As we approach Medicare’s 60th Anniversary this July, the program again finds itself at a critical crossroads, facing demands for higher quality care, expanded access to transformative treatments, and streamlined patient access to their medical information. Decision makers also must integrate digital tools into clinical models, address mounting scrutiny of costs, and ensure accountability for outcomes influenced by social determinants of health.
This period of transition at the Federal level is bringing new scrutiny and pressure for efficiency. With more than 68 million beneficiaries, nearly half of whom are enrolled in Medicare Advantage, the Medicare program is continually evolving to respond to shifting policies and priorities. Organizations that stay ahead of policy changes will be best positioned for success and drive meaningful improvements for Medicare beneficiaries.
When you work with HMA’s federal policy experts, you get access to former CMS officials and plan executives, payment system and coding experts, and policy analysts to support your efforts. HMA’s Medicare team includes experts specializing in Medicare Advantage, dual eligibles, Medicare stars, value-based care, rural health, PACE, actuarial support, and data and quality. We draw on the resources of experts from our HMA companies to provide comprehensive and end-to-end solutions. Read some of our insights in the links below.
Here’s how HMA is helping clients navigate this dynamic landscape:
- Our policy team is working with clients to understand what is happening right now in Congress and in the US Department of Health and Human Services that will usher in significant policy and funding changes. Our teams are advising stakeholders on the short- and long-term implications, strategies to advance their objectives in this new environment, and working with states to understand immediate impacts on local financing.
- Our clinicians are working closely with insurers, providers, and health systems to strengthen models of care that address complex conditions, behavioral health issues, long-term services and supports and unique needs of special Medicare populations.
- Our actuaries are conducting financial modeling and analysis to forecast costs, revenues, and potential outcomes to help navigate financial uncertainties in Medicare Advantage bids, Medicare payment models, and emerging environmental and regulatory issues, including digital quality measure collection, increased focused on dual integration, supplemental benefits, and drug price negotiations.
- Our digital quality experts are working with healthcare organizations to prepare for rapid changes that digital health quality measurement will bring to reimbursement models. Our teams are advising on the influx of newly accessible clinical data to ensure it is properly validated and interpreted and working with insurers and providers to develop strategies allowing them to be more agile in contract negotiations.
To talk to an expert to help support and improve your Medicare programs, contact Greg Gierer with the HMA DC office (ggierer@healthmanagement.com) or Josh Trent with the Leavitt Partners DC office (josh.trent@leavittpartners.com).
For more cutting-edge information check out some of our recent insights:
Policy & Regulatory Strategies: Legislative, regulatory, reimbursement, and budget analysis from experienced former staffers from CMS and various legislative committees. The HMA policy team includes past HHS officials like Amy Bassano and Monica Johnson, as well as the team at Leavitt Partners.
- Webinar Replay — Legislative Reconciliation in a New Era: Understanding Its Role and Impact in the 119th Congress
- Podcast — Has Medicare’s Drug Policy Struck the Right Balance Between Access and Cost?
- Webinar Replay — 2024 Political Checkpoint
- Webinar Replay — The 2024 Election: What It Could Mean for Health Policy
- Report — On Rare Disease Day, HMA releases new report analyzing federal spending on Orphan Drugs
Actuarial & Financial Analytics: Leading actuaries with deep MA experience and robust tools to support innovative benefit and pricing strategies. Encounter data audits to improve risk scores. The HMA Actuarial team includes Wakely Consulting Group and Cirdan Health Systems and Consulting.
- PACE Plans and The Changing Risk Environment
- Webinar Replay — 2025 Medicare Advantage Bids Are Over. Now What?
- Project Spotlight — CMS Encounter Data Quality Review for an I-SNP Plan
Communications & Engagement: Creative campaigns to inform, persuade, and engage providers and payers. The HMA team includes 720 Strategies and Lovell Communications.
- Web campaign — American Association of Nurse Practitioners
- Website — Five Paid Digital Tactics You Need for Advocacy
Strategy & Transformation: Strategy & analytic fundamentals informed by variety of experts in Medicare, health insurance, care delivery for older and vulnerable populations, and value-based payment and delivery innovations.
- Podcast — Can data shape the future of Medicare’s value proposition?[TM6] [GB7]
- Using Virtual Research Data Center (VRDC) Data to Answer Big Questions
- Report — Analyzing the Expanded Landscape of Value-Based Entities: Implications and Opportunities of Enablers for the CMS Innovation Center and the Broader Value Movement
Operations & Implementation: Clinical and administrative operations building care models, implementing value-based payment incentives, technology, and compliance. The HMA Managed Care team is led by Holly Michaels Fisher.
Quality Outcomes & Research: Integrated approach to STARS ratings, building digital quality management tools and strategies for compliance and accreditation. The HMA team includes Caprice Knapp and Sarah Scholle.