Unparalleled insights into the future of Medicare.

The Medicare program is the nation’s single largest health program with over 60 million beneficiaries. The program has undergone rapid change as millions more have enrolled in private managed care plans, including those eligible for Medicaid benefits (dual eligibles). Enrollment growth, budget pressures, new political directions and rapid technological change will continue to shape the program’s future. In response to these pressures, the Medicare program will develop new payment and delivery innovations, impacting health plans, delivery systems, technology companies and providers’ business models. With HMA’s guidance, you are strategically positioned to meet these future changes with success.

Who we help

We understand all aspects of the Medicare program: policy, financing mechanisms, benefits, coverage, operations, quality and the unique care needs of different Medicare populations. Our consulting team focuses on complex business areas in Medicare Advantage and the traditional program.

Our clients include:

  • Medicare Advantage plans, including provider-sponsored and start-up plans
  • Medicare Supplemental and Part D plans
  • Delivery systems, accountable care organizations, hospitals and provider groups
  • State and local governments
  • Post-acute, and home-based and community-based service providers
  • Medical device, biomedical and pharmaceutical companies
  • Research foundations
  • National, state and local advocacy organizations

What we do

Our roles: HMA consultants serve as advisors to C-Suite and operational leaders to develop policies, strategies and tactical work plans to achieve business goals. We often serve as interim Medicare Advantage plan leadership to assist start-up or transition business environments.

Examples of our projects:

Development of comprehensive Medicare Advantage strategies for Medicare Advantage, Special Needs and Dual Eligible plans, including:

  • Feasibility assessments
  • New CMS Medicare Advantage application development
  • Medicare Stars improvement strategies
  • Develop Special Needs Plan (SNP) Model of Care
  • Develop de novo Medicare Advantage applications
  • Implementing critical operational functions and staffing models

Developing and Modeling Innovative Payment Models

  • Evaluate new alternative payment models
  • Develop novel payment concepts to propose to CMS and Medicare Advantage payers
  • Model impacts of CMS payment changes
  • Analyze and forecast size of the post-acute market change
  • Identify new Medicare program reimbursement opportunities under value-based care

Our team

HMA’s multidisciplinary team includes former health plan executives, federal and state policy experts, payment experts, data analysts and physician leaders. These team members offer a wealth of experience in developing and supporting:

  • Health plan strategies and operations
  • Policy development and strategy
  • Navigation and interpretation of new CMS policies and guidance
  • Data analysis and modeling

HMA has more than 20 offices across the country to offer you insightful, innovative and expert Medicare program support.

Ready to talk to a Medicare expert?

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