Managed Care

Make the most of growth opportunities in managed care with the help of HMA.

The Medicare and Medicaid managed care markets are highly complex and competitive. Give your organization an advantage by teaming up with the experts of HMA. Our consultants have unique experience in all areas of the managed care spectrum, from market entry and strategy to procurement and contract award to operational implementation. In fact, many of our team members formerly served as state and federal officials and managed care executives. With this in-depth experience, we can help clients win business and grow membership in the managed care market.

HMA managed care consultants can assist you with both high-level strategy and planning as well as the real-world application that makes new programs successful.

Meet some of our managed care experts.

To navigate the intricacies of managed care, you need an experienced guide. And no one knows the territory better than these HMA managed care consultants.

Making the most of managed care: Our services

HMA managed care services include:

  • Due diligence: Mock audits, gap analysis and readiness reviews in preparation for mergers and acquisitions, state readiness review, program integrity, or accreditation audits and expansion into new markets and programs.
  • Development and management of provider networks, such as programs to address health equity and social determinants of health.
  • Membership growth strategy: Analysis of entry opportunities into new markets and populations, as well as factors that accelerate membership growth such as competitor analysis, supplemental benefit design, network design, partnership models, and outreach and engagement approaches.
  • Implementation of change: Staffing structures and job descriptions, development and implementation of policies and procedures, training curriculum and materials, creating workflows, resources, and managing projects.
  • Procurement support: Strategy development, win-themes, draft development and mock scoring.
  • Interim staffing and onboarding/training: Staffing assistance for start-up operations, new markets, temporary staffing and hard-to-fill replacement positions.
  • Strategies and models of care: Development of effective approaches for complex care populations with chronic conditions and co-morbidities.
  • Development and management of provider networks
  • Payment and reimbursement strategies
  • Evaluation and pursuit of emerging business opportunities: Market analysis, market entry, deliberate assessments, and strategic planning.

HMA has been instrumental in growing our business in the managed care market.

– Healthcare Client

Our expertise within managed care:

Our expertise spans the entire spectrum of populations, including Medicare, Medicaid, and dual eligible members. We provide guidance on a wide range of topics, including:

  • Care management
  • Children in foster care
  • Children with special healthcare needs
  • Financing and rate development
  • Health equity
  • Long-Term Services and Supports (LTSS) and Programs for All-Inclusive Care for the Elderly (PACE)
  • Medicaid waivers
  • Medicare Advantage
  • Member engagement
  • Pharmacy benefit management
  • Quality and accreditation services
  • Regulatory compliance
  • Safety net Provider contracting expertise
  • Social determinants of health
  • Specialty plans
  • Stakeholder engagement and feedback
  • Stakeholder strategy and advocacy
  • Supplemental and directed payment expertise
  • Value-based purchasing

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