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Report examines the value of community behavioral health providers and their networks

A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.

An HMA team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, The Value of Community Behavioral Health Providers & Their Networks with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).

Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.

New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:

Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
Warehouse and including data sharing requirements in future managed care contracts.
Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.

Second behavioral health issue brief focuses on workforce crisis and call for immediate action

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The National Council for Mental Wellbeing (National Council) and HMA have released the second in the series of three issue briefs examining the ongoing, and exacerbated, workforce and staffing crisis facing behavioral health services providers and facilities.

The brief, Immediate Policy Actions to Address the National Workforce Shortage and Improve Care, focuses on clinical transformation and provides short-term recommendations to support states in addressing the workforce shortages, provider burn-out, recruitment and retention.

Recommendations include:

Adopting transformative clinical approaches and team-based care
Identifying short-term actions and developing long-term strategies for improvement
Expanding the workforce to build a more robust provider pipeline
Increase adoption of in-person/telehealth hybrid models

HMA and the National Council colleagues contributed to the briefs and surrounding research.

HMA report compares quality outcomes across state Medicaid program delivery models

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A recently completed analysis of the impact of Medicaid managed care on key quality indicators found managed care organizations (MCO) outperformed fee-for-service (FFS) and primary care case management (PCCM) programs for both Child and Adult Core Set measures, once the data was normalized with respect to beneficiary distribution in each model.

The resulting report was in response to more states transitioning Medicaid beneficiaries from FFS to MCOs with a goal of reducing costs and improving quality. The HMA team, David Wedemeyer, Anthony Davis, Sharon Silow-Carroll, and Joe Moser, used the 2019 Centers for Medicare & Medicaid Services (CMS) Core Set of Adult and Child metrics that cross the care continuum to develop a standardization model. The model aimed to classify quality outcomes on a state-by-state basis, based on the percent of members in direct FFS arrangements, MCOs, and PCCM programs.

The analysis suggested that performance differences could be attributed to the fact MCOs have structured care coordination and specialized programs, such as disease management, population health programs, and social determinants of health programs in place. As the HMA team drilled down into sub-sections of the Core Set related to key domains such as preventive care, women’s health, disease management, and behavioral health, the findings were consistent in that MCOs tended to perform higher overall when compared to FFS and PCCM across all major domain categories.

In summary, HMA’s findings suggest that the growth of Medicaid managed care plans has led to higher quality scores in several core areas of adult and child measures, lending support to the idea that managed care has had a positive impact overall on the quality of care for Medicaid members across the country. Additionally, HMA’s review of the data and the team’s deep understanding of state oversight of managed care programs suggests that when a state strongly embraces a quality improvement framework as a long-term strategy and partners with its managed care plans on performance-based contracts, quality scores and outcomes may be stronger. The report also suggests that stronger state efforts to work with managed care plans to develop clear expectations and collaboration, while also leveraging MCOs’ access to clinical and quality data sources, may contribute to higher quality scores.

HMA experts evaluate differences between Medicare Advantage and Fee-For-Service Medicare responses to the challenges of the COVID-19 pandemic

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In a new report released by the Better Medicare Alliance (BMA), HMA colleagues Zach Gaumer and Elaine Henry concluded that the greater flexibility of the Medicare Advantage plan model enabled plans to offer providers additional support during 2020 that were not found within the Fee-For-Service (FFS) Medicare program. The report’s findings were previewed in a recent panel discussion during the BMA’s Medicare Advantage Summit.

National Council for Mental Wellbeing and HMA have partnered to create a three-part series that examines behavioral health workforce crisis

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As demand for behavioral health services continues to grow, accelerated by the COVID-19 pandemic, staffing and workforce capacity to deliver services has not kept up with demand. In a three-part series of issue briefs, colleagues from Health Management Associates (HMA) and the National Council for Mental Wellbeing (the National Council) offer immediate steps states can take to increase capacity and build a more stable workforce.

The first brief in the series focuses on Policy, Financial Strategies and Regulatory Waivers, and outlines solutions that can be implemented quickly to reduce administrative burden and maximize existing provider resources.

Several HMA and the National Council colleagues, contributed to the briefs and surrounding research.

Study examines Austin LGBTQIA+ community, quality of life

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A new report summarizing the ShoutOut Austin Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual (LGBTQIA+) Quality of Life Study, has been released. The report summarizes research conducted by HMA Community Strategies (HMACS) which included town hall meetings, surveys, stakeholder interviews, and focus group responses from a diverse group of community members.

Center for Medicare and Medicaid Innovation: Recommendations for Future Direction

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A recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous HMA report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.

The brief examines options for how CMMI could refine their approach to testing ideas for improving the Medicare program. HMA colleagues Jennifer Podulka, Yamini Narayan, and Lynea Holmes wrote the brief which was supported by Arnold Ventures.

HMA’s earlier brief examined the progress the Innovation Center has made in learning from Medicare-focused models during its first decade and raised questions to guide policymakers as they plan for the next phase of the Innovation Center’s work. In the new report, the team returns to those questions and offers potential answers.

The brief outlines seven pairs of competing goals and offers four recommendations that may, in part, help to balance these competing goals, as they are designed to increase the transparency of Innovation Center efforts and improve the likelihood that more models succeed in decreasing spending or improving quality. The recommendations include:

The Department of Health and Human Services (HHS) should establish a National Healthcare Transformation Strategy
CMMI should articulate a vision for how different models work together
CMMI should tailor models to test ideas that address the largest areas of spending growth and key areas of quality concerns, including
- Include Part D in models
- Include Part C in models
- Promote primary care as a counterbalance to excessive low-value care
- Address social determinants of health and other drivers of quality and access disparities
Congress and HHS should revisit the Physician-Focused Payment Model Technical Advisory Committee (PTAC)

Strategic approaches to utilize ARPA funds to support older adults issue brief authored by HMA

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A new issue brief, authored by Madeline Shea and Aaron Tripp, provides an overview of key provisions of the American Rescue Plan Act (ARPA) of 2021 which offer the potential to make communities better places to grow older. ARPA provides an opportunity for states to build sustainable, person-centered systems and infrastructure for older Americans. These provisions aim to allow older Americans to age in their home and communities.

The provisions examined in the issue brief include addressing both long-standing and emerging needs of older adults for state government officials, including staff of Medicaid, aging, and housing and community development agencies; state legislators and their staff; and advisors to governors.

The ARPA funds are now available to states and local governments and will allow the development of better systems for older Americans. Key areas of opportunity outlined in the brief include

Building integrated data systems
Expanding affordable housing with services
Enhancing quality measurement and value-based purchasing models
Developing workforce recruitment and retention strategies
Ensuring access to internet services and assistive technology
Aligning Medicaid and Medicare services and payments
Creating ongoing structures to engage stakeholders in designing innovative and integrative approaches to meet community needs and monitoring their effectiveness over time

Case study examines Georgia’s experience unbundling LARC payments from Medicaid prospective payment system

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A new case study prepared by colleagues from Health Management Associates (HMA) analyzes the Georgia Medicaid program’s experience with unbundling long-acting, reversible contraception (LARC) devices and services from the Medicaid prospective payment system (PPS) for reimbursement in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

HMA examined Medicaid claims data from 2012-2019 as well as conducted key interviews to understand whether the unbundling reimbursement policy change could have increased LARC utilization and provided analysis for policymakers and stakeholders in other states pursuing similar strategies and programs.

Additional findings and the full report are available here.

HMA’s research was supported by Medicines360 and Waxman Strategies with support from Arnold Ventures. The HMA team included Rebecca Kellenberg, Diana Rodin, and Jim McEvoy.

HMA colleagues conduct environmental scan of NEMT benefit to Medicaid enrollees

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As part of a larger Medicaid and CHIP Payment and Access Commission (MACPAC) study on Medicaid non-emergency medical transportation (NEMT) in response to a request from the Senate Appropriations Committee, a team of HMA colleagues conducted a 50-state environmental scan of NEMT programs and stakeholder interviews to better understand approaches and trends in the provision of the NEMT benefit to Medicaid enrollees across the United States.

The culminating report included NEMT trends, challenges, and innovations drawn from the scan of programs and interviews with stakeholders including federal officials, Medicaid officials from six study states, NEMT brokers and providers, managed care companies, beneficiary advocates, and subject matter experts.

The key findings are outlined in the report and include information about:

NEMT populations and utilization
Various modes of transportation
NEMT delivery system model variations, advantages, and challenges
NEMT complaints, performance issues, and innovation
Performance improvement, oversight, and program integrity
Transportation network challenges and increasing role of transportation network companies
Coordination across federally assisted transportation services
Stakeholders’ view on the value and role of NEMT

In December 2020, following the completion of the interviews for this study, Congress added a requirement to the federal statute requiring states to provide NEMT to Medicaid beneficiaries who have no other means of transportation to medically necessary healthcare services.

The HMA team included Principals Sharon Silow-Carroll, MSW, MBA and Kathy Gifford, JD, Senior Consultant Carrie Rosenzweig, MPP, Consultants Anh Pham and Julie George, JD as well as retired Managing Principal Kathy Ryland.

The research underlying this report was completed with support from the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed are those of the authors and do not necessarily represent those of MACPAC.

HMA briefs on Medicare-Medicaid integration

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This issue brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)^[1]that meet full benefit dually eligible individuals’^[2] needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.

For a succinct overview of the essential elements and policy recommendations, please access the brief fact sheet. For a full discussion of the elements and policy recommendations, please access the full brief.

The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.^[3]

For further information or questions, contact Sarah Barth, Ellen Breslin or Samantha DiPaola.

[1] Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.

[2] Dually Eligible Individuals: When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.

[3] Narda Ipakchi was formerly a Senior Consultant with HMA.

HMA prepared issue briefs explore MLTSS impacts on state Medicaid programs

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In a recent pair of reports prepared for Arizona for Better Medicaid, HMA colleagues examined the impact of managed long-term services and supports (LTSS) in state Medicaid programs. The first report, Growth in MLTSS and Impacts on Community-Based Care, examines the historical increase in the adoption of LTSS by state Medicaid programs and how that has contributed to a shift in long-term care from institutions to the community. The second report, Managed LTSS Improves Quality of Care, describes the evidence on the impact of managed LTSS in state Medicaid programs on the quality of care.

Authors:
Principal Stephen Palmer
Senior Consultant Ashlen Strong
Senior Consultant Aaron Tripp

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