October 30, 2020
Health Management Associates (HMA), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.
EBPs include Chronic Disease Self-Management Education (CDSME) programs and falls prevention programs. HMA colleagues Principal Sarah Barth, JD and Research Assistant Sarina Coates-Golden, BA, drafted the paper, Reimbursement for Evidence-Based Health Promotion Programs in the Community – Strategies and Approaches to Medicaid and Medicare Advantage Coverage, which identifies:
- Medicaid authorities and financing mechanisms through which states have adopted evidence-based health promotion programs
- Promising practices establishing reimbursable EBP programs and approaches that may be replicated in other states in Medicaid, Medicare Advantage and other emerging markets to support program sustainability beyond grant funding
- Barriers to adoption of evidence-based health promotion programs and actionable steps to avoid or address
- Actionable information to move forward relationships with state Medicaid programs or Medicaid managed care organizations.
The report made recommendations and outlined next steps for moving forward with reimbursable relationships with public and private payers.