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From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

Hospitals across the country are facing unprecedented levels of behavioral health (BH) challenges that impact every facet of operations, from the emergency department to discharge planning. Extended lengths of stay, ED boarding, workplace violence, and staff burnout present clinical issues and pose operational, financial, and reputational risks.

Individuals with BH needs arrive in emergency departments daily, even if the hospital lacks a dedicated BH inpatient unit. These patients require coordinated care across all clinical sites.

HMA offers an end-to-end partnership helping hospitals identify and implement solutions in ways that build internal capacity and deliver measurable results.

Rapid assessments to identify high-impact opportunities

Financial modeling and reimbursement optimization

Strategic and operational planning for BH integration

Partnership development and M&A advisory for BH service lines

Implementation support with measurable results

Effective Strategies

HMA partners with hospitals to address these challenges with a vision of improving care and operations. Our team offers practical, high-impact solutions that enhance patient care, support your workforce, streamline operations, and promote financial stability. Contact us to discuss how solutions can be tailored to your hospital鈥檚 unique needs. Let鈥檚 address your most urgent behavioral health challenges now, before they impact care delivery and financial stability.

Six Priority Areas

While every hospital faces unique behavioral health challenges, the pressures they create are consistent. HMA partners with your leadership and frontline teams to focus on six proven priority areas that create lasting impact. Together, we develop solutions that improve care, strengthen operations, and build resilience across your organization.

Rapid stabilization protocols
Integration of psychiatric expertise into acute care workflows
Boarding reduction strategies

Value: Reduce length of stay, improve throughput, and protect staff safety.

Cross-continuum care pathways
Partnerships with community providers
Readmission prevention frameworks
Accreditation readiness (The Joint Commission, DNV (Det Norske Veritas))

Value: Improve continuity, patient satisfaction, and reduce high-cost utilization.

Optimizing reimbursement (e.g., unbundled billing for injectables)
Service line financial assessment

Value: Unlocking new revenue streams.

Joint ventures with behavioral health providers
Sell-side preparation and merger and acquisitions support
Community and payer alignment

Value: Expand service capabilities while sharing risk and resources.

Staffing models to provide effective and efficient care while reducing burnout
Data-driven performance management
Technology-enabled workflows

Value: Increase efficiency and retention through optimized operations.

Medication Assisted Treatment (MAT) and Medication for Opioid Use Disorder (MOUD) implementation in ED and inpatient settings
Peer navigation programs
Integration with primary and specialty care

Value: Reduce mortality, avoidable readmissions to EDs, and improve community health outcomes.

Proven Results

Our work with hospitals across the country delivers measurable, lasting improvements that strengthen care delivery, operational performance, and financial health.

Reduced ED boarding times by up to 40% through targeted intervention models.
Increased reimbursement for behavioral health 杏吧视频 by optimizing billing practices for long-acting injectables and other high-value 杏吧视频.
Delivered $1.2M in annual savings for a regional hospital through integrated behavioral health response planning.

HMA Differentiators

Many of our team members are former executives and clinical leaders from the behavioral health sector. They bring decades of experience leading behavioral health care in inpatient, outpatient and emergency department settings. HMA provides the depth, agility, and collaborative approach that hospitals need to address today鈥檚 most urgent behavioral health challenges while also building capacity for the future. Our proven track record includes hospitals of all sizes and structures, ensuring that solutions are tailored to your market, patient mix, and resources.

ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations

Applied Behavior Analysis (ABA) is an evidence-based behavior therapy for people with autism spectrum disorder (ASD) and other developmental disorders. In recent years, the diagnosis of ASD and subsequent demand for ABA 杏吧视频 has increased. State Medicaid administrations and Managed Care Organizations (MCOs) are tracking increased ABA utilization and wait times for these 杏吧视频, and in some situations are investigating quality of care and/or fraud, waste, and abuse (FWA) concerns. To optimize quality care for members, MCOs who cover these 杏吧视频 must have policies regarding ABA benefit structure, clinical guidelines, utilization management, and service delivery. Plans also need to monitor for and identify possible FWA concerning documentation and/or billing practices for these 杏吧视频. MCOs with comprehensive ABA compliance and auditing programs can meet these critical needs.

Our team

HMA鈥檚 national presence keeps us at the forefront of ABA-related changes in multiple states. HMA鈥檚 team of behavioral health clinicians have years of experience conducting FWA audits and have specific training required to conduct detailed and meticulous ABA reviews. Our team includes operational and clinical subject-matter experts with board certifications in behavior analysis (BCBA, RBT) who can support auditing activities as well as policy review and revision. We will work with your organization鈥檚 team to provide the insights necessary to maximize ABA quality of care and cost efficiency.

How HMA can help

We work closely with MCOs to develop a customized scope of 杏吧视频 that meet their unique ABA compliance, policy, and strategy needs.

We can help MCOs with:

Establishing their own ABA compliance programs
Conducting audits of ABA provider claims and associated medical records, using customized audit tools and findings reports, to identify potential FWA, including as part of an MCO鈥檚 Special Investigation Unit (SIU) program
Reviewing and providing feedback on ABA-related policies
Developing ABA-related documentation forms
Providing consultation on ABA reimbursement/utilization benchmark development
Providing support in building cohesion/collaboration between MCO and local Department of Developmental Disabilities representatives
Developing strategies to improve care coordination for youth transitioning to adulthood
Assisting MCOs with their Managed Behavioral Healthcare Organizations (MBHO) benefit oversight
Demonstrating how to maximize the interface of organizational Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefits and the intersection with ABA 杏吧视频

We produce results

Our auditing team members have supported the SIUs of three Medicaid health plans in different states. We have demonstrated a 12:1 return on investment for our clients, based on associated recoupment of improper payments and estimated prevented loss.

If you have questions about our ABA compliance, policy, or strategic support 杏吧视频, contact our experts below.

ABA Auditing Services听Case Study

Contact our experts:

Nicole Lehman

Associate Principal

Nicole Lehman is an experienced healthcare professional specializing in the improvement, development, and growth of multifaceted, high-paced managed care organizations. … Read more

Tim Mechlinski

Managing Director

Tim Mechlinski is the Managing Principal of Crestline Advisors. Tim is a well-rounded health care management consultant with experience in … Read more

Shannon Walters

Associate Managing Director

Addressing Behavioral Health Needs in an Aging Population

America鈥檚 healthcare and behavioral health systems are not adequately supporting the mental health and substance use needs of older adults. Unless improved with targeted and innovative policies and operational changes, those systems will do an even poorer job in the immediate future as our country rapidly ages. The result will be an increased number of older adults with untreated mental health disorders, cognitive disorders, and/or substance use disorders, increased rates of hospitalization and institutionalization, and vastly increased care costs.

Available statistics make clear the challenges:

The number of older adults in this country is expected to grow from approximately 56 million in 2020 to 85 million in 2050. Without substantial breakthroughs in treatment and prevention, the number of older adults with diagnosable mental disorders will increase from about 11 to 17 million and those who misuse alcohol and other drugs will increase from 2 to 3.5 million.
During those three decades, the number of Americans with dementia will also nearly double from 7 to 13 million. Many of these elders will have co-occurring behavioral health conditions, such as depression, anxiety, psychosis, and behavioral disturbances which will greatly strain family resources and coping.

If present performance is any predictor of the future, our systems of care now in place will not be able to handle the coming needs. Today fewer than half of older adults with mental or substance use disorders get any treatment at all because of limited-service capacity and access. Much of the care that is provided comes from medical and behavioral health providers without specific training or experience in older adult mental health and substance use disorders. The so-called digital divide鈥攊n which many older Americans are uncomfortable with telehealth or lack the equipment or bandwidth to use it鈥攄isproportionately impacts those with behavioral health disorders who live in rural communities and/or have limited economic means.

To adequately care for these vulnerable older adults, our approach and systems must change. That will require increased attention, investment, and thoughtful planning. Fortunately, there is clinical, operational, and policy expertise available to guide what will necessarily be a decades-long effort.

How HMA can help

HMA works with a range of clients. We work with federal, state and local governments, trade associations, provider organizations and community-based provider organizations (CBOs), delivery systems, managed care organization (MCO)听plans, and philanthropic funders, to design, implement, and sustain effective models and systems of care for older adults with mental health and substance use needs.

We bring together a cross-sector, multidisciplinary team of experts in older adults鈥� needs and mental health and substance use focused on strategy, policy, clinical, operations, and finance systems. Our team members have rich backgrounds across government, payers and provider systems. We understand our clients鈥� needs because we鈥檝e been in your shoes.

Workforce & Capacity Building

Workforce planning: embedding peers, age-friendly training鈥嬏�
Identify and implement caregiver support鈥� models
Develop mental health/substance use and aging coalitions

Policy, Planning & System Redesign

Plan state and local policy and system redesign鈥�
Incorporate mental health and substance use in multi-sector plans on aging and age-friendly communities鈥�
Build age friendly systems of health and mental health/substance use care

Integrated & Specialized Care Models

Establish integration models within and between systems听
Implement care coordination/care transition models, including post-acute care
Develop housing models that integrate mental health and substance use care鈥�
Establish specialized models of care for older adults with serious mental illness and/or substance use disorders

Evidence-Based & Preventive Interventions

Embed evidence-based practices for older adult mental health and substance use needs
Design suicide prevention and crisis systems that supports older adults
Integrate psychoeducation for older adults鈥� and their families

Financing & Technology Infrastructure

Design financing and optimization鈥� of revenue models
Embed tech-enabled care solutions

Provider Access

Conduct workforce planning, including age-friendly training
Identify and implement caregiver support models
Design financing and optimization of revenue models

Discrimination and Awareness

Provide psychoeducation for older adults and their families

Service Access

Plan state and local policy and system redesign
Establish integration models within and between systems 听
Implement care coordination/care transition models, including post-acute care
Incorporate mental health and substance use in multi-sector plans on aging and age-friendly communities听
Build age friendly systems of health and mental health/substance use care
Embed tech-enabled care solutions

Recent Project Examples

Strategic planning

An Area Agency on Aging (AAA) hired HMA to assess the needs of its client population and develop strategies to enhance behavioral health 杏吧视频 and supports. The mental health and substance use needs of older adults, and especially those with both Medicaid and Medicare are among the highest. Through this project, the AAA focused on finding ways to expand service access to older adults. HMA prepared several recommendations to contract with health plans to help older adults access behavioral health 杏吧视频.

Multi-sector plans on aging development

A county hired HMA to help develop a multi-sector plan on aging. Multi-sector plans on aging provide an opportunity to address the unmet mental health and substance use needs of older adults. HMA analyzed relevant assessments and plans and facilitated broad community engagement to help shape the development of the plan.

Skilled nursing facilities practice improvement

A state health department hired HMA to enhance the quality of care of skilled nursing facility residents with substance use disorders. Many residents, including older residents, of nursing homes have unidentified and untreated substance use conditions. HMA delivered on-site technical assistance, in-person staff training, policy and procedure development, community partnership building, and regional forums to foster shared learning.

Affordable housing with integrated 杏吧视频 sustainability

A long-term care trade association hired HMA to develop a braided financial and partnership service model to integrate health, mental health and social 杏吧视频 to support aging in place. Integrated service and financial models can better support the often co-occurring physical, mental, and social needs of older adults. HMA conducted stakeholder engagement, service gap analysis, and strategic alignment to support the development of a sustainable service model.

Post-acute care guide

A state-level hospital association hired HMA to support its hospitals and their staff on post-acute care transitions. Post-acute care transitions are critical to ensuring that older adults have a successful recovery. These transitions are important for preventing complications after leaving an acute care setting like a hospital. The association hired HMA to create first-of-its-kind post-acute care (PAC) guides to support clinicians and family members to find post-acute care resources to address behavioral health needs.

Rural access to 杏吧视频 for older adults

A foundation hired HMA to improve access to integrated care for older adults who were dually eligible for both Medicaid and Medicare. Older adults residing in rural communities have poorer access and outcomes than their urban peers. HMA created a toolkit of actionable solutions for state policymakers to address older adults鈥� mental health needs and social isolation conditions in rural communities.

Contact our experts:

Ellen Breslin

Principal

A seasoned consultant, Ellen Breslin draws upon her nearly 30 years of experience and expertise in health policy, with a … Read more

Barry J. Jacobs

Principal

Dr. Barry J. Jacobs is a noted clinical psychologist and family therapist whose passion for enhancing support for family caregivers … Read more

Patrick Meadors

Associate Principal

An expert in psychological processes and systems thinking, Patrick Meadors is a licensed marriage and family therapist with over 15 … Read more

Kim Williams

Principal

Kim Williams is an experienced executive, policy leader and social worker with a record of transformational growth, accomplishment, and innovation … Read more

Supporting real-time strategic decision-making across the leadership team

HMA was recently contacted by a chief strategy officer of a healthcare company with dominant market share struggling to react to the rapid changes in healthcare policy. His CEO was regularly asking him for updates, and he knew he needed a proactive construct for understanding, reacting, and ultimately shaping the environment. Could we help him build the capability to monitor those changes within the company鈥檚 strategy function? 听

As organizations operate within our highly turbulent policy environment, strategy leaders are well served to consider how they source and socialize the information that sustains strategic decision-making.

While every company is different, strategy leaders should monitor the following:

Regulatory and policy realities

Existing and potential competitive offerings

Market and client needs

Organizational assets and competencies

Formal and informal relationships

These are the ingredients for developing and validating hypotheses for market growth 鈥� a critical function of the strategy office. However, just as important as monitoring this information is socializing it across the leadership team.

On one recent HMA strategy project, the executive team of an association listened soberly as we described their direct competitor. The competitor was growing rapidly and winning over long-time members of the association. They had a small, nimble team, in contrast to the association鈥檚 cumbersome and complex governance structure. As we rehearsed the sentiments of their members, the needs in the markets, their partnerships, their offerings, and the shifting policy environment, we painted an up-to-date picture of their market realities. Their reaction was almost explosive: they had to take action to stem their eroding position.听

By socializing fact-based information, a strategy leader can create the tailwinds for action within an organization. The leader can also ensure that those who need to ratify or support strategic action understand the rationale for change. We think of strategically viable actions as being grounded in the domains above. For example, does the action take advantage of policy opportunities, avoid areas of dense competition, address demonstrated need, and leverage organizational capabilities and relationships? If those blessing the decision understand these same considerations, it will be easier to get to yes.

If you sit in a chief strategy seat, consider building the capability to monitor these domains, and surface your fact-based findings to organizational decision-makers. This information should be the bedrock for strategic decision-making鈥攁nd strategy leaders will find it easier to secure board and executive support if those audiences are grounded in the same set of facts.

Ready to transform your organization?

Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through听implementation.

Related Resources

Learn more about our Strategy & Transformation 杏吧视频

Achieving financial resilience in a time of turbulence

Realize transaction-related cost synergies

Building Sustainable Health Systems

HMA鈥檚 Strategy & Transformation Practice collaborates with Stanford University to drive public health innovation

CMS Shakes Up the Innovation Center Model Landscape: What Comes Next?

How One Organization Unlocked Exceptional Financial Gains Through Revenue Cycle Optimization

Contact our experts:

Rebecca Nielsen

Managing Director

Rebecca Nielsen is a managing director of HMA鈥檚 strategy and transformation practice, where she designs and leads major strategy and … Read more

Alex Rich

Managing Director

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more

Realize transaction-related cost synergies

In the current policy environment, we anticipate increased consolidation in various subsectors due to financial and regulatory headwinds. Organizations can take intentional steps pre- and post-integration to realize cost synergies.

HMA Strategy & Transformation consultants advise organizations in their integration activities, and find it valuable to conduct the following sequence of steps:

Map the operating model pre-close to understand organizational structure, systems, contracts, and key processes across both entities.

Identify risks and quick wins before close鈥攊ncluding staffing gaps, system incompatibilities, or duplicative vendors.

Design a Day 1 plan to keep operations stable, align communication, and ensure continuity for staff, patients, and partners.

Stand up integration teams post-close to drive workstreams across finance, IT, HR, and clinical operations with clear timelines and ownership.

Track synergies and milestones to measure progress, course-correct where needed, and deliver the operational and financial goals of the deal.

A thorough, objective mapping is recommended, to investigate whether to cultivate in-house capabilities or maintain vendor relationships. Considerations include in-house capacity, contracted rates, and the flexibilities and risks associated with outsourcing. We recommend identifying favorable terms in existing vendor contracts that can be leveraged in enterprise-wide contracts.

Although there are internal and external pressures to move aggressively towards transaction deadlines, ensuring that appropriate pre- and post-close activities take place is key.

Ready to transform your organization?

Related Resources

Learn more about our Strategy & Transformation 杏吧视频

Achieving financial resilience in a time of turbulence

HMA鈥檚 Strategy & Transformation Practice collaborates with Stanford University to drive public health innovation

CMS Shakes Up the Innovation Center Model Landscape: What Comes Next?

Building Sustainable Health Systems

How One Organization Unlocked Exceptional Financial Gains Through Revenue Cycle Optimization

Contact our experts:

Rebecca Nielsen

Managing Director

Rebecca Nielsen is a managing director of HMA鈥檚 strategy and transformation practice, where she designs and leads major strategy and … Read more

Alex Rich

Managing Director

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more

Achieving financial resilience in a time of turbulence

Healthcare business leaders face significant policy and regulatory headwinds. Ensuring that your organization is financially resilient to weather the storm should be a priority. Achieving financial resilience enables leaders to preserve core functions and staff. We鈥檝e found that indirect costs are often overlooked and undermanaged and represent an opportunity to build margin (think overhead and administrative costs such as vendor spend).

HMA can help identify cost savings

We find it useful to conduct the following sequence of steps:

Review / categorize all vendor spend to find areas with unnecessary costs, overlapping 杏吧视频, or outdated pricing.

Analyze contracts line -by -line to identify where terms can be improved or where the scope no longer fits current needs.

Stack rank initiatives by risk levels and speed.

Negotiate directly with vendors to lower rates, adjust service levels, or consolidate under better pricing structures.

Monitor results and vendor performance to ensure savings hold over time and 杏吧视频 stay aligned with operational needs.

In assessing indirect costs, we visually depict areas of cost reduction by risk of disruption to support client decision-making. There is often a locus of opportunity that can be trimmed with little or no impact to the core business.

As you prepare to batten the hatches, consider assessing indirect costs. Even if the storm isn鈥檛 fierce, conducting this work will give you improved real options for optimal decision-making.

Ready to transform your organization?

Related Resources

Learn more about our Strategy & Transformation 杏吧视频

HMA鈥檚 Strategy & Transformation Practice collaborates with Stanford University to drive public health innovation

CMS Shakes Up the Innovation Center Model Landscape: What Comes Next?

Building Sustainable Health Systems

How One Organization Unlocked Exceptional Financial Gains Through Revenue Cycle Optimization

Contact our experts:

Rebecca Nielsen

Managing Director

Rebecca Nielsen is a managing director of HMA鈥檚 strategy and transformation practice, where she designs and leads major strategy and … Read more

Alex Rich

Managing Director

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more

Building Sustainable Health Systems

Today鈥檚 healthcare leaders are navigating an era of accelerated disruption. Traditional hospital models are under intense pressure from rising costs, workforce shortages, changing reimbursement landscapes, and shifting community expectations. Hospitals and health systems are increasingly challenged by issues that affect multiple areas of the business from strategy to fiscal management to clinical operations.

Financials & Revenue

Workforce

Improving Health Outcomes

Strategic Partnerships

Technology & Digital Innovation

OUR COMMITMENT

We empower hospitals by guiding transformational decisions 鈥� protecting legacy, stabilizing operations, and building the future of healthcare, one courageous step at a time. Our HMA Delivery Systems team works with hospitals, health systems, federally qualified health centers (FQHCs) and associations to support their strategy, clinical 杏吧视频, operations, finance, and value-based care needs. Let us know how we can help your organization.

Five Critical Priorities for Transformation

Financial Reinvention and New Revenue Models

Optimizing operational efficiencies, increasing price transparency, and diversifying revenue through innovations like hospital-at-home.

We offer board- and CEO-level financial, operational, and strategic assessments and tailored scenario planning to evaluate service realignment, restructuring, and sustainable growth.

Workforce Resilience and Sustainability

Investing in staff retention, interdisciplinary team redesign, leadership development, and pipeline programs to stabilize care delivery and safeguard institutional knowledge.

We support clients with strategic workforce planning, interdisciplinary team optimization, and leadership development frameworks to future-proof talent pipelines.

Expanding Access and Improving Health Outcomes

Advancing accessible, high-quality care and strengthening community loyalty.

We guide the development of community health investment strategies, trust-building frameworks, and initiatives to foster patient and stakeholder loyalty.

Strategic Partnerships and Ecosystem Building

Building alliances across systems, payers, technology firms, and community organizations is essential to expanding reach, managing risk, and accelerating innovation.

We bring expertise in strategic partnership development, merger and affiliation exploration, and collaborative ecosystem strategies.

Technology and Digital Innovation

Deploying technology and AI automation to streamline workflows, enhance patient experience, and lower costs is now a competitive imperative.

We partner with hospitals to develop tailored technology enablement roadmaps鈥攊ntegrating digital solutions aligned with operational goals and future-state visions.

Who We Help

We offer a full suite of professional health and human 杏吧视频 consulting 杏吧视频 to clients serving hospitals and health systems, such as:

Critical access and PPS hospitals

FQHCs, rural health clinics, & provider practice groups

Health plans

National, regional and statewide associations

Federal, state, & local governments

Tribal nations & tribal health organizations

Community based organizations

Foundations

Contact Our Experts:

Warren J. Brodine

Managing Director, Delivery Systems

Warren Brodine partners with communities, federally qualified health centers (FQHCs), and payors to deliver optimal patient and community outcomes, supporting … Read more

Rob Ross

Managing Director, Delivery Systems

An experienced healthcare executive, Robert Ross is dedicated to developing solutions to provide quality, accessible, cost-effective care while ensuring the … Read more

Supporting Medicaid Dental Benefit Administrators: Oral health and dental care are vital for the health of communities听

Whether performing under risk-based prepaid ambulatory health plan (PAHP) contracts or non-risk (administrative service organizations), Medicaid dental managed care organizations (MCOs) and dental benefit administrators (DBAs) face the same challenges as Medicaid MCOs, and state Medicaid agencies, including but not limited to:

– Getting into and staying in compliance with state regulatory and contract requirements
听
– Understanding and responding to new federal and state rules and regulations
听
– Growing market share including success in state procurements, in MCO solicitations for DBAs, and attracting and retaining enrollees

– Improving utilization to meet quality measure targets, medical loss ratios, and margin expectations including increased utilization of preventive oral health care, and decreased utilization of unnecessary care such as avoidable emergency room care for dental diagnoses

– Excelling in benefit administration operations including member 杏吧视频 and engagement, provider network development and provider 杏吧视频, claim/encounter administration, reporting, and other functional areas
听
– Managing financial risk including developing or validating capitation rates and developing value-based payment arrangements

The importance of oral health and dental care

Oral health is integral to the overall health and quality of an individual鈥檚 life, and lack of access to oral health care negatively impacts entire populations.

Tooth decay affects 90% of adults 20 to 64 years of age and costs the U.S. about $45.9B in lost productivity in 2015. This frequently results in visits to hospital emergency rooms where care is often palliative but does not treat the root cause of problems¹

Gum disease affects almost 50% of adults 45 to 64 years of age and is a risk factor for nearly 60 other adverse health conditions, including Alzheimer鈥檚 disease, diabetes, and heart disease²

More than half of working-age adults living in poverty have untreated caries (52%), whereas only 1 out of 5 adults with incomes of twice the federal poverty guideline or higher have untreated caries (20%)³

Tooth decay is preventable but impacts nearly 46% of U.S. children. Left untreated, tooth decay can cause chronic pain, impaired development, disfiguration, and social isolation. In severe cases, bacteria from a tooth infection can even travel to the brain and cause death. Caries disproportionately affect children who experience poverty, belong to certain racial and ethnic groups, or are affected by other social factors⁴

OUR EXPERTISE

At HMA, our consultants have led MCOs, state Medicaid agencies, and include senior officials from Medicare, directors of large nonprofit and social 杏吧视频 organizations, top-level advisors, C-level executives at hospitals, health systems and health plans, and senior-level physicians. We know that oral health, access to dental care, and oral health literacy play a vital role in the health of communities supported by Medicaid MCOs. HMA can support the work that DBAs do and the challenges they face in the changing Medicaid environment.

How HMA can help

HMA has decades of experience working with Medicaid MCOs, DBAs, state Medicaid agency dental policy makers, and oral health providers. HMA can:

Provide actionable insights into new federal and state regulations and guidance to help clients understand potential impacts and opportunities for their business. We assist clients to determine what must be done, what can be done, and develop recommendations for what should be done, and to implement those activities. DBAs are frequently performing as PAHPs and are subject to many of the federal rules related to interoperability, prior authorization, access, and eligibility that apply to Medicaid MCOs. HMA provides our Medicaid provider and payer clients with analyses about those rules, which could also benefit DBAs.

Perform validation and compliance support to help clients identify and address any compliance gaps and support clients in validating their own compliance with any state or MCO imposed Corrective Action Plans. We also support clients to grow and strengthen their own capabilities and infrastructure to perform these functions.

Support client growth with end-to-end procurement assistance, including market conditioning and strategy, writing, mock scoring, orals preparation, implementation, and operations stabilization assistance; and with market analysis.

Support delivery system, reimbursement, and provider network design by conducting research and analysis on oral health delivery system approaches, provider reimbursement structures, coverage, and access trends.

Identify, assess, and help implement best practices in oral health care programs related to special populations, including children鈥檚 access to oral health care and dental access in rural communities.

Support quality improvement and utilization management initiatives that increase appropriate and desired utilization and curb inappropriate utilization. This can include help achieving Healthcare Effectiveness Data and Information Set (HEDIS) measure goals and developing oral health literacy programs, achieving accreditation, developing and implementing Performance Improvement Plans (PIPs), and conducting data analysis to understand utilization and evaluate the impact of program changes on utilization.

Provide actuarial 杏吧视频 in support of benefit and program design, capitation rate development, and capitation rate validation.

Design and evaluate value-based payment models that tie provider payments to quality and value.

Project spotlight

Minnesota Medicaid Dental Program Study

The 2021 Minnesota Legislature directed the Department of Human Services (DHS) to conduct a review of Medicaid dental program delivery systems in states that have enacted and implemented a 鈥渃arve out鈥� dental delivery system. This legislation also directed DHS to conduct an analysis of dental provider hesitancy to participate in the Medical Assistance (MA) program as an enrolled provider. DHS contracted with HMA to conduct the analyses mandated in the legislation. HMA reviewed the Medicaid dental program delivery systems in states that have implemented a carve-out dental delivery system, including comparing state program designs, program costs and rates where available, and quality metrics for children one through 20 years of age with at least one preventive dental service within a year. HMA also surveyed dental providers to better understand hesitancy to participate in Medicaid and opinions on policy approaches to improve provider participation.
The final report, available at , described the analysis of state dental carve-out experiences and the dental provider survey results.

Contact our experts:

Sarah Arvey

Associate Principal

Sarah Arvey is a trained medical anthropologist and qualitative researcher with expertise in the impact of social determinants, cultural norms, … Read more

Rebecca Kellenberg

Principal

Rebecca Kellenberg specializes in assisting public and private health care organizations with Medicaid and CHIP policy analysis and implementation. With … Read more

Beth Kidder

Managing Principal

Beth Kidder is a transformative and innovative health care leader with more than 20 years of experience working within the … Read more

Stephen Palmer

Managing Principal

Stephen Palmer, PhD has a broad range of expertise and skills, which enable him to easily join most types of … Read more

Caroline (Carrie) Rosenzweig

Principal

Carrie Rosenzweig is an experienced consultant specializing in health policy analysis, qualitative research, grant writing, and project management. Her research … Read more

[1] Oral Health in America – April 2022 Bulletin, National Institute of Dental and Craniofacial Research, accessed 4/1/2025,

[2] Oral Health in America – April 2022 Bulletin, National Institute of Dental and Craniofacial Research, accessed 4/1/2025,

[3] National Institutes of Health. Oral Health in America: Advances and Challenges. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2021,

[4] Big Hopes for Little Teeth, National Institute of Dental and Craniofacial Research, accessed 4/1/2025,

HMA helps support Section 1115 Demonstration initiatives across the country

Section 1115(a) demonstrations, informally known as 1115 waivers, are experimental, pilot, or demonstration projects that give states flexibility to design, test, and evaluate state-specific approaches to improve their healthcare programs and better serve eligible populations.

Approved by the Centers for Medicare & Medicaid Services (CMS), 1115 demonstrations provide alternative options to provide access, coverage, financing, and delivery of 杏吧视频 under the joint federal-state funded programs Medicaid and the Children’s Health Insurance Program (CHIP). Across multiple administrations, HMA has helped states write, design, implement and evaluate their 1115 demonstrations aimed at improving program and population health outcomes. Stakeholders need to optimize their role in shaping and implementing 1115 initiatives with practical solutions and effective engagement strategies with states.

Medicaid and CHIP 1115 demonstrations allow states鈥攁nd their stakeholders鈥攖o test new innovations to improve the health of enrollees and advance program efficiencies. These demonstrations require careful planning, political savvy, policy knowledge, and ongoing support through the application, approval, and implementation phases. In today鈥檚 environment, 1115 programs must be responsive to the policy priorities at the federal level and grounded in solutions that work in the state. Stakeholders need aligned engagement strategies and communications plans to achieve shared goals, including monitoring that drives continuous improvements after implementation.

HMA consultants bring extensive real-world and leadership expertise from decades of working with states and federal agencies prior to joining HMA. We offer the range of 杏吧视频 and support needed to advance 1115 programs, including:

Strengthening healthcare safety net sustainability through financial and operational supports

Developing solutions for complex patient populations such as individuals who are justice-involved or have extensive behavioral needs including substance use disorder

Designing coverage strategies for critical social needs, such as community reintegration of vulnerable populations such as the justice involved, including when these require collaboration with agencies and programs beyond Medicaid

Supporting states in meaningful stakeholder engagement efforts, provider training and guidance, and other activities necessary for successful program implementation

Working with managed care organizations, health plans, providers, and other stakeholders to apply our expertise in implementing 1115 demonstrations

HOW HMA CAN HELP

Providing strategic and operational support to design demonstration programs
With several former state Medicaid directors and former CMS officials on staff, HMA helps states design successful new interventions to address the unique needs of their populations and ensures proposals meet CMS鈥� approval requirements and expectations, including aligning 1115 interventions with evolving federal priorities and objectives for the program. With HMA, states and stakeholders gain valuable insights on strategic engagement and partnerships. 听
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Developing applications for 1115 demonstration proposals
HMA has supported a variety of 1115 initiatives in several states, including developing proposals for new, continuing, and amended 1115 demonstration programs. HMA consultants bring decades of experience in 1115 program design that covers all of the components critical to developing and operating 1115 programs 鈥� policy, actuarial and budgeting, operations, communications, project management, and IT.
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Supporting federal negotiations for approval of state 1115 demonstration proposals
HMA helps states navigate the federal processes to secure approval for their 1115 initiatives. In many cases, HMA joins in active negotiations with the state agency to support federal negotiations. HMA has unique insight into federal approval parameters with former CMS officials.

Operational Support
We help stakeholders鈥攊ncluding state agencies and their partners鈥攎anage the challenges of implementing new Medicaid or CHIP initiatives, with a focus on ensuring efficient integration and improvements in outcomes.

Evaluation and Assessment of section 1115 demonstrations
Federal regulations require evaluation of CMS-approved 1115 programs. HMA designs and conducts evaluation reports that meet federal requirements, such as hypotheses, data sources, and comparison strategies. HMA鈥檚 work on evaluation designs and evaluation reports has been held out by CMS as best practice models to other states for evaluating new policy interventions as well as for ongoing monitoring activities.
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Developing materials for and supporting stakeholder engagement from design to implementation.
HMA works closely with states and their partners to engage stakeholders early in the 1115 process to ensure that communities and local organizations are involved in the planning and implementation of 1115 programs.听

Project Spotlights

HMA has supported approved section 1115 demonstration programs testing new strategies for addressing substance use disorder (SUD), serious mental illness (SMI), and/or serious emotional disturbance (SED) through new flexibilities around the federal institution for mental disease (IMD) exclusion in seven states (Alabama, Colorado, Delaware, Indiana, Missouri, Ohio, and Oklahoma). In addition to initial and extension application support, HMA teams also support the evaluation and financial modeling components of 1115 demonstration development. In the last four years, we have delivered six evaluation designs, two midpoint progress assessments, two interim evaluations, and two summative evaluations approved by CMS. In general, HMA鈥檚 approved evaluation design plans use multiple evaluation methods, including a mixed-methods approach, drawing from various data sources, measures, and analytics, including quasi-experimental methods, to produce relevant and actionable study findings to conduct analyses. Additional 1115 demonstration program development activities include completing budget neutrality estimates and rate setting for new interventions proposed under demonstrations.

California is the first state in the nation to receive approval from CMS to provide detained and sentenced individuals with 90-day pre-release healthcare 杏吧视频 and behavioral health linkages. HMA helps clients build administrative capacity, information technology, pre-release 杏吧视频, care management models, and Medicaid claiming infrastructure to meet their unique needs and leverage this significant state-federal demonstration opportunity. Our planning and implementation support spans the breadth of the CalAIM Justice-Involved Initiative including: the pre-release Medicaid application process, 90-day pre-release 杏吧视频, behavioral health links, Enhanced Care Management (ECM), and Community Supports 杏吧视频.听 In addition to California, HMA supported other states, such as Illinois and Maryland, with the design, approval, and/or implementation of justice-involved demonstrations approved by CMS. Learn more about CalAIM Justice-Involved Reentry Initiative Planning and Implementation Services.

HMA has supported multiple states in developing alternate approaches to Medicaid eligibility and enrollment tailored to their unique policy goals. For example, our consultants have worked with the Indiana Family and Social Services Administration on the program design, approval, and implementation of the Healthy Indiana Plan (HIP), Indiana鈥檚 alternative Medicaid expansion demonstration program. We also supported the Iowa Department of Health and Human 杏吧视频 in developing the Iowa Health and Wellness Plan (IHAWP) 1115 demonstration which provides an alternative benefit design to traditional Medicaid expansion. HMA also supported the Kentucky Cabinet for Health & Family Services (CHFS) with a variety of 杏吧视频 related to its section 1115 demonstration, Kentucky HEALTH, the first community engagement program in the nation approved by CMS.

Webinars and other resources:

HMA Helps NEMT Stakeholders Overcome Challenges

Lack of transportation is a common barrier to accessing healthcare, leading to poorer health outcomes and health inequities. Non-emergency medical transportation (NEMT) is a critical Medicaid benefit that helps beneficiaries access the health care they need. However, the NEMT industry has faced numerous challenges. States, NEMT brokers and providers, beneficiaries, and other stakeholders have struggled with member satisfaction, adequate transportation networks and workforce (especially in rural areas), sufficient reimbursement, ride timeliness (e.g. pickup, drop-off, post-discharge), passenger safety, digitization of records, and program integrity.

The NEMT industry is also experiencing significant changes and opportunities related to innovation and new technologies, expansion in modes of NEMT transportation (such as rideshare), standardization of tools and metrics, and the introduction of new NEMT models.

Studies
and Analyses

NEMT policy/regulatory reviews, stakeholder engagement, and identification of new broker models, technologies, challenges, and best practices

State Tracking
and Trends

NEMT contracts/ procurements, managed care carve-in status, trends in standards and models

NEMT Procurement Support

RFP strategy and preparation, proposal writing, mock scoring, contract readiness reviews, auditing support, vendor management

Market and
Growth Analyses

value proposition and competitor assessments, goal setting, financial scenario planning and modeling, sales and marketing strategies

Actuarial
Analyses

rate reviews and modeling

Quality
Improvement

compliance and operational support, development and evaluation of value-based payment and other improvement strategies/initiatives

HMA has a long history of working with the full range of stakeholders directly or indirectly involved in, or affected by, NEMT, including:

State and county Medicaid agencies

Managed care organizations

NEMT brokers

NEMT transportation provider organizations and vendors

Technology companies with NEMT solutions

Contact Center companies

Transportation network companies (TNCs/rideshare)

NEMT associations and commissions

Health systems

Emergency medical 杏吧视频 (EMS)

Transportation insurance providers

Medicaid beneficiary and disability advocacy organizations

Investors/private equity firms

Our team includes:

Former health plan executives, state Medicaid and public health officials, and NEMT provider leads with federal and state NEMT policy and operational expertise

Researchers and evaluators with extensive experience examining the implementation and impact of NEMT policy and operational changes

Actuarial analysts with deep experience in quantitative assessments and analyses of the NEMT benefit

Other resources related to NEMT:

State Medicaid Non-Emergency Medical Transportation Contracts: Key Provisions, Standards, and Considerations

Blog: Medicaid non-emergency transportation benefit: trends and innovations from stakeholders

Report: Medicaid鈥檚 Non-Emergency Medical Transportation Benefit: Stakeholder Perspectives on Trends, Challenges, and Innovations

If your organization is ready to talk about how HMA can help advance your NEMT goals, please contact one of our experts below.

Chip Cantrell

Principal

Chip Cantrell鈥檚 broad knowledge base and front line experience means he knows how to help clients manage today鈥檚 moving pieces … Read more

Caroline (Carrie) Rosenzweig

Principal

Carrie Rosenzweig is an experienced consultant specializing in health policy analysis, qualitative research, grant writing, and project management. Her research … Read more

Sharon Silow-Carroll

Principal

Sharon Silow-Carroll specializes in health policy research and analysis. She has more than 25 years of experience collaborating with public … Read more

Tonya Woods-Copeland

Managing Principal

Tonya Woods-Copeland is a strategic executive leader with more than 20 years of experience in Medicare, Medicaid, managed long-term 杏吧视频 … Read more

Digital Quality Measurement: A Key Driver to Value

The healthcare industry is on the cusp of a seismic shift in how quality data are collected, analyzed and reported. Beginning in January 2027, new federal interoperability and prior authorization rules will require widespread data exchange, paving the way for full digital quality measurement (dQM) by 2030. This move toward dQM presents enormous opportunity to enhance quality outcomes, strengthen value-based arrangements, and streamline operations. However, it also requires substantial strategic, operational, and technological changes that most organizations simply cannot manage alone.

Regulatory Mandates

Organizations that delay preparing for the 2027 rule risk costly setbacks and non-compliance.

Opportunity for Transformation

dQM drives efficiency and quality improvement, supporting population health initiatives, care coordination, and value-based contracting.

Complexity and Risk

dQM implementation spans multiple departments鈥擨T, quality improvement, analytics, legal, and more鈥攃reating a host of challenges requiring specialized expertise.

Competitive Advantage

Early adopters will have a first mover advantage. This advantage could result in revenue associated with auto-assignment, STARS bonus, value-based purchasing, reduced sanctions and fine, etc.

Why Partner with HMA?

HMA鈥檚 dQM consulting team understands the operational, clinical, and technical dimensions of transitioning to digital quality measurement. Leveraging deep expertise across health plans, provider organizations, and state and federal agencies, we help you plan, implement, and evaluate your dQM strategies at every stage.

1. Speed to Solution

Front-Seat Knowledge: HMA, together with Leavitt Partners, an HMA Company, is actively influencing and shaping national conversations on interoperability and digital measures. Our front-line insights mean you gain rapid access to the latest best practices, regulatory updates, and strategic guidance.
Streamlined Roadmap & Implementation: We help you develop a clear, achievable plan of action鈥攕aving you from the pitfalls of trial-and-error by fast-tracking your implementation and monitoring the results.

2. Cross-Department Coordination

Complexity of Transformation: dQM requires alignment across IT, quality, clinical operations, and finance鈥攐ften a monumental undertaking for organizations already at capacity. Robust change management & strategic planning and communications is crucial for success.
Meet Mandated Timelines: Waiting to act can result in financial risk, stressed operations, and missed opportunities to optimize reimbursement.
Manage Risk: Because digital quality measurement is in an emerging phase, organizations face higher levels of uncertainty. HMA mitigates risk by leveraging our extensive experience and industry partnerships.

3. Proven Expertise and Ongoing Support

Full Project Lifecycle: From early planning and strategy development through implementation and evaluation, we stand by you every step of the way.
Value Beyond Compliance: Our team identifies how dQM can drive broader business goals鈥攊mproving population health, care coordination, and value-based contracting performance..

Ready to Transform Your Quality Measurement?

HMA鈥檚 expert consultants provide the advanced technical, business, and operational skills you need to succeed in today鈥檚 rapidly evolving regulatory landscape. Don鈥檛 let the complexity of dQM derail your strategic plans or burden your teams. With HMA as your partner, you can confidently navigate and optimize your transition to digital quality measurement.

Take the first step toward harnessing the power of digital quality measurement. Partner with HMA to position your organization for success today鈥攁nd well into the future.

Contact our HMA dQM experts to discuss your organization鈥檚 goals and challenges:

Jeff Booth

Principal

Ryan Howells

Principal

Mark Marciante

Director

Sarah Scholle

Principal

Daniela Simpson

Senior Consultant II

David Wedemeyer

Principal

Supporting New York to improve reproductive health outcomes and equity

New York healthcare providers and community-based organizations will have new opportunities to use state funding to strengthen reproductive healthcare infrastructure and improve the quality of maternity care. Governor Hochul鈥檚 proposed FY 2025 budget includes funding to increase access to comprehensive reproductive healthcare, and capital investment for renovations, equipment upgrades, planning, and construction, to help facilities modernize and secure their operations. The proposed budget also provides flexible funding streams for 杏吧视频 and increased reimbursement for hospitals that meet new maternal health quality metrics.

HMA can help your organization

Strategically seek funding to meet your goals and increase access to 杏吧视频

Develop successful grant applications that position your organization for long-term success and sustainability in New York鈥檚 transforming publicly financed healthcare environment

Implement new programs and 杏吧视频 and measure their impact and value

Improve the quality and accessibility of 杏吧视频 you offer.

Identify potential partners with whom to collaborate to expand new and existing 杏吧视频

Anticipated opportunities include:

Proposed in Governor鈥檚 Budget	Opportunity Summary
Safety Net Transformation Program Funding	Would dedicate additional funding to support partnerships between safety-net hospitals and other healthcare organizations.
Reproductive Freedom and Equity Grant Funding	Would distribute $25 million in funding for the program with focus on strengthening access to comprehensive reproductive care.
Strengthening of Reproductive Healthcare Infrastructure	Would invest an additional $5 million in the Reproductive Freedom and Equity Grant Fund and security grant funding to expand capital investment support for providers; enables renovations, equipment upgrades, planning and construction to help facilities modernize and secure their operations.
Fair reimbursement for Abortion Services	Would invest an additional $20 million to enhance a new flexible funding stream to allow providers to better adapt to the impact of the incoming federal administration and ensure that providers are fairly reimbursed for providing abortions.
Safeguarding of Abortion as Emergency Medical Care	Codifies abortion as protected emergency medical care in New York State and requires hospitals to provide this stabilizing emergency medical care, reinforcing access to abortion 杏吧视频 when medically necessary.
Increase in Hospital Reimbursement for High-quality Maternity Care	Increases Medicaid rates for hospitals that meet maternal healthcare quality metrics.
Expansion of Medicaid Coverage for Fertility Treatment	Extends coverage for fertility preservation 杏吧视频 to Medicaid members undergoing medical treatments that may lead to infertility and expands eligibility for the Infertility Reimbursement Program.

HMA鈥檚 nationwide team of experts include:

Former state directors of Title X, Title V Maternal and Child Health programs, and the Children鈥檚 Health Insurance Program (CHIP)

Former senior officials from the Centers for Medicare & Medicaid Services and the Health Resources and Services Administration

Advocates and former leaders of community-based organizations, foundations, and other programs that support reproductive health

Clinicians with experience providing a full range of reproductive health 杏吧视频

Social workers and behavioral health professionals working to integrate approaches that address social and behavioral health needs

Program development, strategic planning, and technical assistance experts working to implement innovative models of perinatal care and policy change to address social and economic drivers of maternal health

Experts in value-based payment and operations related to innovative models of perinatal care from the payer and provider perspectives

Researchers and evaluators with extensive experience examining the implementation and impact of policy and operational changes

Our Maternal & Child Health Team at HMA

HMA bring together experts from a full spectrum of reproductive health 杏吧视频 including policy, clinical, operations, and research. We work with clients to reach shared goals of supporting maternal and child health, expanding access to the full spectrum of reproductive health 杏吧视频, reducing high rates of maternal and infant mortality and morbidity, and addressing deep and persistent racial disparities in birth outcomes and the inequities that drive them. We help clients stay ahead of the curve in publicly funded healthcare by providing technical assistance, resources, decision support and expertise.

Contact our experts:

Heidi Arthur

Principal

Heidi Arthur has over 20 years of experience in delivery system redesign to promote community-based access to health and human … Read more

Jodi Pekkala

Managing Director, Quality and Accreditation

Jodi Pekkala is an experienced researcher in healthcare quality measurement and improvement with more than 20 years dedicated to analysis, … Read more

Diana Rodin

Associate Principal

Diana Rodin has more than 15 years of experience conducting policy analysis and program evaluations, providing technical assistance and developing … Read more

Caroline (Carrie) Rosenzweig

Principal

Carrie Rosenzweig is an experienced consultant specializing in health policy analysis, qualitative research, grant writing, and project management. Her research … Read more

Sharon Silow-Carroll

Principal

Sharon Silow-Carroll specializes in health policy research and analysis. She has more than 25 years of experience collaborating with public … Read more

Elizabeth Wolff

Principal

Elizabeth Wolff, MD, MPA is a physician executive who utilizes her expertise in population听health, quality improvement, and practice operations to … Read more

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HMA 杏吧视频 - Spotlight

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HMA Spotlight

From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems

.cls-1 { fill: none; stroke: #fff; stroke-linecap: round; stroke-linejoin: round; stroke-width: 2px; } Rapid assessments to identify high-impact opportunities

.cls-1 { fill: none; stroke: #fff; stroke-linecap: round; stroke-linejoin: round; stroke-width: 2px; } Financial modeling and reimbursement optimization

Strategic and operational planning for BH integration

Partnership development and M&A advisory for BH service lines

Implementation support with measurable results

Effective Strategies

HMA Spotlight

ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations

Contact our experts:

Associate Principal

Managing Director

Associate Managing Director

HMA Spotlight

Addressing Behavioral Health Needs in an Aging Population

How HMA can help

Provider Access

Discrimination and Awareness

Service Access

Recent Project Examples

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Principal

Associate Principal

Principal

HMA Spotlight

Supporting real-time strategic decision-making across the leadership team

Ready to transform your organization?

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Managing Director

Managing Director

HMA Spotlight

Realize transaction-related cost synergies

Ready to transform your organization?

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Managing Director

Managing Director

HMA Spotlight

Achieving financial resilience in a time of turbulence

HMA can help identify cost savings

Ready to transform your organization?

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Managing Director

Managing Director

HMA Spotlight

Building Sustainable Health Systems

Financials & Revenue

Workforce

Improving Health Outcomes

Strategic Partnerships

Technology & Digital Innovation

OUR COMMITMENT

Five Critical Priorities for Transformation

Who We Help

Contact Our Experts:

Managing Director, Delivery Systems

Managing Director, Delivery Systems

HMA Spotlight

Supporting Medicaid Dental Benefit Administrators: Oral health and dental care are vital for the health of communities听

OUR EXPERTISE

How HMA can help

Project spotlight

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Principal

Managing Principal

Managing Principal

Principal

Project Spotlights

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HMA Spotlight

HMA Helps NEMT Stakeholders Overcome Challenges

Rapid assessments to identify high-impact opportunities

Financial modeling and reimbursement optimization

Studies
and Analyses

State Tracking
and Trends

Market and
Growth Analyses

Actuarial
Analyses

Quality
Improvement