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Blog

Advancing workforce through Collective Impact

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The launched the (the Partnership is now called the Workforce Solutions Partnership) in 2023 in partnership with and 杏吧视频 (HMA). The partnership is leveraging to address the workforce crisis, and using a cross-sector approach to address the long-standing challenges for expanding and solidifying the behavioral health workforce. The partners identified a gap in advancing workforce solutions with many national convenings creating various sets of recommendations without a coordinated or clear approach to moving recommendations to action.

Why use Collective Impact?

  • Workforce challenges and solutions require a cross-sector approach including changes in Federal and State regulations as well as at the provider level. Need a coordinated approach to truly reach change.
  • There are a lot of recommendations nationally with stalled action in many cases because the recommendations require other implementers to act.
  • No single accountable entity to ensure recommendations move forward
  • Need for cross-sector agreement on strategies and then cross-sector implementation
  • Scale of the challenge can create overwhelm and inertia to address big gaps
  • Leverage the work being done across partners while building a coordinated effort

Check out this webinar recording to learn more about the history of this effort.

Watch the webinar,

2023 Progress

The partnership was busy in 2023 with activities to build multiple avenues for change:

  • Building a robust partnership and backbone for the collective impact approach which is working seamlessly to support a national and cross-sector group of leaders to support implementation of recommendations that often require multiple levels of the system and cross-sector engagement.
  • Developing a draft framework for the complexity of the workforce challenges and solutions and thinking about the implementers (regulators, policy makers, providers, and others) that are needed to implement recommendations.
  • Cross-walking more than 400 recommendations from national sources including national and state approaches as well as provider lessons using the framework to understand consistent recommendations, identify themes and prioritize where to focus moving recommendations to action.
  • Launching a Behavioral Health Provider and Association building a network of providers to share case studies and learn from each other and discuss innovative solutions for addressing workforce challenges.
  • Continuing to identify funding support to move the collective impact approach forward.

What鈥檚 Coming in 2024?

  • National Workforce Conversation鈥攁 virtual meeting open to all interested nationally to communicate and share information broadly and to collectively track what鈥檚 working and lessons learned in workforce efforts.
  • Launch Steering Committee and Working Groups鈥攚hich will include national key decision makers who will guide a coordinated approach to implementing recommendations and working cross-sector to be accountable to change.
  • Launch Second ECHO for Providers and Associations to continue to share what鈥檚 working and improve the immediate workforce crisis at the provider level. Stay Tuned
  • NatCon鈥�24: Register and join the Workforce Development and Talent Management Track (April 15 鈥� 17, 2024)
Blog

Collaborating to improve children鈥檚 behavioral health

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Investments in children鈥檚 behavioral health represent a critical window of opportunity for fostering healthy child development and nurturing the resilience necessary for lifelong well-being. With over 40 percent of U.S. children and youth relying on the Medicaid system for healthcare coverage, it presents a platform to significantly enhance early intervention and prevention 杏吧视频, particularly for vulnerable children. Federal and state policymakers are increasingly active in formulating policies that prioritize investments in initiatives promoting mental and physical health at this pivotal developmental stage.

杏吧视频 (HMA) has partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of 杏吧视频 for children. Beyond the statistics lie the stories of countless vulnerable children and families facing immediate and critical needs. Addressing these issues requires comprehensive cross-system reforms, including policies that promote integrated financing, enhance care coordination, facilitate provider collaboration, and bolster upstream prevention efforts.

The importance of socio-emotional wellbeing as core to childhood development is underscored by evidence-based models and approaches, which consistently demonstrate the substantial value and long-term impact of investing in children’s mental and behavioral health. These investments not only benefit children and adolescents but also extend their positive effects to primary caregivers, creating a comprehensive and sustainable framework for fostering well-rounded, mentally resilient, and physically healthy lives.

The insights and recommendations presented in these briefs* underscore the urgency of coordinated action to improve the well-being of our nation’s youth and the opportunity for collaborative approaches to improve outcomes:

  1. Bolstering The Youth Behavioral Health System: Innovative State Policies To Address Access & Parity (previously published in 2022)
  2. System Integration Across Child Welfare, Behavioral Health, And Medicaid (previously published in 2022)
  3. State Policy and Practice Recommendations to Advance Improvements in Children’s Behavioral Health*
  4. Improving Outcomes for Children in Crisis with Evidence-Based Tools*
  5. The Role of Specialized Managed Care in Addressing the Intersection of Child Welfare Reform and Behavioral Health Transformation*
  6. Early Childhood Mental Health: the Importance of Caregiver Support in Promoting Healthy Child Development and Clinical Interventions for Children*
  7. Connecting Schools to the Larger Youth Behavioral Health System: Early Innovations from California*

*Briefs 3-7 were funded by SAMHSA鈥檚 TT1 grant award for FY 2023.

This is part of a larger effort supported by HMA and a number of partner organizations, including NASMHPD, The Annie E. Casey Foundation, Casey Family Programs, MITRE, National Association of Medicaid Directors (NAMD), Child Welfare League of America (CWLA), and the Federal Government agencies ACF and SAMHSA, to help create a dialogue among state agencies and stakeholders working to improve child welfare. The briefs HMA released are a starting point for much of the upcoming dialogue. A federal policy discussion is being held at SAMHSA in mid-November.

Recognizing the complexity of the challenges that lie ahead, it is evident that no single agency can tackle them in isolation. This approach requires adequate funding and robust partnerships at all levels, from local to state and federal. HMA and our partners are producing a unique convening of state agencies promoting a collective approach to improving child-centered care, one that emphasizes child and family-centered practices and fosters local collaborations across each community’s system of care. This invitation-only event in early February 2024 will convene eight state government child welfare agencies and experts to develop methods for improving their 杏吧视频.

The work HMA is doing with our partners highlights the gravity of the problems while providing inspiring examples of successful collaborations from across the country. By examining what works in these models, the way forward becomes evident 鈥攁 path toward the development of more seamless systems of care for children and youth grappling with behavioral health needs. As states and communities navigate these critical issues, we put forward this body of work as a valuable resource, offering insights and strategies to transform our approach to children and youth well-being and behavioral health support.

HMA will be sharing more about this effort in the coming months, including a webinar with our partners on December 12; registrants will receive a summary of the findings following the February 2024 event. If you want to learn more about this and other initiatives in child behavioral health, please contact our featured children鈥檚 behavioral health experts.

Timeline of Key Events

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Medicaid managed care final rule anticipated soon

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HMA has previously reviewed and discussed some of the implications of provisions put forward in the  published by the  back in May 2023. It is now anticipated that . Given that the final rule, if it codifies many of the proposed provisions as written, will have a significant impact across Medicaid stakeholders including states, managed care organizations (MCOs), and providers, and that its publication appears imminent, it is valuable to recall the major areas that the final rule will likely address.

The final rule is anticipated to include policy changes in several major areas. These include in lieu of 杏吧视频 (ILOS), the Medicaid and CHIP Quality Rating System (MAC QRS), medical loss ratios (MLRs), network adequacy, and state directed payments. When taken together, the policymaking in each of these areas represents the start of a new era of accountability and transparency in the Medicaid program and will affect Medicaid coverage and reimbursement for years to come.

HMA is on the alert for the final rule and will provide analysis and expertise relevant to states, MCOs, and providers, both before and following its release. Whether it is understanding the opportunities to leverage ILOS to address health-related social needs, ensuring operational readiness for data collection and calculation obligations for the MAC QRS, or preparing to comply with MLR requirements related to provider incentive arrangements and quality improvement activity reporting, as well as a host of other topics, HMA will be able to provide insight.

For More Information

If you have questions about how HMA can support your efforts related to the final rule鈥檚 implications for states, MCOs, or providers, please contact our featured experts.

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HMA experts to present on “Lifting Voices” project at NATCON24 in St. Louis, April 15-17

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At the upcoming NATCON24 convention, HMA principals Heidi Arthur and Ellen Breslin will conduct a motivating workshop called 鈥淟ifting Voices for Meaningful, Actionable Change: 杏吧视频 from Navigating the Children鈥檚 System of Care.鈥� During this workshop, Heidi and Ellen will discuss how their own journeys as mothers of children with significant behavioral health needs have informed their work as policy and practice advisors to state and local authorities. They will lift up the voices of their fellow parents and youth, whose insights they sought in order to inform improvements to behavioral health care and access at the state and local levels around the country. Heidi and Ellen seek to make this an engaging workshop for attendees and encourage all to join the call to action. 

Please join their workshop at NATCON24 on Monday, April 15, 2024 from 10:30鈥� 11:30 AM CT in room 132, Level 1, ACCC.

As longtime leaders in health and human 杏吧视频, HMA鈥檚 behavioral health experts bring front line and leadership experience to their work supporting behavioral health authorities, child welfare programs and community and school-based providers of all kinds. We consult with public and private sector entities who serve children and families in order to improve access, streamline, and integrate care. We aim to advance equity and improve quality in state, county, and local program development. Contact us to learn more.

Learn more about the foundations of this project by accessing the Lifting Voices report from October 2023 below.

READ THE FULL REPORT
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CMS releases Medicare Advantage and Part D payment policies for CY 2025

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This week, our In Focus section reviews the recently  policy and payment updates from the Centers for Medicare & Medicaid Services (CMS) that will affect Medicare Advantage (MA) and Medicare Part D programs in calendar year (CY) 2025. We also take a look at the CY 2025 Part D Redesign Program . 

Both the rate announcement and program instructions include important technical updates and payment policy changes that will affect MA and Part D plans.鈥疌MS previously released a proposed rule in November 2023 that included proposed policy changes to MA and Part D. 杏吧视频, Inc., colleagues are closely monitoring how the final Rate Notice will shape the industry鈥檚 approach to the separately proposed policies for supplemental benefits, integrated dual eligible special needs plans (D-SNPs), and encounter data policies among others.  

The following are highlights from the CY 2025 Rate Announcement and significant changes CMS made from the Advance Notice released earlier this year. 

Payment Impact on MA 

CMS estimates that the final ate announcement will lead to a 3.70 percent increase in average payments to MA plans in CY 2025. This reflects the net payment impact of policy changes and updates to MA plan payments relative to 2024 and is the same amount as proposed in the CY 2025 Advance Notice released on January 31, 2024.鈥疉s a result, MA plans will receive an estimated $16 billion increase in payments for CY 2025, and according to CMS, the federal government is expected to make $500鈭�$600 billion in payments to MA plans in 2025.鈥疶his reimbursement increase鈥攚hich include all the various elements affecting MA plan payments, including the MA risk score trend鈥攔epresents the average payment increase across all MA plans, although the actual impact on each plan will vary. 

Effective Growth Rate 

The effective growth rate finalized in the CY 2025 rate announcement is 2.33 percent, down slightly from 2.44 percent in the advance notice.鈥疶he effective growth rate is driven largely by growth in Medicare fee-for-service expenditures, and the CY 2025 Rate Announcement was updated to include program payments during the fourth quarter of 2023.鈥疘n addition, the technical medical education adjustment has declined from 67 percent in the Advance Notice to 52 percent in the Rate Announcement. 

Medicare Advantage Risk Adjustment and Coding 

The rate announcement continues to phase in the updated risk adjustment model by blending 67 percent of the risk score calculated using the updated 2024 MA risk adjustment model with 33 percent of the risk score calculated using the 2020 MA risk adjustment model.鈥� These revisions to the MA risk adjustment model, which include important technical updates to improve the model鈥檚 predictive accuracy, were finalized last year under the CY 2024 Rate Announcement with a three-year phase-in.鈥疶he Rate Announcement also finalizes that CMS will adopt a new methodology for normalizing risk scores to more accurately address the effects of the COVID-19 pandemic. 

Consistent with what the agency proposed in the Advance Notice, in CY 2025, CMS will apply the statutory minimum 5.90 percent MA coding pattern difference adjustment. 

Star Ratings 

CMS continues work toward implementing the 鈥淯niversal Foundation鈥� of quality measures鈥攁 subset of metrics aligned across public programs.鈥疌MS invites stakeholder feedback as it continues to explore adding measures to the Star Ratings, which are components of the Universal Foundation. 

For the CY 2025 rate announcement, Star Ratings changes include the types disasters that are included in the adjustment, updates to the non-substantive measure specification, and the list of metrics for inclusion in the MA and Part D improvement measures and Categorical Adjustment Index for 2025 Star Ratings. 

Part D Design and Part D Risk Adjustment Changes 

The Rate Announcement details several important changes to the standard Part D drug benefit for CY 2025 as required by the Inflation Reduction Act (IRA). These adjustments include eliminating the coverage gap phase from a three-phase benefit (deductible, initial coverage, and catastrophic) and setting the annual cap on patient out-of-pocket prescription drug costs at $2,000.鈥疶he changes in Part D coverage design will have a significant impact on liability for Medicare beneficiaries, Part D plans, drug manufacturers, and CMS.  

CMS also finalized updates to the Part D risk-adjustment model to reflect Part D design changes included in the IRA and to ensure Part D plan sponsors can develop accurate bids for CY 2025.鈥疶hese changes include calibrating the Part D risk model using more recent data years and updating the normalization factor to reflect differences between MA-PD plan and standalone Part D plan risk score trends. 

Key Considerations 

Overall the final rate notice maintains stability and the opportunity for beneficiary choices in the MA program even as it continues to implement noteworthy changes in risk adjustment. The payment policies finalized in the CY 2025 Rate Announcement will have varying effects across MA plans, with some experiencing larger or smaller impacts in CY 2025.鈥疨lans should assess these effects as they prepare their bid submissions for 2025. 

In the CY 2025 rate announcement, CMS indicates that the 3.70 percent increase will provide continued stability in beneficiary access, choice, and benefits while ensuring accurate, appropriate payments to Medicare Advantage organizations. 

Looking ahead, CMS also has proposed policy and technical changes to the MA and Part D programs, which are expected to be finalized in the coming days.鈥疕MA鈥檚 summary analysis homes in on key issues that likely will be included in the final rule. CMS continues to solicit feedback from stakeholders on ways to reinforce and improve transparency in the MA program through the CMS  on MA data collection. Comments are due May 29, 2024. 

The HMA team will continue to analyze the important payment and technical changes finalized in the CY 2025 rate announcement.鈥疻e have the depth, experience, and subject matter expertise to assist with tailored analysis and the modeling capabilities to assess the policy impacts across the multiple rules and guidance. 

If you have questions about the comments of the CY 2025 Rate Announcement and payment policies that impact MA plans, providers, and beneficiaries, contact our featured experts.

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HMA experts in data integrity and governance to present at NATCON24 in St. Louis, April 15-17

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At the upcoming NATCON24 convention, HMA principals Robin Trush and Jodi Pekkala will present 鈥淎chieving Data Integrity and Staff Satisfaction through Technology Data Governance.鈥� Health equity, alternative payments, and social determinants of health are all healthcare 鈥淣orth Stars鈥� in healthcare grounded in data collection. To achieve standard metrics and address patient care coordination, EHRs, population-health platforms and other technology innovations must be used accurately, consistently and be configured properly. Cross-department database governance is grounded in standards to ensure data integrity. Too often, organizations have been unable to successfully stand-up technology and maintain consistent use over time, resulting in staff dissatisfaction and turnover.

This presentation will provide an overview of proven methods for bringing technology governance and leadership into clinical planning and operations, resulting in staff satisfaction, and putting your organization on the path toward those North Stars. Presenters will share lessons in how to bring technology management into clinical planning and operation. This enhanced organizational integration model will drive better outcomes and support the staff experience.     

Learning Objectives:

  • Describe current industry initiatives with technology infrastructure requirements.
  • Define and address common technology pain points for organizations and staff.
  • Define guidance for data governance, data integrity, and staff satisfaction.
  • Provide tools to take an organizational 鈥減ulse鈥� and create a path to improvement.

Please join this workshop at NATCON24 on Monday, April 15, 2024 from 4:15 鈥� 5:15 PM CT Location: 100/101, Level 1, ACCC

As longtime leaders in health and human 杏吧视频, HMA鈥檚 behavioral health, IT and data experts bring front line and leadership experience to their work supporting Health and Human Services IT projects. Combine this with the broad programmatic and operations expertise of the HMA team鈥攚hich includes former clinicians, Medicaid directors, and leaders of provider and payer organizations鈥攁nd we are able to deliver targeted, relevant, actionable advice to our clients. We aim to advance equity and improve quality in state, county, and local program development. Contact us to learn more.

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CMS Innovation Center announces ACO PC Flex model to enhance Medicare access

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This week, our In Focus section looks at the voluntary Accountable Care Organization Primary Care Flex (ACO PC Flex) Model, which the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced on March 19, 2024. This model is designed to increase the number of low revenue ACOs in the Medicare Shared Savings Program (MSSP). Model participants will receive a one-time advanced shared savings payment and monthly prospective population-based payments. The ACO PC Flex Model is intended aims to support care delivery transformation, innovation, and team-based approaches to improve quality and reduce costs of care.

The ACO PC Flex Model is structured to increase the number of low revenue ACOs (i.e., ACOs composed of physicians, a small hospital, and/or serve rural areas). CMS  results in August 2022 indicating  that low revenue ACOs generated $113 more per capita savings than their high revenue counterparts.  CMS  in July of 2023 that the agency was seeking new opportunities for ACOs to serve Medicare beneficiaries. With this model, the Innovation Center is providing flexible payment to support innovative, team-based, person-centered, and proactive approaches to care for a subset of ACOs that have historically generated savings.

ACO PC Flex Model payments are structured to provide advanced shared savings to support administrative activities necessary for the model and ongoing payments specifically for primary care. The payment approach includes:

  • A monthly prospective primary care payment consisting of 1) a county base rate determined by average primary care spending, and 2) payment enhancements to support increased access to primary care, provision of care, and care coordination, which are exempt from CMS recoupment
  • An advanced shared savings payment as a one-time advance the changes needed to support needed operations and administration

With the approach, the Innovation Center anticipates CMS will be able to improve access to primary care 杏吧视频, particularly for underserved communities, and empower providers through flexible, stable payments to innovate care delivery to better meet their patients鈥� needs.

The demonstration will start January 1, 2025, and run for five years. The request for applicants (RFA) is expected in the second quarter of 2024, and ACOs must apply for participation in MSSP as a new or renewing organization to be eligible for ACO PC Flex. Applications for MSSP close June 17, 2024.

More details are expected to be included in the RFA. If you are interested learning more about the ACO PC Flex Model, please contact our featured experts.

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HMA 2024 Spring Workshop summary and key takeaways

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On March 6, HMA convened a spring workshop of 100 healthcare stakeholders interested in making value-based care delivery and payment work better. This event was designed for those engaging in value-based care and payment transformation, but who are looking to learn from peers to overcome challenges; participants included insurers, health systems, data and tech innovators, service providers, and trade associations.

The event鈥檚 name implored people to 鈥淕et Real鈥� about the challenges we all face, while reminding ourselves of the imperative of making this transition to ensure the sustainability of our uniquely American healthcare system. In between plenary panels, participants were engaged in cohort discussions exploring the opportunities for progress in areas critical to making value-based care work.  While a summary cannot recreate the real-time discussions and simulations from the event, our discussions delivered insights on several critical themes that we believe are important to track. 

EMPLOYERS ARE LEANING IN: For all employers pay, they are getting less value over the past decade; the changes made to ERISA that hold the C-suite accountable for paying fair prices for healthcare benefits is a seismic shift in making healthcare purchasing a more strategic priority for employers.

  • Elizabeth Mitchell of the Purchaser Business Group on Health illustrated the shift in employers鈥� awareness 鈥� due to data transparency rules 鈥� that they aren鈥檛 getting the quality they thought they were getting for all that they pay. Transparency, plus a recent change to the Employee Retirement Income Security Act of 1974 (ERISA), is bringing employers back to the table with very specific requests for better outcomes, which they are increasingly pursuing through direct contracting and specific quality frameworks for primary care, maternal care, and behavioral health. Participants continued to reflect on this dynamic in all subsequent discussions, underscoring that this could be a really big deal.
  • Cheryl Larson of the Midwestern Business Group on Health talked about the cost pressure on her members leading them to partner in new and different ways, expressing optimism about all payer solutions and other innovative approaches to leverage the cost data that are now available. In her closing plenary session, she said 鈥渢his issue of accountability on employers鈥 am excited and optimistic that there are things we can do to get there faster now.鈥�

Data & Technology HAVE TO IMPACT DECISION MAKING: Patients are using the system the way it is designed today, so we can鈥檛 just blame them for poor outcomes鈥e have to actually stop doing things that don鈥檛 work and start measuring things the right way.

  • Dr. Katie Kaney opened with a dinner keynote discussing her efforts to create metrics that give purchasers a better measurement of whole person care, including clinical, genetic, behavioral, and social factors. Audience members remarked that this was a novel approach to quantify what has become accepted correlation in adverse health outcomes.
  • , , and Stuart Venzke led discussions on Data & Technology, diving into updated federal regulations that present both opportunities and challenges for stakeholders, as well as ways to create corporate strategies that include data and technology, as these issues are no longer optional for anyone in this business. The breakout discussions talked about where we are today vs where we need to be – bridging the gap between data and decision making.

Payment & Risk TOOLS ARE ALIGNING INFORMATION TO ACTION:  Achieving meaningful risk-based contracts is possible but the details matter鈥ismatched data and information leads to unequal buying power, which cannot be the case in value-based care.

  • , , , and Kate de Lisle led discussions on Payment & Risk, including an exciting hands-on simulation exercise that helped participants understand ways to increase premium scores by implementing risk-based payment approaches within the care delivery system; this session provided very concrete takeaways for those who attended by combining a simulation with a discussion on measures of success to improve risk-based contracting strategies.
  • Amy Bassano and Kate de Lisle discussed their recent publication on the expanded ecosystem of value-based care entities, looking at the 鈥渆nablers鈥� who are working with providers and payers to manage risk. This groundbreaking landscape of this market segment highlighted a set of Guiding Principles to ensure these entities are aligned with CMS, provider, and patient goals. Participants had lots of questions for the presenters and were anxious to read the HMA .

CARE DELIVERY MEASURES MUST BE TANGIBLE TO PROVIDERS AND PATIENTS: Value-based care requires aligning the right metrics with the right incentives, ensuring providers understand not only WHY but HOW they help improve patient outcomes.

  • Rachel Bembas, Dr. Jean Glossa, and Dr. Elizabeth Wolff led discussions on Care Delivery Measures, underscoring the importance of involving clinicians in the establishment of outcomes measures, as well as ensuring that the diversity of patient experiences are included. Participants remarked that we have a lot of “messy” data today, so we now have to ask the next set of questions on how we best use the messy data to make an impact?
  • Former Congresswoman Allyson Schwartz talked about the continuing promise of Medicare Advantage, and the opportunity to convene a new alliance around Medicare quality metrics as well as the increasing pressure to align these metrics across payers. In the closing plenary, she said “We need to define what we want healthcare in America to look like and then go out and get it…. We have to align the measurements and the standards we use so that providers understand what’s needed and it benefits government, taxpayers, and beneficiaries…we should require plans to have risk-based contracting with providers.”

Policy & Strategy HAVE TO STAY THE COURSE TO ALIGN INCENTIVES: Policymakers can help or hinder movement forward to ensure success鈥alue-based care has to be more than a section in an RFP, but part of the entire scope of paying for outcomes-based care delivery.

  • Governor and former HHS Secretary Mike Leavitt reminded us of the political and policy journey that got value to where it is today, and the unique moment we are in right now that gives us hope as we enter this post-pandemic phase of healthcare spending and policy. He reflected, 鈥淲e are beginning to see regulations and mechanisms to hold people accountable for healthcare costs鈥e have to integrate value and caregiving or we will never get to value.鈥�
  • Theresa Eagelson, former Illinois Director of Healthcare and Family Services, talked about the opportunity for states to expand value-based care by setting strong expectations through contracting and by thinking differently about policy choices. She reflected on the role of state administrators, “When we sit here and talk about value-based care, do we know what our north star is? Have we mastered what we want to see in RFPs (for Medicaid)?  We鈥檙e working on a good FQHC model in Illinois, but should it be just for FQHCs? We need to spend more time together, across payers, across plans and providers and consumers to figure out what success looks like.”
  • Caprice Knapp and Teresa Garate led a discussion on state and local Policy & Strategy to support integrated care and 杏吧视频 that are required to achieve better outcomes. There is a need for 杏吧视频 to better coordinate and manage care across social and health 杏吧视频, bringing contracting and payment expertise to more efficiently serve patients. The highly anticipated Medicaid managed care rule can help guide states in updating their approach. Federal analysis of Medicaid data is needed to set benchmarks before we can get to total cost of care approaches.
  • Amy Bassano and Anne Marie Lauterbach led a discussion on federal policy alignment of Medicare FFS and Medicare Advantage, particularly looking at drug spending and the very real burden of medical debt as a driver of policy change. Participants reflected that half the country is indirectly covered through some public insurance. It’s just being done hyper-inefficiently.

HMA is leading the way on value-based care and is committed to continuing these dialogues to drive local, state, and national change. HMA鈥檚 value-based care expertise draws from our acquisition of and , two firms with deep ties and expertise on policy, strategy and risk-based pricing strategies, as well as recruitment of clinicians and operational experts who have led organizations through this transition. We will continue to advance the dialogue 鈥� and the work 鈥� to drive value as a critical way to ensure that our systems of health and healthcare are more affordable, equitable, and sustainable.

Let鈥檚 keep the conversation going! Learn more about how HMA can help you succeed with value-based payments and check out the newly released value-based payment readiness assessment tool for behavioral health providers.

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State teams convene to strengthen collaboration across child welfare, behavioral health, and Medicaid

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This week, our In Focus section highlights the Children鈥檚 Behavioral Health (CBH) State Policy Lab, held February 7鈭�9, in Baltimore, MD. 杏吧视频, Inc., (HMA), in partnership with national philanthropies and associations, hosted the Policy Lab, which provided an unprecedented opportunity for state cross-systems teams to conduct in-depth work toward creating an equitable behavioral health system of care for children and youth.   

Background 

The lack of collaboration and misaligned strategies and policies across state child welfare, behavioral health, and Medicaid has contributed to unsatisfactory outcomes for children and youth in our communities. The COVID-19 public health emergency exacerbated these issues, as the rate of mental health and substance use disorders (SUD) increased and many families experienced traumatic events during this time. Increasingly, states and local jurisdictions are exposed to threats or actual class action lawsuits based on the inadequate care of children and youth involved in the child welfare settings.  

Fortunately, federal and state efforts and investments to address the youth systems of care鈥攊ncluding schools, community, delivery systems, and community-based child placing agencies鈥攁re in motion. Though the diversity of efforts being implemented across local and state agencies are critical, these complex issues require collaboration across multiple systems, including Child Welfare, Behavioral Health authorities, Medicaid, and K-12 Education. A cross-sector strategic approach will enable comprehensive identification of gaps, policy solutions, and best practices, as well as highlight opportunities for cross-sector braided or blended funding to build a system of care that supports the needs of multi-system children, youth, and their families.  

Child Behavioral Policy Lab 

The current behavioral health crisis presents an opportunity to address long-term challenges and divisions and to build a truly comprehensive approach. This is why HMA sponsored the Children鈥檚 Behavioral Health State Policy Lab which convened key partners within a state and across states. The Annie E. Casey Foundation, Casey Family Programs, National Association of State Mental Health Program Directors (NASMHPD), the Child Welfare League of America (CWLA), the American Public Human Services Association (APHSA), National Association of Medicaid Directors (NAMD) and MITRE, a Children鈥檚 Behavioral Health (CBH) State Policy Lab, joined HMA in funding, organizing and providing consultation support for the meeting. 

The nine participating states鈥�Georgia, Kansas, Kentucky, Maryland, Missouri, Pennsylvania, Texas, Utah, and Wisconsin鈥攚ere selected through a competitive process based on the goals and commitment of the state and the thorough analysis of gaps and opportunities, demonstration of collaborative state interagency partnerships, and engagement of youth and adults. 

The participating states committed their leadership teams to join the Policy Lab in laying the foundational work of development of statewide plans that would advance their collective goal of creating a more united system of care. Participants learned about intergenerational trauma and resilience. The sessions also provided participants with data that helped provide context to the problems we are trying to solve. Presenters included Aliyah Zeien, a national child welfare policy advocate and youth ambassador, with lived experience who highlighted that 25 percent of foster youth will spend time in prison or other enforcement systems within two years of leaving the child welfare system. Her experience and reflections served as call for action to actively engage families and youth in all system planning, advocacy, and policy work.  

Key areas of focus 

Following these brief educational sessions, each state had substantial 鈥渢eam time鈥� to develop a road map and set of next steps for continuing their work after the Policy Lab. Expert facilitators guided state teams through discussions on three key issues:  

  • Service array. State teams were challenged to define their array of 杏吧视频 and develop collective agreements on how to develop enhanced treatment options for children and their families. With an emphasis on building a full continuum of care with community-based supports and fewer children in residential facilities, each team considered challenges such as eligibility, access, and workforce. Prevention, diversion, and engagement of people with lived experience to help with system development were common commitments in state action teams.  
  • Financing. The teams considered their statutory authority, funding streams, funding partners, contract vehicles, and financing mechanisms. They also worked on ideas for blending and braiding funding, with a focus on Medicaid and leveraging collective opportunities to develop staff and contractual resources.  
  • Governance. State teams worked through difficult conversations, including how to measure success, how to manage accountability and monitoring, how to collaboratively design 杏吧视频 and case practice, while meaningfully sharing data and creating interoperability within their systems while respecting confidentiality and privacy concerns.  

What鈥檚 Next  

Since the Policy Lab program, most participating states have embarked on next steps identified during the workshop, such as vetting their plans with state leadership, creating an ongoing team for implementation, and identifying community partners. HMA and HMA Companies, including Leavitt Partners, are collaborating with our Policy Lab partners and the state agencies to further develop these plans and prepare for implementations that rethink our approach to 杏吧视频 for youth and their families. 

For more information about the Policy Lab and follow-on work, please contact our experts below.

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New Leavitt Partners report examines site-neutral payments

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A new report by Leavitt Partners, an HMA Company, outlines the concept of site-neutral payment reforms being considered as a potential program improvement, and proposes a compromise approach to implementing site-neutral payments that benefits beneficiaries, hospitals, and the Medicare program. Site-neutral payments, which would equalize payment for the same 杏吧视频 across all settings of care, are most commonly considered in connection with outpatient or ambulatory settings. Because out-of-pocket costs for Medicare beneficiaries are based on a percentage of the total reimbursement costs, any policy that reduces reimbursement for some 杏吧视频 would result in savings to Medicare beneficiaries.

The approach proposed in the report lowers out-of-pocket costs to Medicare beneficiaries, improves the financing of the Medicare program by addressing a payment distortion, and reinvests in hospitals through new targeted funding and inclusion of policy priorities. 

If you have any questions, contact our expert below.

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Federal policymakers consider current and future spending measures on simultaneous tracks

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This week, our In Focus section covers Congress鈥檚 and the Administration鈥檚 parallel efforts to finalize fiscal year (FY) 2024 spending bills and begin the budget process for FY 2025.  

Congress approved a bipartisan package for some of the FY 2024 spending bills, and on March 9, 2024, President Biden signed the Consolidated Appropriations Act of 2024 into law (). Programs funded through this measure include the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and other federal nutrition supports, rental assistance for safe and affordable housing, and veterans medical care and benefits.  

Several mandatory funding extensions of public health programs and health-related policies also found their way into the 2024 consolidated appropriations package, including extending the Community Health Center Fund, delaying reductions in the disproportionate share hospital allotments, defining Certified Community Behavioral Health Centers (CCBHCs) as a Medicaid service, extending incentive payments for certain Medicare providers, and mitigating the impact of cuts to the Medicare physician fee schedule.  

These policies, however, addressed a narrower set of issues than the expansive and bipartisan legislation that has been moving through both chambers of Congress. For example, House and Senate members have worked on respective bipartisan policies affecting price transparency, pharmacy benefit managers, and Medicare site-neutral policies, among others.  

Meanwhile, President Biden released the  proposal March 11, 2024, kicking off the annual budget process. Like the administration鈥檚 FY 2024 budget proposal, the FY 2025 plan emphasizes deficit reduction and continues to make equity and Medicare solvency cornerstones of the budget. Health-related priorities include expanding access to affordable healthcare 杏吧视频, lowering drug costs, improving maternal health, addressing the mental health and substance use disorder crises, and enhancing biodefense and preparedness activities.  

Check out the from Leavitt Partners, a 杏吧视频, Inc. (HMA), company, and a into the Consolidated Appropriations Act of 2024.

What We鈥檙e Watching 

Congress is continuing negotiations on the outstanding spending bills, including the one that funds the Departments of Health and Human Services, Labor, and Education through September 2024. Lawmakers are working to reach an agreement before the next funding deadline of March 22.  

The administration鈥檚 FY 2025 budget proposals are generally being characterized as a blueprint for President Biden鈥檚 re-election campaign and, if successful, a policy agenda for his second term. Though Congress has already begun holding hearings on the budget request, members on both sides of the aisle will likely focus on issues that resonate in an election year.  

Regardless of the outcome of the November elections, Congress has an opportunity to address unfinished business during the lame duck session later this year.  

HMA and Leavitt Partners collaborate to monitor legislative and regulatory developments in healthcare and adjacent spaces and to assess the impact of policy changes on the healthcare industry. 

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Medicaid managed care spending in 2023

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This week, our In Focus section analyzes preliminary 2023 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), HMA received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2023. Based on the preliminary estimates, Medicaid expenditures on medical 杏吧视频 across all 50 states and six territories in FFY 2023 totaled nearly $852.9 billion, with 59.6 percent of that amount now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative 杏吧视频 was $33.8 billion, bringing total program expenditures to $886.7 billion.

Total Medicaid Managed Care Spending

Total Medicaid managed care spending (including the federal and state share) in FFY 2023 across all 50 states and six territories was $508.1 billion, up from $468.3 billion in FFY 2022. This figure includes spending on comprehensive risk-based managed care programs as well as prepaid inpatient health plans (PIHPs) and prepaid ambulatory health plans (PAHPs). PIHPs and PAHPs refer to prepaid health plans that provide only certain 杏吧视频, such as dental or behavioral health care. Fee-based programs such as primary care case management (PCCM) models are not included in this total. Following are some key observations.

  • Total Medicaid managed care spending grew 8.5 percent in FFY 2023.
  • Managed care spending growth has decreased in since the end of the COVID-19 pandemic, after peaking in FFY 2021.
  • In terms of dollars, the increase in Medicaid managed care spending from FFY 2022 to FFY 2023 was $39.8 billion, compared with $47.8 billion from FFY 2021 to FFY 2022.
  • Medicaid managed care spending has increased at a compounded annual growth rate (CAGR) of 14.2 percent since FFY 2007, compared with a 6.5 percent growth in total Medicaid spending.
  • Compared with FFY 2022, Medicaid managed care spending as a percent of total Medicaid spending in FFY 2023 increased by 0.5 percentage points to 59.6 percent.

Table 1. Medicaid MCO Expenditures as a Percentage of Total Medicaid Expenditures, FFY 2007鈭�2023 ($M)

As the table below indicates, 68.9 percent of FFY 2023 spending came from federal sources, which is 11.5 percentage points higher than the pre-Medicaid expansion share in FFY 2013 and 1.3 percentage points higher than FFY 2020.

Table 2. Federal versus State Share of Medicaid Expenditures, FFY 2013鈭�2023 ($M)

State-Specific Growth Trends

A total of 44 states and territories report managed care organization (MCO) spending in the CMS-64 report. Average MCO spending during FFY 2023 increased 8.5 percent. On a percentage basis, Missouri experienced the highest year-over-year growth in Medicaid managed care spending at 51.7 percent, followed by Washington at 31.4 percent and Georgia at 29.3 percent.

The chart below provides additional detail on Medicaid managed care spending growth in states with risk-based managed care programs in FFY 2023.

Figure 1. Medicaid Managed Care Spending Growth on a Percentage Basis by State, FFY 2022-2023

Source: CMS-64; *Note: Not all states are included in the table.

Looking at year-over-year spending growth in terms of dollars, New York experienced the largest increase in Medicaid managed care spending at $5.9 billion. Other states with significant year-over-year spending increases included Washington ($4.1 billion), Illinois ($2.8 billion), and California ($2.4 billion). The chart below illustrates the year-over-year change in spending across the states.

Figure 2. Medicaid Managed Care Spending Growth on a Dollar Basis by State, FFY 2022鈭�2023 ($M)

Source: CMS-64; *Note: Not all states are included in the table.

The percentage of Medicaid expenditures directed through risk-based Medicaid MCOs increased by more than one percentage point in 15 states from FFY 2022 to FFY 2023. The managed care spending penetration rate rose 6.7 percentage points in Missouri, 6.5 percentage points in Georgia, 6.3 percentage points in Louisiana, and 5.7 percentage points in Puerto Rico. In all, 22 states saw a decrease in managed care penetration from FFY 2022 to FFY 2023.

Table 3. Medicaid MCO Expenditures as a Percentage of Total Medicaid Expenditures in States with a One percent or Greater Increase from FFY 2022 to FFY 2023 ($M)

Source: CMS-64 Note: Washington was excluded from the data table.

The table below ranks the states and territories by the percentage of total Medicaid spending through Medicaid MCOs. Iowa reported the highest percentage at 100 percent, followed by Puerto Rico at 97.5 percent and Kansas at 94.5 percent.

In many states, certain payment mechanisms may never be directed through managed care, such as supplemental funding sources for institutional providers and spending on retroactively eligible beneficiaries. As a result, the maximum achievable penetration rate in each state will vary and may be below the amount achieved in other states. The Medicaid managed care spending penetration rate is greatly influenced by the degree to which states have implemented managed long-term 杏吧视频 and supports (MLTSS) programs.

Table 4. Medicaid MCO Expenditures as a Percent of Total Medicaid Expenditures, FFY 2016-2023

Source: CMS-64
Note: Washington was excluded from the data table.

If you鈥檙e interested in becoming an HMAIS subscriber and for access to the CMS-64 data, contact our expert below.

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