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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Webinar

Webinar Replay – Health Performance Accelerator Webinar Series: Achieving Health Equity for Disadvantaged Populations

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This webinar was held on September 1, 2020.

Across the nation, an unprecedented focus is being placed on achieving the goal of health equity. This goal requires acquiring, aggregating, and analyzing data on social determinants of health to help identify and address the root causes of health disparities. During this webinar, experts from HMA and HealthEC provided a roadmap for how states, health plans, and providers can leverage data to support the design, development, and implementation of successful health equity initiatives.

Learning Objectives:

  • Understand why achieving health equity is an increasingly important goal for state Medicaid agencies, health plans and providers.
  • Learn how racial inequality and social determinants of health contribute to inequities in health care access, outcomes, and status.
  • Assess the readiness of states, health plans, and providers to address concerns over the impact of health equity on the morbidity and mortality or disadvantaged populations.
  • Understand the role of analytics and population health management in identifying the causes of health disparities and building successful health equity initiatives.

Speakers

Desmond Banks, MPH, PhD, Senior Consultant, HMA, Washington DC
Jennifer Leaf Jaeger, MD, MPH, MS, Health EC, Senior Medical Director

Blog

HMA Summary of Democratic Nominee Joe Biden’s Healthcare Plan

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This week, our In Focus section reviews Democratic Nominee Joe Biden’s healthcare plan to protect and build on the Affordable Care Act (ACA). On August 18, 2020, Biden was officially nominated as the presidential candidate. Biden vowed at the 2020 Democratic National Convention (DNC) that if elected, he would strengthen the ACA and provide a Medicare-like public option. HMA summarizes Biden’s official plan below.

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Webinar

Webinar Replay: National and State Strategies for Long-Term Care at Home

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This webinar was held on August 31, 2020.

The COVID-19 pandemic has created greater impetus for the growth of home-based care alternatives to hospital and institutional care. In this webinar, HMA experts provided a national overview of the trend toward home-based care and highlighted innovations in state policies, payer programs, clinical models, and payment models. Speakers also took an in-depth look at California’s new LTC at Home benefit.

Learning Objectives:

  • Understand how the pandemic is spurring new interest and growth in home-based alternatives to institutional care.
  • Identify trends among home health and home care providers in the era of COVID-19.
  • Learn about promising state and payer initiatives for promoting home-based long-term care (LTC)
  • Explore the details and ramifications of California’s new LTC at Home benefit.

HMA Speakers

Karen Brodsky, MHS, Principal, New York
Jody Gastfriend, LCSW, Principal, Boston
Barry Jacobs, Psy.D., Principal, Philadelphia
Jason Silva, JD, Senior Consultant, Sacramento

Materials Referenced in this Webinar

Continuum of Care Table
​​​​​​​​​​​DHCS Long-Term Care at Home​

Blog

HMA Summary of Medicare Fee-For-Service (FFS) Proposed Rules

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This week, our In Focus section reviews two Medicare fee-for-service (FFS) proposed rules recently issued by the Centers for Medicare & Medicaid Services (CMS). On August 3, 2020, CMS released a proposed rule that includes updates to services furnished under the Medicare Physician Fee Schedule (PFS). On August 4, CMS released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. These proposed regulations include payment rate and policy changes for the upcoming calendar year. Key features in this year’s PFS proposed rule include: policies to retain, extend, or end certain telehealth flexibilities implemented in response to the novel COVID-19 public health emergency (PHE), changes to enable certain health care professionals to practice at the top of their licenses, modifications to opioid treatment programs (OTPs), and updates to the Medicare Shared Savings Program (MSSP). Additional information on the PFS Proposed Rule can be found here. Among the most notable policy changes in the OPPS and ASC proposed rule are: 1) transitioning services to lower cost settings by eliminating the inpatient-only list to enable more services to be provided in the outpatient settings and increasing the scope of procedures that can be provided in ASCs, 2) further reducing payments for the 340B drug program, and 3) modifying the formula for calculating Hospital Star Ratings, and expand the use of prior authorization for outpatient services. Additional information about these proposals can be found here.

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Brief & Report

HMA examines current state of Medicare-Medicaid integration programs

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The experts at Health Management Associates (HMA) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.

Based on HMA’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.

HMA colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.

For the next phase of research, HMA will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.

The project was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.  

Blog

Regulatory Changes to Medicare in Response to COVID-19

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This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.  As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.

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Brief & Report

HMA releases COVID-19 Medicare regulation tracking tool

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The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, HMA, commissioned by The Commonwealth Fund and The SCAN Foundation, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.

HMA Senior Consultant Jennifer Podulka and Managing Principal Jon Blum led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief Regulatory Changes to Medicare in Response to COVID-19 and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.

The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.

Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.

These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.