The Centers for Medicare & Medicaid Services (CMS) is on the cusp of possessing the data needed to make long anticipated changes to the Medicare fee-for-service (FFS) ground ambulance payment system. It has been more than two decades since CMS revised these payment rates through a negotiated rulemaking process that was exclusive of actual cost … Read More
Private Equity Investment in AI in the Healthcare Sector
April 1, 2025
HMA will be offering analyses on various investor related topics in the healthcare sector. Our first report examines the growth of Artificial intelligence (AI) in the US healthcare market. AI is expected to reach projected revenues of $102 billion by 2030. Learn more in this analysis.
New Insights on Medicaid Spending: An Analysis of Disaggregated Managed Care Spending
March 20, 2025
Medicaid is a federal/state health insurance program that served more than 86 million lower-income people in fiscal year (FY) 2021. The combined federal and state spending for Medicaid totaled $717 billion that year, $420 billion of which was spent on providing care to Medicaid managed care organization (MCO) members, and $297 billion on services provided … Read More
Workforce Solutions Partnerships: Call to Action to Build a Sustainable Behavioral Health Workforce
March 17, 2025
The Workforce Solutions Partnership, a collaboration of The National Council for Mental Wellbeing, The College for Behavioral Health Leadership, and Health Management Associates has worked since 2021 to create both short and long-term solutions addressing the behavioral health workforce crisis. In this whitepaper, we issue a Call to Action to partners across all sectors to … Read More
HMA Prepares Health and Human Services Assessment for the City of Watertown
March 4, 2025
On Tuesday, February 25, 2025, the Watertown City Council unanimously endorsed the recommendations of a year-long health and human services assessment prepared by HMA for the City of Watertown, Massachusetts. The report, released in November 2024, included a qualitative and quantitative assessment of the community’s health and human service needs and recommended resources to fill … Read More
On Rare Disease Day, HMA releases new report analyzing federal spending on Orphan Drugs
February 28, 2025
Rare Disease Day is observed globally each year on February 28 to raise awareness, access, and diagnosis to therapies for people with rare diseases. Today HMA releases a report titled Analyzing the Impact of Policies to Exclude Certain Orphan Drugs from the Drug Price Negotiation Program of the Inflation Reduction Act, that examines how many orphan … Read More
State Cost Growth Benchmarking Programs: An Evaluation of Eight States’ Experiences and the Lessons Stakeholders Have Learned
February 25, 2025
Background In 2024, Health Management Associates (HMA) evaluated programs implemented by eight states (California, Connecticut, Delaware, Massachusetts, New Jersey, Oregon, Rhode Island, and Washington) aimed at controlling healthcare cost growth. In recent years, these states have tried to address the trend of escalating healthcare costs using an approach referred to as cost growth benchmarking (CGB). … Read More
Medicare Hospital Inpatient Device-Intensive Payment Policy
February 13, 2025
Medicare’s fee-for-service (FFS) payment system includes payment policies that support providers’ use of innovative medical device technologies. The continued evolution of these policies is necessary to keep pace with current and future medical innovation. In this report, HMA summarizes models testing the implementation of a newly proposed policy for the hospital inpatient system which aims … Read More
HMA helps navigate dQM to improve health outcomes
February 13, 2025
The healthcare industry is undergoing a seismic shift in how quality data are collected and reported, creating opportunities to use digital quality measures (dQM) to significantly improve health outcomes and efficiency. Starting in January 2027, new federal interoperability and prior authorization rules will promote widespread data exchange, enabling full digital quality measurement. Payers and providers … Read More
340B Duplicate Discounts: Enforcement Inconsistent and Weak Due to Lack of Data Transparency and Despite Federal Prohibition
February 10, 2025
At the intersection of the federal 340B Drug Pricing program and the federal Medicaid Drug Rebate Program (MDRP), a potentially large set of Medicaid claims are generating duplicate discounts, which pharmaceutical manufacturers provide to eligible entities such as hospitals and health centers. These two complex federal programs were designed to reduce the costs of prescription … Read More