September 4, 2024
How States Are Shaping Medicaid Managed Care and Marketplace Participation
1022 Results found.
HMA fosters harm reduction from street to suite
HMA’s trusted experts have a wealth of harm reduction experience, from training volunteers for community outreach to managing state procurement processes for harm reduction tools, to policy analyses at all levels of government.
Our consultants have worked with stakeholders of all walks of life including people with lived and living experience of drug use, sex work, and homelessness. In fact, we believe in talking to them first to understand local needs and feasible solutions.
What is harm reduction?
The term “harm reduction” is often used to describe:
provision of risk reduction tools, like condoms, naloxone, and sterile syringes;
approach of meeting people where they are and supporting them at their own pace, without judgement, to pursue self-determined goals; and,
philosophy that promotes equitable access to resources for people who use drugs and struggle to meet basic needs due to the impact of social structures.
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as a practical and transformative approach that incorporates community-driven public health strategies — including prevention, risk reduction, and health promotion — to empower people who use drugs and their families with the choice to live healthier, self-directed, and purpose-filled lives.
The President’s National Drug Control Strategy is the first-ever to champion harm reduction to meet people where they are and engage them in care and services.
People are dying from drug overdose at an alarming rate in the U.S. For the fourth year in a row, we have lost over 100,000 people (enough to fill the University of Michigan stadium). Many of these deaths are preventable. Harm reduction interventions proven to stop overdose deaths include making the overdose reversal drug naloxone available to all at risk of overdose, reducing barriers to medications that treat opioid use disorder, and providing supervised drug consumption services for rapid overdose response. Moreover, successful harm reduction programs rely on reducing the stigma of drug use and people who have an addiction.
How HMA can help
Harm reduction is more than handing out naloxone or syringes; it’s a nonjudgemental approach that affirms participant autonomy and engages people in care over the long term.
Here are just a few services HMA can offer to help clients establish, expand, or improve services for people who use drugs, respond to overdose and infectious disease syndemics (combinations of two or more diseases or health conditions that interact within a population, often due to social and structural factors and inequities), and prevent the next drug crisis.
HMA provides training and technical assistance to a range of clients – from community-based organizations conducting outreach, to medical providers wishing to better serve their patients, to large hospital systems wishing to incorporate drug user health into their systems. HMA can:
- Plan, coordinate and evaluate learning collaboratives.
- Provide 1-1 coaching to staff and teams.
- Produce and implement industry-specific toolkits aimed at reducing overdose, like for construction businesses, restaurants or harm reduction vending machines.
- Train different audiences and teams, including youth treatment providers, primary care settings, and carceral settings, on harm reduction.
- Support startup of new naloxone distribution and/or syringe services programs and develop capacity building plans for program growth.
- Improve access to medications for opioid use disorder.
A quality improvement (QI) strategy is vital for healthcare organizations to maximize patient outcomes and satisfaction, achieve efficiency, and ensure compliance with regulations. HMA can:
- Apply established QI models to increase reach of harm reduction and drug user health services within community-based programs, government agencies, and provider programs and systems.
- Plan, assess, and evaluate QI efforts.
- Increase team buy-in for harm reduction as a QI initiative.
- Provide QI tools such as rapid assessment participant surveys, risk screeners, provider checklists, and guides.
Many funding opportunities require (or can benefit from) a detailed assessment of the community’s need for the services being funded. Our experts can help gather both quantitative data and qualitative stakeholder input to ensure that the client’s proposed plan targets the populations, communities, and gaps in service for which resources will be most impactful. HMA can:
- Conduct interviews and focus groups with people who use drugs and the service providers they interact with to identify local needs and solutions.
- Assess and predict drug user health syndemics using infectious disease and overdose metrics.
- Demonstrate trends among diverse populations, including youth and racial, ethnic, sexual, and gender minorities .
- Guide efforts to integrate harm reduction into a broader continuum of care, including prevention and treatment interventions.
The legal landscape related to drug use varies across communities and does not always facilitate a public health approach. HMA can:
- Identify policy options and facilitate choice of the most effective and feasible one for the client’s local context.
- Evaluate new or existing policies that impact people who use drugs such as Good Samaritan laws, opioid treatment program regulations, and criminal charges.
- Apply statistical methods to policy evaluation such as time-interrupted analysis.
Multi-sector collaboration is essential to develop sustainable, impactful solutions to reduce physical and structural harms related to drug use. HMA can:
- Facilitate workgroup-driven policy recommendations for expansion of behavioral health treatment and overdose prevention approaches such as safer supply.
- Design social media campaigns that center the voices of people most impacted by overdose.
- Strategize, create, and plan marketing and communications campaigns for harm reduction, stigma reduction, or program promotion.
- Facilitate community mobilization efforts and multi-sector alliances to generate and implement strategies for policy change.
- Build harm reduction resource libraries for stakeholder use.
HMA consultants work with clients to review program efficacy and cost efficiency based on process, outcomes, costs and more, considering quantitative and qualitative data sources and using data-driven tools to assess and measure impact. HMA can:
- Conduct environmental scans of jurisdictional resources to highlight opportunities for and threats to harm reduction programs .
- Build maps that overlay various metrics of drug user health, including infectious disease burden, overdose, and socio-economic indicators.
- Map overdose fatality and naloxone saturation to prioritize distribution efforts in areas of high-need.
- Conduct regression analysis to identify risk profiles and predictive values to evaluate impact.
Project Spotlight
Contact our experts:
Anika Alvanzo
Principal
Dr. Anika Alvanzo is a distinguished healthcare executive with over 20 years of experience in specialty addiction treatment, behavioral health … Read more
Jennifer Bridgeforth
Associate Principal
Jennifer Bridgeforth is a dedicated executive with more than 17 years of experience in the healthcare industry. She is a … Read more
Mayur Chandriani
Senior Consultant
An experienced non-profit manager, Mayur Chandriani is committed to programs focused on immigrant healthcare, maternal and child health and community … Read more
Tricia Christensen
Senior Consultant
Tricia Christensen is a harm reduction and drug policy expert focused on high impact relationship building and policy change to … Read more
Liddy Garcia-Bunuel
Principal
Liddy Garcia-Buñuel has the vision, passion and expertise to effect organizational and systematic change. She takes a collaborative approach. She … Read more
Rachel LaFlame
Research Associate
Rachel LaFlame, MPH, is a driven, early career professional interested in the intersection of public health and policy. She is … Read more
Nicole Lovitch
Research Associate
Nicole Lovitch is a skilled generalist researcher with extensive public health and healthcare experience. She has worked with clinicians, providers, … Read more
Trish Marsik
Principal
Trish Marsik has extensive experience supporting providers, healthcare organizations, and state and federal governments to provide quality behavioral healthcare. Prior … Read more
John O’Connor
Managing Director
John O’Connor is a seasoned executive with extensive management, program, strategy, media, fundraising and advocacy experience in dynamic foundation, corporate … Read more
Charles Robbins
Principal
Charles Robbins has been transforming communities for the past three decades. His extensive community-based organization career spans healthcare, child welfare, … Read more
Deborah Rose
Associate Principal
Deborah Rose is an experienced executive with a demonstrated history of designing and scaling new initiatives in the healthcare industry. … Read more
Erin Russell
Principal
Erin Russell is a dedicated harm reduction expert with an unwavering commitment to public health and equity. Prior to joining … Read more
Kate Washburn
Associate Principal
Kate Washburn is a public health and program leader with over 20 years of experience in both public health departments … Read more
Chris Wilks
Senior Consultant
Chris Wilks is a senior consultant for HMA. She manages long-term research projects and works closely with clients and project … Read more
Emily Wilson
Associate Principal
A multi-disciplinary public health leader, Emily Wilson is passionate about bringing people together to solve the most pressing problems in … Read more
Harnessing opioid abatement funds to prevent overdoses and enhance community care
This week, our In Focus section recognizes International Overdose Awareness Day (IOAD), August 31, by highlighting how states can use opioid abatement funds to mitigate the persistent overdose crisis in communities across the country.
In honor of IOAD, the August 2024 edition of HMA’s Podcast, Vital Viewpoints, features Erin Russell, a Principal at Health Management Associates (HMA), who discusses the importance of emphasizing harm reduction as a compassionate approach to drug policy. Meanwhile, this article addresses current gaps, opportunities, and strategies for applying opioid abatement funds to make further progress in addressing overdoses and the crisis.
Context for Opioid Abatement
Overdoses have claimed more than one million lives since the late 1990s, with more than 100,000 deaths occurring annually. Exacerbating the overdose epidemic and the racial and ethnic disparities in fatal overdoses are persistent inequities in access to evidence-based treatment, which extend to biases based on physical and/or mental ability, sexual orientation and gender identity, geographic location, and socioeconomic and housing status.
In 2021, nationwide settlements were awarded to resolve all opioid litigation that states and local subdivisions brought against pharmaceutical distributors and manufacturers, with subsequent agreements reached in 2022 against pharmacy chains and additional manufacturers. These historic opioid settlement agreements, which total more than $56 billion, will provide funds to state and local governments to address the crisis in their communities.
Policy changes and investments to address this epidemic remain critical. These approaches require careful consideration of the data and evidence-based strategies that are responsive to the crisis. In 2024, the US Department of Health and Human Services issued a rule that updates the regulations regarding the governance of opioid treatment programs; for example, removing barriers to the treatment of substance use disorder (SUD) and expanding access to care. The State Opioid Response and Tribal Opioid Response grant programs are another significant tool to improve prevention, expand treatment, and deliver free, lifesaving medications. Medicaid, including Medicaid managed care plans, also can be instrumental in supporting harm reduction strategies and enhancing access to addiction treatment and recovery support.
Opioid abatement funds offer states the opportunity to apply innovative solutions in response to the overdose epidemic. Despite their potential, however, HMA experts have identified significant opportunities across many states to effectively use available opioid abatement funds.
Opioid Abatement Funds and planning for Community Needs
Strategic planning processes allow state and community leaders to understand the needs of residents, examine current services offered and their existing strengths, and explore barriers to accessing care to make informed decisions about how the settlement funding can be used successfully. A strategic plan can assist in tracking progress and establishing a clear vision for an organization’s future and can yield a living document that guides the most advantageous use of the funds. HMA experts supported a strategic planning process for Carrabus County, NC, that identified strategies for designing, implementing, and evaluating tailored solutions for disbursing opioid abatement funds. The following are examples of approaches that are included in strategic plans for opioid abatement.
Sequential intercept model (SIM). SIM, one of the models used to support communities in building a stronger system of care, helps identify intervention opportunities with the highest potential for success based on a community’s strengths and needs. SIM maps out the stages of intervention to pinpoint gaps and opportunities, ensuring funding is used to address the most critical areas for improving community care systems, including those integrated within Medicaid managed care delivery systems (see Figure 1).
Figure 1: Sequential Intercept Model
Low-barrier/low-threshold recovery supports and treatment. The expansion of low-barrier/low-threshold recovery supports and treatment, including access to medications for opioid use disorder, is essential to reducing overdose deaths. States, local jurisdictions, and individual providers can redesign their treatment delivery systems to incorporate person-centered, low-barrier treatment access, including flexible scheduling and walk-in visits, same-day admission and medication initiation, and revision of clinic policies and procedures to eradicate practices that produce high barriers to treatment.
Though expanding low-barrier care in traditional treatment settings is an essential element of the response, implementation of nontraditional delivery modalities is another important target for using opioid abatement funds. Examples include:
- Emergency medical service (EMS)-initiated buprenorphine
- Medication units in unconventional locations (e.g., housing units)
- Mobile medication units and delivery of street/shelter medicine in which SUD treatment and services are brought to disenfranchised and marginalized communities.
Finally, the availability of opioid abatement funds can introduce opportunities for local governments to partner with community members, including people with both past and current lived experience, to design, implement, and disseminate culturally responsive and tailored SUD treatment and recovery support services, including services to address health-related social needs to mitigate barriers to treatment entry and engagement.
Continuous quality improvement (CQI) plans. Locales that receive opioid abatement funds have the opportunity to develop strategies to create transformational systemic change. Each entity should have an intentional CQI plan in place. Ensuring the presence of strong CQI processes can streamline and improve services, connect data to practice, and ensure interventions are progressively more effective.
Connect with Us
The upcoming HMA event, Unlocking Solutions in Medicaid, Medicare, and Marketplace, will offer more opportunities to engage with leaders across multiple sectors and industries advancing innovations in the design of mental health and SUD systems, value-based purchasing, and care strategies. Notably, state Medicaid and behavioral health directors, insurance commissioners, health plan executives, and community leaders, among others, will share insights into major initiatives under way in their states to manage ongoing crises in mental health and SUDs.
HMA has a strong, diverse bench to help communities maximize opioid abatement funds and build a stronger system of care. We provide technical assistance in large-scale initiative implementation, convening stakeholder groups, designing CQI strategies, developing planning documents, and facilitating strategic discussions. For more information about HMA’s work, contact our featured behavioral health experts below.
August 28, 2024
Harnessing Opioid Abatement Funds to Prevent Overdoses and Enhance Community Care
HMA believes “together we can” end the overdose crisis on IOAD
On International Overdose Awareness Day (IOAD), August 31st, communities worldwide come together to honor, without stigma, the people who have lost their lives to overdose. It’s a day for families to recognize their loved ones and for all of us to acknowledge the grief of family and friends who have experienced this loss. It’s also an opportunity to think critically about the programs and policies our communities need to finally put an end to the overdose crisis. In honor of this year’s IOAD theme, “Together we can,” HMA recognizes the power of community when we all stand together with a united goal of ending overdose.
Overdose can affect anyone. In the last twelve months alone, there were more than 100,000 reported overdose deaths across the U.S., and 42 percent of Americans now report they know someone who has died of drug overdose. More than ever, we need strong, multifaceted coalitions to shift the narrative around overdose and ensure we are using resources effectively to reduce harm, increase chances of overdose survival, and promote quality of life for people who use drugs, people in recovery, and the communities where they live.
HMA brings together people with lived and living experience, local community members, and public health professionals to plan, evaluate, and implement meaningful programs across the continuum of care to address overdose as the health crisis that it is. Our trusted subject matter experts have their own lived experience that influences HMA’s approach, and we strive to center the voices of people who are most impacted at every opportunity.
HMA is committed to helping clients prioritize effective solutions to the overdose crisis, which includes promoting services that are evidence-based and designed with robust input from community stakeholders. HMA supports naloxone distribution by engaging in street-based outreach, developing mapping tools for organizations to see the impact of their efforts in real time, and training healthcare providers on harm reduction. In 2024, HMA also hosted the Compassionate Overdose Response Summit to address questions about naloxone dosing and the long-term effects of precipitated withdrawal. HMA continues to be a leader in helping clients revolutionize treatment, particularly for priority populations such as children’s behavioral health and the justice involved. Earlier this year HMA led a webinar series called the Substance Use Disorder (SUD) Ecosystem of Care Webinar Series: Pivoting to Save Lives describing a whole person, integrated, solutions-based approach to the ongoing overdose epidemic. The series encourages leaders to reconsider standard attempts to solve this crisis and be willing to pivot away from approaches that have not yielded the level of impact that this crisis demands.
On IOAD, and every day, HMA stands united with the communities that are left behind to experience the long-lasting impacts of grief, and we celebrate the thousands of people who have experienced overdose and survived. Every overdose survival is another opportunity to uplift the strategies that work to save lives. We honor everyone impacted by overdose by using a community-led approach that encourages collective action to prevent, and ultimately end, all overdoses.
For more information on HMA overdose prevention services, visit our Harm Reduction solutions page or contact our featured experts below.
How Is Harm Reduction Redefining Recovery in Modern Treatment Approaches?
Erin Russell is a principal at Health Management Associates and joins our podcast to discuss the importance emphasizing harm reduction as a compassionate approach to drug policy. She shares her journey from volunteering at a syringe service program to becoming deeply invested in harm reduction, highlighting how these programs offer critical support and connections to treatment and reduce overdose deaths. Erin also explores the impact of drug policy on drug-related harms, advocating for the need to overcome stigmas that impede treatment.
This podcast is being released the same week as International Overdose Awareness Day (IOAD), which is observed on Saturday, August 30th. In honor of this important day, check out HMA’s special blog post highlighting the importance of harm reduction efforts in connection with IOAD at this link.
#TogetherWeCan #IOAD2024 #EndOverdose
Substance Use Disorder in California – A Focused Landscape Analysis
HMA found that the substance use disorder treatment system, which sits outside of specialty mental health and mild-to-moderate mental health services, results in an inconsistent and siloed system. The delivery of programs and services across the state vary because of differences in geography (rural, suburban, and urban densities) as well as county participation in the Drug Medi-Cal Organized Delivery System (DMC-ODS). This landscape analysis provides a deeper exploration into the challenges and opportunities specific to addressing substance use disorder.
The analysis was produced with support from the California Health Care Foundation.
Webinar Replay: 2025 Medicare Advantage Bids Are Over. Now What?
This webinar was held on September 5, 2024.
The Medicare Advantage (MA) market has had an eventful year, and the chaos is expected to continue. As plans begin their preparation for the upcoming 2026 Plan Year, what are the emerging trends in benefits, STARS, revenue optimization and the regulatory environment? Are you a Medicare Advantage health plan leader overwhelmed with all the changes in the industry? Check out this webinar for some helpful information.
Learning Objectives:
- Review recent high-level challenges in the MA market.
- Gain an understanding of several “hot topics” that MA plans should be thinking about as they begin planning for 2026.
- Learn from HMA experts on recommended actions for each of these topics
Improving healthcare for justice-involved populations: key insights on Medicaid Section 1115 reentry demonstrations
This week, our In Focus section considers state and local initiatives centered on the intersection of carceral care and state Medicaid programs.
The Health Management Associates (HMA) team includes clinicians and leaders who bring extensive expertise in justice healthcare, Medicaid, managed care, administration and operations, quality and accreditation, and information technology. Drawing on this wealth of experience, we provide five key insights for states, industry professionals, and other stakeholders aiming to improve healthcare access and related services for justice-involved populations.
Community Reentry: A Pivotal Point to Impact Health Outcomes
The Centers for Medicare & Medicaid Services (CMS) designed the Medicaid Section 1115 Reentry Demonstration Opportunity to improve access to community resources that address the healthcare and health-related social needs of people who are preparing to reenter their communities after incarceration. Medicaid enrollment assistance and prerelease coverage for certain services can help ensure successful care transitions during reentry. This demonstration allows states to provide Medicaid-reimbursable services up to 90 days before release from carceral facilities. These services include care management, behavioral health consultations, and peer support designed aiming to smooth the transition back into the community.
States and their partners are using these Medicaid regulatory flexibilities to develop—and eventually implement—programs that focus on the critical point of transition and reduce emergency department visits and inpatient hospital admissions for both physical and behavioral health issues once individuals are released and return to the community.
Recent State Activity Interest in Medicaid Reentry Initiatives
In July 2024, CMS approved Medicaid Section 1115 reentry demonstration proposals from Illinois, Kentucky, Oregon, Utah, and Vermont. These states join California, Washington, Montana, and Massachusetts in their work to develop the operational details and implementation plans to cover some services prior to release, increasing access to and continuity of care for returning individuals. According to HMA’s monitoring and analysis, another 13 states and the District of Columbia have reentry proposals pending CMS review.
Roles for Medicaid Partners
With 41 states, including the District of Columbia, using managed care for specific Medicaid populations, local and regional managed care organizations (MCOs) are integral to this landscape. The Medicaid Reentry Section 1115 Demonstration highlights the importance of early engagement with state partners and MCOs in preparing to serve the justice-involved population effectively.
By understanding these demonstrations and strategically developing their policy and operational plans, states and MCOs can enhance their services and improve outcomes for individuals transitioning out of carceral facilities. The continued focus on integrating comprehensive care models reflects a commitment to advancing the quality of healthcare for justice-involved individuals and ensuring their successful reentry into the community.
Key Considerations for States and Partners
CMS approval of state reentry demonstration proposals is the first of several critical steps required to improve access to services and health outcomes. Based on their real-world strategy, policy, and operational experience in Medicaid and correctional systems, the HMA team identified the following key considerations for states and their partners pursuing reentry initiatives:
- Successful reentry programs require breaking down longstanding silos and challenges in policy, funding, contracting, systems/IT, bias, and other aspects integral to reentry.
- All stakeholders will benefit from operationalizing best practices that use data metrics and reporting to demonstrate compliance with federal and state oversight and monitoring across carceral, public health, and Medicaid programs.
- State and local carceral facilities may need to change their contracts with healthcare vendors to meet contractual and quality standards and best practices, including, in some cases, transitioning to provision of care to public health systems and university partners.
- Build a team that will support successful state reentry programs. For example, government and their partners need expertise in the intersection of healthcare and correctional systems, skills in delivery system transformation, and knowledge of the publicly funded healthcare industry. The team will benefit from comprehensive experience with state prison systems, county and municipal jails, drug courts, and probation and parole, including implementing and coordinating medications for addiction treatment along a continuum of care in response to the substance abuse and opioid use disorder crisis facing communities nationwide.
- Prepare to collaborate with new entities that have a range of experiences and perspectives.
Connect with Us
The July 2024 edition of HMA’s Podcast, Vital Viewpoints, features a discussion with HMA Managing Director for Justice-Involved Services Linda Follenweider about her insights on this pivotal moment in carceral healthcare. Linda, an advanced practice registered nurse and board-certified family nurse practitioner, discusses the critical gaps in continuity of care for incarcerated individuals. She emphasizes how many people receive necessary medical care while in jail or prison but struggle to maintain these services upon release. The episode showcases the opportunities presented by adopting routine screening questions about incarceration history to ensure better health outcomes and resource utilization.
The upcoming conference, Unlocking Solutions in Medicaid, Medicare, and Marketplace, hosted by HMA, will offer more opportunities to engage with fellow executives, policymakers, and thought leaders across multiple sectors and industries advancing policy and programmatic innovations in carceral care and reentry. Notably, HMA experts Tonya Moore and Stuart Venske offer invaluable insights from their involvement in the development and execution of the CMS Section 1115 demonstration policies, including the reentry opportunity.
For more information about HMA’s work at the intersection of carceral care and Medicaid, contact our featured experts below.
August 21, 2024
Improving Healthcare for Justice-Involved Populations: Key Insights on Medicaid Section 1115 Reentry Demonstrations
State Approaches to Managing the Medicaid Pharmacy Benefit
Millions of Americans rely on Medicaid drug coverage to treat acute illnesses and manage chronic and disabling conditions. Though optional, all states provide pharmacy benefits under Medicaid but administer the benefit in different ways in accordance with federal guidelines. To better understand how states across the country administer the Medicaid pharmacy benefit, as well as states’ planned priorities and anticipated future challenges, HMA surveyed all 50 states and the District of Columbia in early 2024. A total of 46 states and the District of Columbia participated.
The report includes survey findings addressing a variety of topics including how states administer the pharmacy benefit and use of pharmacy benefit managers, state containment and utilization management strategies, payment and rebate approaches, value-based arrangements, planned policy changes, priorities and challenges in managing the pharmacy benefit in FY 2025 and beyond, and more. The HMA authors are Kathy Gifford, Aimee Lashbrook, and Constance Payne.
The report authors will also be discussing this paper and presenting their findings at a pre-conference workshop “Paying for Innovative Pharmaceuticals: State and Federal Trends Shaping Public Programs” at HMA’s Unlocking Solutions in Medicaid, Medicare, and Marketplace conference, October 7-9. Register today!