This week, HMA Principal Juan Montanez, of our Washington, D.C. office, provides an update on the fiscal crisis in Puerto Rico, the relationship between the fiscal crisis and Puerto Rico’s Government Health Plan (GHP), as well as what may lie ahead for the GHP. Puerto Rico has been in the news over the last couple of years, primarily because of the central government’s inability to meet its debt obligations. In 2015 the central government’s finances reached a point where it could have literally run out of cash to service its debt and fund regular operations. A significant contributor to this fiscal crisis is the cost of and associated funding for the GHP, known colloquially on the island as Mi Salud (“My Health”). This article provides some history and context on the GHP, in addition to outlining current proposals for addressing the program’s impending funding “cliff.”
March 30th is Doctors’ Day, and for most physicians that means a special lunch in the hospital cafeteria or a carnation on their white coat. But a few years ago, I hung up my white coat and made the transition to healthcare consulting. The questions immediately started. Won’t you miss seeing patients? What exactly will you do? Did you lose your license? That last one is my favorite. So what exactly is a doctor like me doing in a place like this?
This week, we reviewed updated reports issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “December 2016 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on February 28, 2017. Additionally, we review 2017 Exchange enrollment data from the “Health Insurance Marketplaces 2017 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on March 15, 2017. Combined, these reports present a picture of Medicaid and Exchange enrollment at the beginning of 2017, representing more than 74 million Medicaid and CHIP enrollees and more than 12 million Exchange enrollees.
This blog post was authored by HMA clinicians Margaret Kirkegaard, MD, MPH, and Jeffrey Ring, PhD
While most people would agree that social relationships improve day-to-day quality of life, do social connections actually provide a health benefit? The answer is a resounding yes!
In 1921, a remarkable study began tracking the lives of 1,500 Americans from childhood to death. It sought to track what factors in life — such as faith, marriage, pets and exercise — increased longevity. The most significant finding was that strong social networks mattered the most. The quality of social connections was more significant than the quantity. In an interview with National Public Radio, lead researcher Howard Friedman notes, “We saw that over and above the number of connections and the frequency of interactions that when those connections involved helping other people, reaching out, being actively engaged to do things for others, that was an added bonus on top of what we already see as quite beneficial from the social contacts themselves.”
This week, we reviewed the Medicaid long-term services and supports (LTSS) redesign draft paper published on March 7, 2017, by the Nebraska Department of Health and Human Services (DHHS). The paper is the follow-up to a January 2016 DHHS concept paper, which identified increasing pressure on the state’s Medicaid LTSS system. The LTSS redesign paper addresses identified high-priority systemic issues in the current LTSS system, recommends longer-term system changes, and outlines a transition to managed LTSS (MLTSS). Nebraska has long been in discussion around a transition to MLTSS, and this draft redesign paper potentially puts the state on a timeline to begin providing mandatory MLTSS statewide to older adults and individuals with disabilities (Phase 1) as of January 1, 2019, with MLTSS to follow for individuals with intellectual or developmental disabilities (Phase 2) on July 1, 2019. We estimate the potential MLTSS population at more than 50,000 beneficiaries with annual LTSS spending between $800 million and $850 million.
Below is the news release HMA issued March 13th.
WASHINGTON, D.C. – Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the signing of an agreement by which HMA will acquire SVC, a consulting firm which is owned by Seema Verma, founder and president, and recently confirmed Administrator of the Centers for Medicare & Medicaid Services (CMS).
SVC will become HMA Medicaid Market Solutions, a new subsidiary of HMA.
This week’s review comes to us from HMA Principal Karen Brodsky and Research Assistant Anh Pham, both of our New York City office. Anh and Karen provide a review of the “Medicaid 2.0 Blueprint for the Future” issued by the New Jersey Health Care Quality Institute (Quality Institute). Funded by The Nicholson Foundation, the Quality Institute embarked on a year-long project convening a wide variety of stakeholders in New Jersey with the goal of redesigning and modernizing the State’s Medicaid program. The report is a culmination of 24 recommendations to promote the efficient delivery of quality healthcare services to New Jersey’s most vulnerable populations.
This week, we reviewed the request for proposals (RFP) issued on February 27, 2017, by the Illinois Department of Healthcare and Family Services (HFS) to rebid the majority of the state’s existing Medicaid managed care program contracts, consolidate multiple programs into a single streamlined program, and expand managed care statewide. The RFP will consolidate the current Family Health Plans/ACA Adults (FHP/ACA) program, the Integrated Care Program (ICP), and the Managed Long Term Services and Supports (MLTSS) program into a single contracting approach, while reducing the number of contracted managed care organizations (MCOs) from 11 to between four and seven. The RFP does not impact the Medicare-Medicaid Alignment Initiative (MMAI) duals demonstration at this time. When fully implemented by the end of 2018, the new managed care program will cover roughly 2.7 million Medicaid beneficiaries in all 102 counties in Illinois.
This week, we reviewed the Washington Health Care Authority’s (HCA’s) request for proposals (RFP) for the North Central Regional Service Area (RSA) transition to Fully Integrated Managed Care (FIMC) under the Apple Health Medicaid program. Under the RFP, HCA will contract with fully integrated Medicaid managed care organizations (MCOs) – integrating physical and behavioral health – for the North Central RSA, which consists of Chelan, Douglas, and Grant counties. HCA previously issued a FIMC RFP for Clark and Skamania counties in the second half of 2015. The state eventually intends to transition all counties to the Apple Health FIMC model. Awarded MCOs will begin serving the North Central RSA on January 1, 2018. There are more than 66,200 Apple Health members in the North Central RSA as of February 2017.
This week, we reviewed the request for proposals (RFP) issued by the Mississippi Division of Medicaid (DOM) for the reprocurement of Mississippi Coordinated Access Network (MississippiCAN) Medicaid managed care plans. Under the RFP, the DOM is adding 1915(i) Intellectual/Developmental Disabilities Community Support Program (IDD CSP) and Mississippi Youth Programs Around the Clock (MYPAC) services to the MississippiCAN benefit package. As of February 2017, MississippiCAN enrolls roughly 490,000 Medicaid members across all 82 counties in the state, with annual spending of more than $2.7 billion.