Insights

HMA Insights: Your source for healthcare news, ideas and analysis.

HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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1851 Results found.

Solutions

Using Virtual Research Data Center (VRDC) Data to Answer Big Questions

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Health Management Associates (HMA) is utilizing Virtual Research Data Center (VRDC) data to do what HMA does best: solve publicly funded healthcare’s most challenging problems. The combination of our deep analytics expertise and our nationally renowned subject matter experts can help you solve your toughest challenges.

We are committed to helping clients meet their needs through:

Market Analysis

Want to know how many psychologists are treating Medicaid patients in a county? Or how many duals got NEMT in a year? We can tell you that. How many folks on Medicare got drugs for Memory Loss last year? We can tell you that too. The VRDC allows us to examine the Medicaid and Medicare populations with significant precision to inform your decisions.

Consulting Services

We love hard questions. Carefully designed smaller queries can add up to answer big questions like “Does access to Non-Emergency Medical Transportation help patients managing challenging chronic medical conditions?” or, “Are services critical to patient success being delivered equitably to patient populations?” HMA can help you answer your hardest questions by breaking them into smaller questions that add up to big results. Outcomes Survey (HOS) specific to BH, and align data performance to quality improvement efforts.

Quality Improvement and KPI Benchmarking

HMA’s team of quality experts can help you identify metrics that matter internally to your organization as well as to your payers and providers. We can run metrics against these Medicaid and Medicare data to prepare you to manage risk through deep data analysis and creation of benchmarks that help manage access, cost, quality, and utilization.

HMA’s access to VRDC data through this agreement include:

Data representative of 100 percent of Medicare and Medicaid beneficiaries and their medical experience expressed as claims

Data representative of 100 percent of Part D Drug Event (PDE) data

Detailed Long-Term Care data for all Medicare and Medicaid beneficiaries through the MDS dataset

We can help organizations including:

State and municipal departments of health and public health

Health plans

Provider organizations

Analytics and technology vendors

Private equity

Correctional health

Contact our experts:

Jim McEvoy

Jim McEvoy

Data Analytics Resources Director

Jim McEvoy is accomplished in architecting robust technology solutions for state agencies, health plans and service providers. Jim understands the … Read more
HMA News

New experts join HMA in August 2023

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HMA is pleased to welcome new experts to our family of companies in August 2023.

Dianne Bisacky – Principal
HMA

Dianne Bisacky is a seasoned professional with C-Level executive experience and a strategic mindset dedicated to driving growth and implementing innovative solutions.

Sheila Wilson – Principal
HMA

Sheila Wilson is a registered nurse with over 35 years of experience in both the clinical and managed care environments.

Read more about our new HMA colleagues

Sheila Wilson

Sheila Wilson

Principal

Blog

Florida releases procurement for statewide Medicaid prepaid dental program

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This week, our In Focus section reviews the Florida Statewide Medicaid Prepaid Dental Program invitation to negotiate (ITN) released October 6, 2023, by the Florida Agency for Health Care Administration (AHCA). Contracts will serve 4.4 million Statewide Medicaid Managed Care (SMMC) members.

Background

The Florida Statewide Medicaid Prepaid Dental Program is a full-risk capitated dental program, which began rolling out by groups of regions in December 2018. The incumbent statewide Medicaid dental plans are DentaQuest, Liberty, and MCNA Dental.

Florida also is reprocuring its traditional managed medical assistance (MMA) program and managed long-term care program under SMMC. Awards for Medicaid managed care organizations (MCOs) are expected in February 2024.

ITN

Florida intends to award contracts to at least two plans. One of AHCA’s goals is to contract with plans that will support the HOPE Florida: Pathways to Prosperity initiative, which focuses on community collaboration between the private sector, faith-based community, not-for-profits, and government entities to break down traditional community silos. Through this program, AHCA seeks to:

  • Improve oral health outcomes by implementing a quality continuum
  • Enable personalized oral healthcare, particularly for people with special needs
  • Strengthen the network of dental providers
  • Integrate medical and dental care

In addition to the services currently provided, dental plans will cover authorized hospital outpatient and ambulatory surgery center (ASC) services as part of the new contracts. Plans will cover ancillary medical services provided secondarily to dental care in an ASC or outpatient hospital setting when medically necessary.

Dental plans will continue to operate statewide across all regions. Capitation rates for Medicaid and dually eligible members, however, are set regionally. Rates for medically necessary procedures are set at a statewide level. The new contracts will consolidate the 11 regions into nine as shown in the table below.

Timeline

Responses are due January 5, 2024, and notification of intent to award is anticipated to be released on March 29, 2024. Contracts will run from the execution date in 2024 through 2030.

Evaluation

Technical proposals will be scored using a total weighted score of 6,600, as shown in the table below.

Link to RFP

Solutions

Consumer Assessment of Healthcare Providers Systems (CAHPS): Improving Member Experience

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Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and should, work to improve their Consumer Assessment of Healthcare Providers Systems (CAHPS) scores.

The CAHPS annual survey measures member experience with providers and Medicare and Medicaid health insurance plans. It has also become a critical metric used by the Centers for Medicare and Medicaid Services (CMS).

Plans can work to improve CAHPS scores by developing a comprehensive improvement plan involving a holistic year-around approach that involves monitoring the member experience from enrollment through disenrollment. With score improvement comes incentive payments tied to high quality performance.

CAHPS SCORES ARE USED BY:

The National Committee for Quality Assurance (NCQA) to STAR rate health plans in accreditation scoring

Potential members to compare plan scores against one another on the NCQA website

Several state Medicaid programs that require plans to report these surveys and use scores as part of their incentive programs

CMS, which has increased its STAR rating, CAHPS-related measure from double weighted to quadruple weighted in contract year 2021

Medicare Advantage Prescription Drug (MAPD) plans, which use CAHPS to calculate 32% of the overall aggregate score

CAHPS COHORTS THAT ARE MEDICARE STAR MEASURES

PART C CAHPS MEASURES (WEIGHTS)

Getting needed care (4)

Getting appointment and care quickly (4)

Customer service (4)

Rating of healthcare quality (4)

Rating of health plan (4)

Care coordination (4)

Annual flu vaccine (1)

PART D CAHPS MEASURES (WEIGHTS)

Rating of drug plan (4)

Getting needed prescription drugs (4)

ADDITIONAL STAR MEASURES AND ACTIVITIES THAT RELATE TO MEMBER EXPERIENCE

PART C MEASURES (WEIGHTS)

Complaints about the health plan (2)

Member choosing to leave the plan (2)

Plan makes timely appeals decisions (2)

Reviewing appeal decisions (2)

Call center, language interpreter and TTY availability (2)

Health plan quality improvement (5)

PART D MEASURES (WEIGHTS)

Call center, language interpreter and TTY availability (2)

Complaints about the drug plan (2)

Member choosing to leave the drug plan (2)

Drug plan quality improvement (5)

Health Management Associates’ expert colleagues can help plans outline an organizational assessment of member experience and customize interventions and solutions to increase scores.

Our team of quality and accreditation experts can help organizations improve customer service and scores by:

Establishing a year-around effort

Using an organizational effort to break down department silos and improve cooperation between departments

Assessing core functions within the plan and contractors that contribute to member experience including marketing, enrollment, disenrollment, UM, QI, member service, grievances, appeals, etc.

Identifying and addressing patient frustrations with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Recognizing social determinants of health (SDOH) are often overlooked in access to care-related issues, such as lack of transportation or lack of funds for co-payments

Outlining techniques for obtaining point-of-service feedback to help address potential member experience issues before they arise

Contact our experts:

Sarah Owens

Sarah M. Owens

Principal

A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
David Wedemeyer

David Wedemeyer

Principal

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
Solutions

Star Rating: We Can Help You Navigate to a Higher Level

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What is the VALUE of a Star in your plan(s)?

What initiatives have you introduced to prepare for the changes in the Star Rating that may impact your overall Star Rating results?

What are you doing for health equity focus? What data are you collecting for health equity?

What do you think are your organization’s financial implications when Star Rating requirements change?

What are your Star Rating strategies for increasing your organization’s market share and viability?

What sort of interventions, data sources, analytics and reporting have you found to be successful to improving your Star Rating?

WE CAN HELP YOU BY:

Establishing a year-around effort to improve Star Rating performance

Assessing core functions within the plan and contractors that contribute to understanding members

Identifying and addressing customer concerns with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Working on health equity issues including sharing techniques for obtaining data

Leveraging all data and intervention efforts (such as risk and quality) to drive decision and focus

Contact our experts:

Sarah Owens

Sarah M. Owens

Principal

A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
David Wedemeyer

David Wedemeyer

Principal

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
Solutions

HMA Can Help You Prepare for The Joint Commission (TJC) Accreditation and Certification

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HMA’s team of experts have completed accreditation requirements with our clients as well as in our formal executive and operational leadership roles in the health care setting.  We work closely with our clients and with TJC and other accreditation programs with a focus on improving healthcare quality and favorable outcomes. Our team of seasoned healthcare executive consultants bring more than 100 years of experience in clinical, quality, and operations, with proven results. HMA offers a full continuum of accreditation services for hospitals, ambulatory surgical centers (ASCs), Federally Qualified Health Centers (FQHCs) and behavioral health (BH) care settings. We work closely with FQHCs to provide assistance for certifications and advanced certifications in health equity (HE). HMA can offer onsite or virtual mock survey and gap analysis preparation for TJC accreditation, as well as tactical and advisory support to prepare our client leadership teams for a winning accreditation survey results and supporting the development of a sustainable plan to achieve year over year success!

Our experts can help you by:

Assessing core functions supporting the implementation of the latest TJC standards and interpretation of the standards

Building the business case for TJC accreditation

Guiding your team through the new HE standards

Creating quality and assessment improvement plan (QAPI) to lead to a successful survey

Continuous survey readiness support via a sustainable plan

And so much more across the continuum

Contact us at [email protected]

Contact our experts:

Trisha Bielski

Trisha Bielski

Senior Consultant

A highly specialized critical care, trauma and flight nurse, Trisha Bielski has deep experience in nursing leadership, military healthcare, and … Read more
Ruth Danielzuk

Ruth Danielzuk

Senior Consultant

Driven by collaboration across the healthcare landscape, Ruth Danielzuk is a seasoned quality and innovation expert with experience managing programs … Read more
Matthew Sandoval

Matthew Sandoval

Principal

Matthew Sandoval is an accomplished leader in healthcare with a proven track record of managing the administration, operations, and quality … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
Blog

Kansas releases KanCare, CHIP Medicaid managed care RFP

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This week, our In Focus section reviews the KanCare Medicaid capitated managed care request for proposals (RFP), released October 2, 2023, by the Kansas Department of Health and Environment and Department for Aging and Disability Services. The program covers approximately 520,000 beneficiaries and is worth $4.1 billion. New contracts would begin January 2025.

KanCare Background

KanCare is the state’s Medicaid managed care program, covering both traditional Medicaid and Children’s Health Insurance Program (CHIP) members. In all, KanCare covers approximately 320,000 children, 79,000 parents and pregnant women, 59,000 individuals with disabilities, and 54,000 individuals ages 65 and older.

Managed care organizations (MCOs) provide statewide integrated physical health, behavioral health, and long-term services and supports. Covered services include nursing facility care and home and community-based services, as well as Medicaid-funded inpatient and outpatient mental health and substance use disorder services and seven Section 1915(c) HCBS waiver programs.

Kansas is not currently an expansion state. While the governor’s 2024 budget plan called for Medicaid expansion, lawmakers rejected the proposal during the last legislative session.

In 2022, the state legislature delayed the procurement until 2023 to ensure that it occurred after the gubernatorial election and extended current MCO contracts through 2024.

RFP

Kansas expects to select three MCOs. The RFP includes a renewed focus on integrated, whole-person care, workforce retention, and accountability measures for the MCOs. The state lists the main goals for the KanCare procurement as:

  • Improve member experience and satisfaction
  • Improve health outcomes by providing integrated, holistic care with a focus on the impacts of social determinants of health
  • Reduce healthcare disparities
  • Expand provider network and direct care workforce capacity and skill sets
  • Improve provider experience and encourage provider participation in Medicaid
  • Increase the use of cost-effective strategies to improve health outcomes and the service delivery system
  • Leverage data to promote continuous quality improvement

Timeline

A mandatory pre-bid conference will take place on October 16, 2023. Proposals are due January 4, 2024, with awards expected April 12, 2024. Contracts will be effective January 1, 2025, through December 31, 2027, with up to two one-year renewal options. Following is the timeline leading up to implementation.

Current Market

Incumbents are Centene, CVS/Aetna, and UnitedHealthcare. A breakdown of market share by enrollment as of June 2023 can be seen in the table below. Other insurers have already cited their interest in bidding for the new contracts.

Link to RFP