Navigate the world of Medicare with a world-class consulting team.
Payment systems, policy and legislative issues, benefits, coverage, operations, quality — Medicare stakeholders are faced with a dizzying array of challenges and decisions every day. That’s why HMA has a team of world-class consultants to help you, including former CMS officials and plan executives, payment system and coding experts, policy analysts, and many others. We can also draw on the resources of experts from our HMA companies to provide comprehensive and end-to-end solutions, including Wakely Consulting Group and Cirdan Health Systems and Consulting for actuarial services, and Leavitt Partners for political and policy engagement.
Together, we can give your organization a strong, actionable strategy for success in the Medicare policy arena and marketplace.
Meet some of our Medicare experts.
Our services: Making Medicare work better for everyone.
HMA provides a comprehensive suite of Medicare policy and operational services, informed by our vast experience in the areas of healthcare reform, Medicare payment systems and reimbursement policy, Medicare Advantage, dual eligibles, and prescription drug and biotechnology pricing.
Our comprehensive strategy services include:
- New CMS Medicare Advantage application assistance
- Development of Special Needs Plans (SNP) and their Models of Care
- Market assessments
- Product development
- Operations evaluation arriving at actionable outcomes
- Implementation assistance to address gaps and overall operational improvement
- Medicare Stars improvement strategies
- Implementation of critical operational functions and staffing models
- Audit support
In 2021, HMA acquired The Moran Company, widely recognized as experts in the design, implementation, and evaluation of healthcare payment systems, with a focus on Medicare. This expanded the depth and breadth of HMA’s capabilities, allowing us to better assist your organization with:
- Analysis of Medicare provider payment systems (inpatient hospital, outpatient hospital, physician fee schedule, ambulance fee schedule, etc.)
- Evaluation of new alternative payment models
- Development of novel payment concepts to propose to CMS and Medicare Advantage payers
- Modeling impacts of CMS payment changes
- Analysis and prediction of provider market changes
- Identification of new Medicare program reimbursement opportunities under value-based care
HMA provides highly sophisticated data analysis to help our clients develop policies, strategies, and tactical work plans to meet their business goals. We use a number of data sources, including Medicare-Medicaid Plan Encounter Data and a full suite of Medicare fee-for-service claims data to help our clients answer strategic questions.
Our data analysis services include:
- Analysis of Medicare claims data to provide information on patterns of care
- Analysis of future reforms to Medicare payment policy
- Replication of fee-for-service payment systems using Medicare claims data
- Customized data analysis to inform your organization’s unique challenges and decisions
If your organization is navigating Medicare, let us be your guide.
HMA’s Medicare team assists a wide range of healthcare clients, including:
- Medicare Advantage plans, including provider-sponsored and start-up plans
- Medicare Supplemental and Part D plans
- Hospitals, health systems, physicians, and other provider groups
- Post-acute, home-based, and community-based service providers
- Medical device, biomedical, and pharmaceutical companies
- Research foundations
- National, state, and local advocacy organizations
- Value-based care entities
Project example: How we helped a leading delivery system and its commercial health plan.
A leading delivery system was looking to start its own Medicare Advantage (MA) plan. HMA teamed up with them to:
Conduct a market assessment to determine opportunities for this line of business
Assist with the completion of their CMS MA application through the deficiency process
Complete an infrastructure gap analysis
Develop and monitor their implementation plan to address the gaps
Provide targeted SME assistance in areas such as sales
Conduct a readiness assessment before “go-live” to ensure the plan was ready to accept enrollment
Related insights from our experts.
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