped to provide support and implementation of workforce initiatives across a variety of content areas over a flexible duration.

Rapid Deployment of Existing Strategies

Preparation & Education

Evaluation & Analysis

Implementation & Support

Strategic Assessment

Regulatory & Policy Consulting

Proven Results

HMA has worked on national projects aimed at resolving workforce shortages.  HMA is a founding member of the Workforce Solutions Partnership, a collaboration among the College for Behavioral Health Leadership and the National Council for Mental Health Wellbeing.  HMA has a national lens on the behavioral health workforce experiences and has worked with clients to identify pathways to strengthen and diversify the workforce in ways that are equitable, sustainable, and community informed. Our established services ensure that we translate insights from our methods into actionable and meaningful recommendations for workforce development. 

HMA Differentiators

Many of our team members are former executives and clinical leaders from the BH workforce sector, including doctors, policy experts, social workers and administrative leaders from health plans, health systems, community-based organizations, FQHCs, and government agencies at the local, state and national levels. Our clinicians bring decades of experience leading BH care in inpatient, outpatient and emergency department settings.

OUR EXPERTISE

HMA subject matter experts with national BH workforce experience analyze existing data—such as strategic plans, funding streams, licensing, and workforce initiatives—to identify policy gaps, infrastructure readiness, and innovative care models.

With a deep understanding of current and emerging shifts in care and policy, our BH Workforce consultants are well equipped to provide specialized services.

Contact our experts:

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Paul Fleissner

Senior Principal

Working to integrate services across systems and communities, Paul Fleissner is a seasoned executive who has developed programs and policies … Read more
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Allie Franklin

Managing Director

Allie Franklin is a licensed clinical social worker with decades of experience in public, private, and non-profit behavioral health, healthcare, … Read more
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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

HMA’s Experts Support States in Rural Health Initiatives

HMA Solutions

HMA’s Experts Support States in Rural Health Initiatives

RHTP Requirements and Opportunities: Now What?

In 2026, each state is receiving distributions from the Rural Health Transformation Program (RHTP), designed to support communities across the United States who face unique and persistent healthcare challenges. States will be using these funds,
developing comprehensive plans to enhance rural healthcare infrastructure, improve access, integrate care, and demonstrate measurable outcomes within tight timelines.

The Centers for Medicare & Medicaid Services (CMS) has made award decisions, with states receiving notice of their allocations and feedback on their application content. States are now tasked with developing comprehensive plans to enhance rural healthcare infrastructure, improve access, integrate care, and demonstrate measurable outcomes within tight timelines. The RHTP requires:  

A strong management structure at the state level, including dashboards and oversight of programs funded through this award

Defined goals and sustainable initiatives in chronic disease management, primary care, behavioral health, maternal health, digital innovation, workforce initiatives, and other topics

Demonstrated outcomes that evidence improvements in rural access and health outcomes, as well as the care experience of rural residents

The short turnaround and wide range of components and requirements in the RHTP application process will mean there is a lot of detail left to be decided. States should be prepared to engage in a planning process that capitalizes on near-term opportunities and lays the groundwork for implementing sustainable transformation initiatives. HMA is ready to provide support with practical, field tested solutions for immediate effect and support the development of last reforms. 

HMA’s Rural Track Record

HMA is a national leader in healthcare consulting, with a multidisciplinary team of experts experienced in policy, finance, clinical services, analytics, and community engagement. HMA has supported a diverse array of clients serving rural and frontier communities, including state and local governments, health systems, federally qualified health centers, tribal organizations, providers of every specialty, and community-based groups.

Examples of some of HMA’s past work in rural health include:  

Primary Care improvement: HMA partnered with New Mexico Human Services Department to reform primary care payment models, addressing sustainability and fiscal soundness for rural providers. This work involved designing, testing, and evaluating new models, engaging stakeholders, and supporting implementation through provider training and analysis.

Tribal Behavioral Health Systems: In Montana, HMA assessed gaps and provided the state recommendations to improve behavioral health systems for tribal communities, focusing on culturally competent, integrated care models.

Strengthening the financial health of rural providers: In Colorado and Georgia, HMA supported the development of value-based payment strategies for rural providers by analyzing fiscal operations and performance and creating operational pathways to enhance sustainability and care quality.

Supporting rural residents through community interventions: HMA developed a toolkit for tackling access challenges for dually eligible individuals in rural areas, offering actionable solutions for policymakers and providers to improve care and outcomes. 

Workforce Development: HMA has led numerous initiatives to address workforce shortages in rural settings, providing solutions for recruitment, retention, and care coordination, particularly in behavioral health. As a founding member of the Workforce Solutions Partnership, we have captured near- and longer-term solutions to behavioral health workforce shortages. 

How HMA Can Assist States in Executing RHTP

HMA offers a comprehensive suite of services to help states and their partners successfully implement RHTP initiatives, all under one roof. From actuarial and financial skills to clinical and operational expertise, policy, and analytics, HMA can support successful implementation of your State’s Rural Health Transformation program.

Here are some of the ways we can support your efforts:  

Program integrity and effectiveness

Design robust oversight tools to monitor state programs, ensuring transparency in funding flows, program goals, and outcomes.

Provide data-driven insights, program monitoring, and evaluation to demonstrate impact and guide continuous improvement.

Conduct financial assessments and provide recommendations to improve the solvency of rural healthcare systems.

Initiative design and implementation

Support and coach providers and health systems in operational change, clinical organization, e-health adoption, and integrated care models tailored for rural settings.

Leverage proven strategies to address workforce shortages, integrate behavioral health with primary care, and implement scalable solutions.

Design and help execute chronic disease management programs tailored to rural populations and systems.

Help implement the maternal “hub-and-spoke” model and other efforts to improve birth outcomes and access to care

Offer field-tested tools for community engagement and assessment like the HEARD Toolkit for rural residents and other resources to address disparities, improve access, and ensure the needs of vulnerable rural populations are met.

Design, test, and scale innovative models and pilots that align with state and community RHTP goals.

Sustainability

Develop and facilitate effective partnerships and information exchange among government entities, providers, payers, and community organizations to align efforts and maximize the impact of RHTP investments.

Provide a range of financial, revenue, and operational tools for states and rural providers. These tools can help make grant-funded activities sustainable, lasting change.

Conduct a range of workforce development initiatives to enhance access and optimize virtual and in-person care experiences.

A unique HMA differentiator is our team of clinicians – primary care and specialty care physicians, nurse practitioners and physician assistants, registered nurses, behavioral health providers among others – who bring years of direct care delivery experience and the ability to engage other clinicians to effect change and innovation across the delivery system. All of our clinicians have worked in rural and economically disadvantaged communities, and most have worked on rural health initiatives in Alaska, Idaho, South Dakota and other states. This team has been instrumental in developing solutions that encompass a deep understanding of the interplay between medical, behavioral health and social determinants of health as they all contribute to the individuals’ and communities’ wellbeing. Moreover, this team has helped design innovative solutions that incorporate telehealth, remote monitoring, patient apps, and other technologies that engage patients in their care, facilitate care team collaboration, and ultimately close care gaps and reduce instances of avoidable, costly care.

With extensive hands-on experience and a deep understanding of the rural health landscape, HMA is uniquely positioned to help states navigate the complexities of the RHTP, drive sustainable change, and improve health outcomes for rural communities nationwide.

Contact our experts:

Headshot of John Eller

John Eller

Regional Director

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
Headshot of Farah Hanley

Farah Hanley

Regional Director

Farah Hanley is a healthcare executive with more than 30 years of experience with state Medicaid programs, policies, and budget … Read more
Headshot of Alicia Johnson

Alicia M. Johnson

Regional Director

Alicia M. Johnson is a visionary leader with nearly three decades of experience driving transformative change in the public and … Read more
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Beth Kidder

Regional Director

Beth Kidder is a transformative and innovative health care leader with more than 20 years of experience working within the … Read more
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Andrea Maresca

Managing Director, Strategy and Transformation

With nearly two decades of experience in healthcare, Andrea Maresca is a skilled legislative and regulatory analyst and strategy developer. … Read more
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Juan Montanez

Managing Director

Effectively applying information technology (IT) solutions and optimizing information management processes, Juan Montanez has driven operational and service delivery improvements … Read more
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Tonya Moore

Associate Principal

Tonya Moore is a lawyer and public healthcare professional with more than 28 years of government experience at the Centers … Read more
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Kathleen Nolan

Senior Advisor

Kathleen Nolan has been actively engaged in the national dialogue during one of the most transformative periods in the history … Read more
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Robin A. Preston

Senior Regional Vice President

Robin Preston is dedicated to improving access to healthcare for low-income populations. She has been working in the policy and … Read more
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Lina Rashid

Principal

Lina Rashid is a nationally recognized expert in public policy, communications, and outreach, with over 15 years of federal leadership … Read more
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Jay Reiser

Vice President, Health Plan Partnerships

Jay Reiser is a healthcare executive with extensive experience driving growth and operational excellence across Medicare, Medicaid, and ACA programs. … Read more
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Matt Roan

Vice President, Client Partnerships & Business Sector Growth

Matt Roan brings a valuable perspective having worked for the past 15 years on issues impacting healthcare stakeholders in the … Read more
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Margaret Tatar

Vice President, Client Solutions

Margaret Tatar has more than 25 years of public and private sector experience in managed care program and policy development, … Read more
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Patrick Tigue

Senior Vice President, Practice Groups

Patrick Tigue is an accomplished executive with experience leading and managing critical efforts to achieve strategic health policy goals on … Read more

From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

HMA Spotlight

From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

Hospitals across the country are facing unprecedented levels of behavioral health (BH) challenges that impact every facet of operations, from the emergency department to discharge planning. Extended lengths of stay, ED boarding, workplace violence, and staff burnout present clinical issues and pose operational, financial, and reputational risks.
 
Individuals with BH needs arrive in emergency departments daily, even if the hospital lacks a dedicated BH inpatient unit. These patients require coordinated care across all clinical sites.  
 
HMA offers an end-to-end partnership helping hospitals identify and implement solutions in ways that build internal capacity and deliver measurable results.

Rapid assessments to identify high-impact opportunities

Financial modeling and reimbursement optimization

Strategic and operational planning for BH integration

Partnership development and M&A advisory for BH service lines

Implementation support with measurable results

Effective Strategies

HMA partners with hospitals to address these challenges with a vision of improving care and operations. Our team offers practical, high-impact solutions that enhance patient care, support your workforce, streamline operations, and promote financial stability. Contact us to discuss how solutions can be tailored to your hospital’s unique needs. Let’s address your most urgent behavioral health challenges now, before they impact care delivery and financial stability.

Six Priority Areas

While every hospital faces unique behavioral health challenges, the pressures they create are consistent. HMA partners with your leadership and frontline teams to focus on six proven priority areas that create lasting impact. Together, we develop solutions that improve care, strengthen operations, and build resilience across your organization.

  • Rapid stabilization protocols
  • Integration of psychiatric expertise into acute care workflows
  • Boarding reduction strategies

Value: Reduce length of stay, improve throughput, and protect staff safety.

  • Cross-continuum care pathways
  • Partnerships with community providers
  • Readmission prevention frameworks
  • Accreditation readiness (The Joint Commission, DNV (Det Norske Veritas))

Value: Improve continuity, patient satisfaction, and reduce high-cost utilization.

  • Optimizing reimbursement (e.g., unbundled billing for injectables)
  • Service line financial assessment

Value: Unlocking new revenue streams.

  • Joint ventures with behavioral health providers
  • Sell-side preparation and merger and acquisitions support
  • Community and payer alignment

Value: Expand service capabilities while sharing risk and resources.

  • Staffing models to provide effective and efficient care while reducing burnout
  • Data-driven performance management
  • Technology-enabled workflows

Value: Increase efficiency and retention through optimized operations.

  • Medication Assisted Treatment (MAT) and Medication for Opioid Use Disorder (MOUD) implementation in ED and inpatient settings
  • Peer navigation programs
  • Integration with primary and specialty care

Value: Reduce mortality, avoidable readmissions to EDs, and improve community health outcomes.

Proven Results

Our work with hospitals across the country delivers measurable, lasting improvements that strengthen care delivery, operational performance, and financial health.

  • Reduced ED boarding times by up to 40% through targeted intervention models.
  • Increased reimbursement for behavioral health services by optimizing billing practices for long-acting injectables and other high-value services.
  • Delivered $1.2M in annual savings for a regional hospital through integrated behavioral health response planning.

HMA Differentiators

Many of our team members are former executives and clinical leaders from the behavioral health sector. They bring decades of experience leading behavioral health care in inpatient, outpatient and emergency department settings. HMA provides the depth, agility, and collaborative approach that hospitals need to address today’s most urgent behavioral health challenges while also building capacity for the future. Our proven track record includes hospitals of all sizes and structures, ensuring that solutions are tailored to your market, patient mix, and resources.

ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations

HMA Spotlight

ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations

Applied Behavior Analysis (ABA) is an evidence-based behavior therapy for people with autism spectrum disorder (ASD) and other developmental disorders. In recent years, the diagnosis of ASD and subsequent demand for ABA services has increased. State Medicaid administrations and Managed Care Organizations (MCOs) are tracking increased ABA utilization and wait times for these services, and in some situations are investigating quality of care and/or fraud, waste, and abuse (FWA) concerns. To optimize quality care for members, MCOs who cover these services must have policies regarding ABA benefit structure, clinical guidelines, utilization management, and service delivery. Plans also need to monitor for and identify possible FWA concerning documentation and/or billing practices for these services. MCOs with comprehensive ABA compliance and auditing programs can meet these critical needs.

Our team

HMA’s national presence keeps us at the forefront of ABA-related changes in multiple states. HMA’s team of behavioral health clinicians have years of experience conducting FWA audits and have specific training required to conduct detailed and meticulous ABA reviews. Our team includes operational and clinical subject-matter experts with board certifications in behavior analysis (BCBA, RBT) who can support auditing activities as well as policy review and revision. We will work with your organization’s team to provide the insights necessary to maximize ABA quality of care and cost efficiency.

How HMA can help

We work closely with MCOs to develop a customized scope of services that meet their unique ABA compliance, policy, and strategy needs.

We can help MCOs with:

  • Establishing their own ABA compliance programs
  • Conducting audits of ABA provider claims and associated medical records, using customized audit tools and findings reports, to identify potential FWA, including as part of an MCO’s Special Investigation Unit (SIU) program
  • Reviewing and providing feedback on ABA-related policies
  • Developing ABA-related documentation forms
  • Providing consultation on ABA reimbursement/utilization benchmark development
  • Providing support in building cohesion/collaboration between MCO and local Department of Developmental Disabilities representatives
  • Developing strategies to improve care coordination for youth transitioning to adulthood
  • Assisting MCOs with their Managed Behavioral Healthcare Organizations (MBHO) benefit oversight
  • Demonstrating how to maximize the interface of organizational Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefits and the intersection with ABA services

We produce results

Our auditing team members have supported the SIUs of three Medicaid health plans in different states. We have demonstrated a 12:1 return on investment for our clients, based on associated recoupment of improper payments and estimated prevented loss.

If you have questions about our ABA compliance, policy, or strategic support services, contact our experts below.

ABA Auditing Services Case Study

Contact our experts:

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Nicole Lehman

Associate Principal

Nicole Lehman is an experienced healthcare professional specializing in the improvement, development, and growth of multifaceted, high-paced managed care organizations. … Read more
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Shannon Walters

Associate Managing Director

Addressing Behavioral Health Needs in an Aging Population

HMA Spotlight

Addressing Behavioral Health Needs in an Aging Population

America’s healthcare and behavioral health systems are not adequately supporting the mental health and substance use needs of older adults. Unless improved with targeted and innovative policies and operational changes, those systems will do an even poorer job in the immediate future as our country rapidly ages. The result will be an increased number of older adults with untreated mental health disorders, cognitive disorders, and/or substance use disorders, increased rates of hospitalization and institutionalization, and vastly increased care costs.

Available statistics make clear the challenges:

  • The number of older adults in this country is expected to grow from approximately 56 million in 2020 to 85 million in 2050. Without substantial breakthroughs in treatment and prevention, the number of older adults with diagnosable mental disorders will increase from about 11 to 17 million and those who misuse alcohol and other drugs will increase from 2 to 3.5 million.
  • During those three decades, the number of Americans with dementia will also nearly double from 7 to 13 million. Many of these elders will have co-occurring behavioral health conditions, such as depression, anxiety, psychosis, and behavioral disturbances which will greatly strain family resources and coping.

If present performance is any predictor of the future, our systems of care now in place will not be able to handle the coming needs. Today fewer than half of older adults with mental or substance use disorders get any treatment at all because of limited-service capacity and access. Much of the care that is provided comes from medical and behavioral health providers without specific training or experience in older adult mental health and substance use disorders. The so-called digital divide—in which many older Americans are uncomfortable with telehealth or lack the equipment or bandwidth to use it—disproportionately impacts those with behavioral health disorders who live in rural communities and/or have limited economic means.

To adequately care for these vulnerable older adults, our approach and systems must change. That will require increased attention, investment, and thoughtful planning. Fortunately, there is clinical, operational, and policy expertise available to guide what will necessarily be a decades-long effort.

How HMA can help

HMA works with a range of clients. We work with federal, state and local governments, trade associations, provider organizations and community-based provider organizations (CBOs), delivery systems, managed care organization (MCO) plans, and philanthropic funders, to design, implement, and sustain effective models and systems of care for older adults with mental health and substance use needs.

We bring together a cross-sector, multidisciplinary team of experts in older adults’ needs and mental health and substance use focused on strategy, policy, clinical, operations, and finance systems. Our team members have rich backgrounds across government, payers and provider systems. We understand our clients’ needs because we’ve been in your shoes.

Workforce & Capacity Building

Policy, Planning & System Redesign

Integrated & Specialized Care Models

Evidence-Based & Preventive Interventions

Financing & Technology Infrastructure

Provider Access

  • Conduct workforce planning, including age-friendly training
  • Identify and implement caregiver support models
  • Design financing and optimization of revenue models

Discrimination and Awareness

  • Provide psychoeducation for older adults and their families

Service Access

  • Plan state and local policy and system redesign
  • Establish integration models within and between systems  
  • Implement care coordination/care transition models, including post-acute care
  • Incorporate mental health and substance use in multi-sector plans on aging and age-friendly communities 
  • Build age friendly systems of health and mental health/substance use care
  • Embed tech-enabled care solutions

Recent Project Examples

Strategic planning

An Area Agency on Aging (AAA) hired HMA to assess the needs of its client population and develop strategies to enhance behavioral health services and supports. The mental health and substance use needs of older adults, and especially those with both Medicaid and Medicare are among the highest. Through this project, the AAA focused on finding ways to expand service access to older adults. HMA prepared several recommendations to contract with health plans to help older adults access behavioral health services.

Multi-sector plans on aging development

A county hired HMA to help develop a multi-sector plan on aging. Multi-sector plans on aging provide an opportunity to address the unmet mental health and substance use needs of older adults. HMA analyzed relevant assessments and plans and facilitated broad community engagement to help shape the development of the plan.

Skilled nursing facilities practice improvement

A state health department hired HMA to enhance the quality of care of skilled nursing facility residents with substance use disorders. Many residents, including older residents, of nursing homes have unidentified and untreated substance use conditions. HMA delivered on-site technical assistance, in-person staff training, policy and procedure development, community partnership building, and regional forums to foster shared learning.

Affordable housing with integrated services sustainability

A long-term care trade association hired HMA to develop a braided financial and partnership service model to integrate health, mental health and social services to support aging in place. Integrated service and financial models can better support the often co-occurring physical, mental, and social needs of older adults. HMA conducted stakeholder engagement, service gap analysis, and strategic alignment to support the development of a sustainable service model.

Post-acute care guide

A state-level hospital association hired HMA to support its hospitals and their staff on post-acute care transitions. Post-acute care transitions are critical to ensuring that older adults have a successful recovery. These transitions are important for preventing complications after leaving an acute care setting like a hospital. The association hired HMA to create first-of-its-kind post-acute care (PAC) guides to support clinicians and family members to find post-acute care resources to address behavioral health needs.

Rural access to services for older adults

A foundation hired HMA to improve access to integrated care for older adults who were dually eligible for both Medicaid and Medicare. Older adults residing in rural communities have poorer access and outcomes than their urban peers. HMA created a toolkit of actionable solutions for state policymakers to address older adults’ mental health needs and social isolation conditions in rural communities.

Contact our experts:

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Patrick Meadors

Associate Principal

An expert in psychological processes and systems thinking, Patrick Meadors is a licensed marriage and family therapist with over 15 … Read more
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Kim Williams

Principal

Kim Williams is an experienced executive, policy leader and social worker with a record of transformational growth, accomplishment, and innovation … Read more

Supporting real-time strategic decision-making across the leadership team

HMA Spotlight

Supporting real-time strategic decision-making across the leadership team

HMA was recently contacted by a chief strategy officer of a healthcare company with dominant market share struggling to react to the rapid changes in healthcare policy. His CEO was regularly asking him for updates, and he knew he needed a proactive construct for understanding, reacting, and ultimately shaping the environment. Could we help him build the capability to monitor those changes within the company’s strategy function?  

As organizations operate within our highly turbulent policy environment, strategy leaders are well served to consider how they source and socialize the information that sustains strategic decision-making.

While every company is different, strategy leaders should monitor the following:

Regulatory and policy realities

Existing and potential competitive offerings

Market and client needs

Organizational assets and competencies

Formal and informal relationships


These are the ingredients for developing and validating hypotheses for market growth – a critical function of the strategy office. However, just as important as monitoring this information is socializing it across the leadership team.


On one recent HMA strategy project, the executive team of an association listened soberly as we described their direct competitor. The competitor was growing rapidly and winning over long-time members of the association. They had a small, nimble team, in contrast to the association’s cumbersome and complex governance structure. As we rehearsed the sentiments of their members, the needs in the markets, their partnerships, their offerings, and the shifting policy environment, we painted an up-to-date picture of their market realities. Their reaction was almost explosive: they had to take action to stem their eroding position. 


By socializing fact-based information, a strategy leader can create the tailwinds for action within an organization. The leader can also ensure that those who need to ratify or support strategic action understand the rationale for change. We think of strategically viable actions as being grounded in the domains above. For example, does the action take advantage of policy opportunities, avoid areas of dense competition, address demonstrated need, and leverage organizational capabilities and relationships? If those blessing the decision understand these same considerations, it will be easier to get to yes.


If you sit in a chief strategy seat, consider building the capability to monitor these domains, and surface your fact-based findings to organizational decision-makers. This information should be the bedrock for strategic decision-making—and strategy leaders will find it easier to secure board and executive support if those audiences are grounded in the same set of facts.

Ready to transform your organization?

Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.

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Realize transaction-related cost synergies

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Contact our experts:

Headshot of Rebecca Nielsen

Rebecca Nielsen

Managing Director

Rebecca Nielsen is a managing director of HMA’s strategy and transformation practice, where she designs and leads major strategy and … Read more
Headshot of Alex Rich

Alex Rich

Senior Advisor

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more

Realize transaction-related cost synergies

HMA Spotlight

Realize transaction-related cost synergies

In the current policy environment, we anticipate increased consolidation in various subsectors due to financial and regulatory headwinds. Organizations can take intentional steps pre- and post-integration to realize cost synergies.

HMA Strategy & Transformation consultants advise organizations in their integration activities, and find it valuable to conduct the following sequence of steps:

Map the operating model pre-close to understand organizational structure, systems, contracts, and key processes across both entities.

Identify risks and quick wins before close—including staffing gaps, system incompatibilities, or duplicative vendors.

Design a Day 1 plan to keep operations stable, align communication, and ensure continuity for staff, patients, and partners.

Stand up integration teams post-close to drive workstreams across finance, IT, HR, and clinical operations with clear timelines and ownership.

Track synergies and milestones to measure progress, course-correct where needed, and deliver the operational and financial goals of the deal.

Intregration with HMA Strategy

A thorough, objective mapping is recommended, to investigate whether to cultivate in-house capabilities or maintain vendor relationships. Considerations include in-house capacity, contracted rates, and the flexibilities and risks associated with outsourcing. We recommend identifying favorable terms in existing vendor contracts that can be leveraged in enterprise-wide contracts.

Although there are internal and external pressures to move aggressively towards transaction deadlines, ensuring that appropriate pre- and post-close activities take place is key.

Ready to transform your organization?

Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.

Related Resources

Learn more about our Strategy & Transformation services

Achieving financial resilience in a time of turbulence

HMA’s Strategy & Transformation Practice collaborates with Stanford University to drive public health innovation

CMS Shakes Up the Innovation Center Model Landscape: What Comes Next?

Building Sustainable Health Systems

How One Organization Unlocked Exceptional Financial Gains Through Revenue Cycle Optimization

Contact our experts:

Headshot of Rebecca Nielsen

Rebecca Nielsen

Managing Director

Rebecca Nielsen is a managing director of HMA’s strategy and transformation practice, where she designs and leads major strategy and … Read more
Headshot of Alex Rich

Alex Rich

Senior Advisor

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more

Achieving financial resilience in a time of turbulence

HMA Spotlight

Achieving financial resilience in a time of turbulence

Healthcare business leaders face significant policy and regulatory headwinds. Ensuring that your organization is financially resilient to weather the storm should be a priority. Achieving financial resilience enables leaders to preserve core functions and staff.  We’ve found that indirect costs are often overlooked and undermanaged and represent an opportunity to build margin (think overhead and administrative costs such as vendor spend).

HMA can help identify cost savings

We find it useful to conduct the following sequence of steps:

Review / categorize all vendor spend to find areas with unnecessary costs, overlapping services, or outdated pricing.

Analyze contracts line -by -line to identify where terms can be improved or where the scope no longer fits current needs.

Stack rank initiatives by risk levels and speed.

Negotiate directly with vendors to lower rates, adjust service levels, or consolidate under better pricing structures.

Monitor results and vendor performance to ensure savings hold over time and services stay aligned with operational needs.

Cost Saving with HMA Strategy

In assessing indirect costs, we visually depict areas of cost reduction by risk of disruption to support client decision-making. There is often a locus of opportunity that can be trimmed with little or no impact to the core business.

As you prepare to batten the hatches, consider assessing indirect costs. Even if the storm isn’t fierce, conducting this work will give you improved real options for optimal decision-making. 

Ready to transform your organization?

Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.

Related Resources

Learn more about our Strategy & Transformation services

HMA’s Strategy & Transformation Practice collaborates with Stanford University to drive public health innovation

CMS Shakes Up the Innovation Center Model Landscape: What Comes Next?

Building Sustainable Health Systems

How One Organization Unlocked Exceptional Financial Gains Through Revenue Cycle Optimization

Contact our experts:

Headshot of Rebecca Nielsen

Rebecca Nielsen

Managing Director

Rebecca Nielsen is a managing director of HMA’s strategy and transformation practice, where she designs and leads major strategy and … Read more
Headshot of Alex Rich

Alex Rich

Senior Advisor

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more
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