Leading ideas and solutions for long-term services and supports.
Changing consumer choices, new expectations from federal and state governments and the drive to achieve fully integrated service delivery are driving a dramatic shift to community-based services and managed care delivery systems. As change ripples through the system, it’s more important than ever to optimize long-term services and supports (LTSS) coordination while ensuring the effectiveness and sustainability of public coverage programs and the quality and financial viability of service providers.
We’re working with the federal government, states, health plans, advocates and providers to meet the challenge and lead the search for new ideas, approaches and solutions. Our expertise encompasses the unique needs of individuals who are aging, children and adults with physical disabilities, individuals with intellectual and developmental disabilities (ID/DD), and children and adults of all ages who need LTSS and have complex medical and behavioral health needs.
Serving the needs of the elderly and those who are dually eligible for Medicaid and Medicare also includes establishing Programs for All-Inclusive Care for the Elderly (PACE) in targeted areas. HMA’s team of care delivery, finance, and operational experts can provide PACE organizations guidance on policy, the application process, and operational readiness.
The PACE landscape is shifting and has led to increased competition and greater regulatory oversight. HMA’s team has the experience and knowledge to help clients develop new PACE program capabilities through feasibility studies, navigating the state and federal application processes, and PACE readiness activities necessary to support new PACE organizations.
Our experts will work with your team to implement program efficiencies and process improvement solutions while improving clinical services. Our knowledge of publicly financed healthcare allows our team to conduct long-term, strategic planning that will allow PACE organizations to diversify and develop new and innovative approaches to transform existing capabilities and better serve seniors in innovative ways.
Our experts include former state Medicaid directors, LTSS managed care executives, directors of home and community-based services, PACE experts and practicing clinicians. They’re ready to consult with you to meet your needs while keeping costs down and quality high. Their expertise includes:
Supporting policymakers in:
- The development and evaluation of LTSS policies
- The analysis, design and implementation of effective and compliant home and community-based services (HCBS) models, including managed LTSS, health homes, and self-directed service options under the full range of Medicaid state plan and waiver authorities
- The assessment of Home and Community Based settings for compliance and remediation
- Effective stakeholder engagement for the design, implementation and on-going effectiveness of managed LTSS
- The development and effective oversight of managed LTSS quality and performance standards
- Readiness review for states and contracted managed care plans
Increasing health plan success with managed LTSS through:
- Gap analysis of core capabilities and health plan infrastructure
- Competitive procurement support
- Support for startup and implementation including consumer and family engagement, LTSS network development, care coordination design, community-based organization partnerships, operation of self-directed models and development of value-based financial arrangements
- Development of SNP models, including Model of Care development
- Integration of behavioral health and physical healthcare with LTSS
Supporting success for providers and investors with:
- Medicaid policy and contract analysis
- Market analysis and business opportunity identification, including assistance with the development of go-to-market business development approach for the dual eligible and Managed LTSS market
- Identification of new business offerings based on core competencies and changing market dynamics
- PACE and managed LTSS technical assistance
- Strategic business, contracting and reimbursement approaches and options in managed care environments
- Institutional policy analysis, facility analysis and facility compliance services