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
Los Angeles County State of Children’s Health Report: Policy Briefs
January 14, 2025
Informed by research and exploration of the on some of the most complex challenges facing children in a post-pandemic world, experts from L.A. Care Health Plan, the nation’s largest publicly operated plan, and Children’s Hospital Los Angeles (CHLA), one of the nation’s leading pediatric hospitals, unveiled their first-ever Los Angeles County State of Children’s Health … Read More
Substance Use Disorder in California – A Focused Landscape Analysis
August 26, 2024
HMA found that the substance use disorder treatment system, which sits outside of specialty mental health and mild-to-moderate mental health services, results in an inconsistent and siloed system. The delivery of programs and services across the state vary because of differences in geography (rural, suburban, and urban densities) as well as county participation in the … Read More
State Approaches to Managing the Medicaid Pharmacy Benefit
August 20, 2024
Millions of Americans rely on Medicaid drug coverage to treat acute illnesses and manage chronic and disabling conditions. Though optional, all states provide pharmacy benefits under Medicaid but administer the benefit in different ways in accordance with federal guidelines. To better understand how states across the country administer the Medicaid pharmacy benefit, as well as … Read More
Economic Analysis of Opioid Use Disorder in the Medicare Fee-for Service Program
June 27, 2024
This report quantifies the economic impact of opioid use disorder (OUD) specific to the Medicare fee-for-service (FFS) program, which covers approximately 51.6 percent of Medicare beneficiaries. We find that the cost to Medicare for managing these newly diagnosed patients was $29,669 more per patient than the propensity-matched control patients without OUD in 2022. We thus … Read More
HMA paper examines federal funding streams supporting crisis pregnancy centers
June 17, 2024
Crisis pregnancy centers (CPCs) are organizations that represent themselves as reproductive healthcare clinics offering services for pregnant people and appear similar to clinics offering a full range of reproductive health services. Federal funding to CPCs may constitute non-allowable uses of such support based on the legislative intent and grant requirements of these programs. In this … Read More
HMA report evaluates needs of Nevada’s Medical Assistance for the Aged, Blind, and Disabled program
June 14, 2024
The Nevada Division of Health Care Financing and Policy (DHCFP) engaged HMA to evaluate Nevada’s Medical Assistance for the Aged, Blind, and Disabled (MAABD) program and the needs of its participants. A targeted focus of the evaluation was on home and community-based services (HCBS) within the Nevada MAABD population, including Nevada’s Frail Elderly (FE) and … Read More
New HMA report using VRDC data analyzes hip fracture outcomes in Dual Eligible population
May 14, 2024
In this new report, “Answering Questions Using Virtual Research Data Center (VRDC): How using Home and Community-Based Services (HCBS) Impacts Hip Fracture Outcomes“, HMA is now using Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center (VRDC) to answer important healthcare questions. One contractual obligation for use of CMS data is the release … Read More