1344 Results found.
Economic Analysis of Opioid Use Disorder in the Medicare Fee-for Service Program
This report quantifies the economic impact of opioid use disorder (OUD) specific to the Medicare fee-for-service (FFS) program, which covers approximately 51.6 percent of Medicare beneficiaries. We find that the cost to Medicare for managing these newly diagnosed patients was $29,669 more per patient than the propensity-matched control patients without OUD in 2022. We thus estimate that newly diagnosed OUD patients cost the Medicare program $4.3 billion in 2022. If these incident patient results were extrapolated into a 10-year budgetary impact analysis and if we assume constant rates of OUD incidence in the Medicare population, we estimate that the 10-year impact of OUD to the Medicare program would be $62.56 billion.
Our analysis demonstrates that OUD results in significant Medicare spending, including rising costs to beneficiaries through copayments and increased premiums. Additional work may be needed to determine whether the cost differential for incident patients with OUD generalizes to prevalent OUD patients as well. Though the 10-year budgetary impact figures require extrapolation and assumptions about future OUD use, they illustrate for policymakers the size of the fiscal challenge created by OUD in the Medicare population.
The case for a state-based marketplace
Former Speaker of the House Tip O鈥橬eill made famous the phrase 鈥渁ll politics is local,鈥� meaning electoral success is related directly to a politician鈥檚 understanding of and ability to address the local issues that matter most to constituents. This concluded that local knowledge of health care challenges and collaboration among local organizations to find solutions were major contributors to communities鈥� improvement on scorecard rankings.
One state-level decision that can boost responsiveness to local needs is whether to establish a state-based marketplace (SBM) for health insurance. Health insurance marketplaces are required in every state under the Affordable Care Act (ACA). Under the ACA, states were given a choice about whether to establish an SBM and receive some federal funding to do so or rely on the federally facilitated marketplace (FFM) to serve their residents. Marketplaces are designed to do two basic things: (1) enroll individuals and families who do not have access to Medicaid, Medicare, or employer-sponsored health insurance coverage in private coverage and (2) connect eligible individuals with financial assistance (premium tax credits and cost-sharing reductions) to reduce their cost of coverage. To date, 19 states have established SBMs and others continue to entertain the possibility of establishing one.
Why would states want to establish and operate a new agency of government to administer coverage for people who are receiving federal tax credits for their health insurance coverage? Surely this could create redundant and/or uncoordinated functions between states and the federal government and place an unwanted burden on capacity-strapped state governments. However, states that have established SBMs have not found this to be the case. Instead, in evaluating the FFM versus SBM decision, and in operating SBMs, states have found that SBMs offer distinct advantages over the FFM. These include:
- Lower Costs: States have historically demonstrated that they can operate SBMs at a lower overall cost than they would pay in fees through the FFM which has led, in part, to the recent reductions to the Healthcare.gov user fee. States also directly benefit through their ability to retain marketplace revenue and spend it locally. Lastly, SBMs can claim federal financial participation for functions they perform supporting and facilitating Medicaid enrollment.
- Better Service: States have an almost 60-year history of enrolling low-income individuals and families enroll in and stay enrolled in Medicaid. Many of these individuals cycle in and out of Medicaid eligibility due to changes in income. States can coordinate between SBMs and Medicaid to reduce gaps in coverage. They also can simplify eligibility and enrollment through SBMs that deliver a better customer experience through knowledge of their markets and residents and on the ground enrollment assistance and initiatives.
- More Policy Influence: SBMs can be launchpads for access and affordability innovations not possible with the FFM. State innovations to date include public option plans, state-funded subsidies such as premium and cost-sharing wraparound support, basic health plans, undocumented immigrant coverage programs, and collaborative enrollment initiatives with Medicaid agencies, unemployment programs, and tax departments.
In addition to states, managed care organizations (MCOs), particularly local and regional MCOs, can also reap the benefits of an SBM:
- Local Governance: With governance for an SBM taking place at the state level (versus the federal level), MCOs have the opportunity for more thorough engagement with state officials around operational and policy decisions and issues.
- Aligned Market Expectations: MCOs participating in both the marketplace and Medicaid will benefit from a higher probability of aligned expectations and priorities across both markets with those expectations and priorities being uniformly set at the state level with an SBM.
- Local Market Sensitivity: MCOs that operate and are rooted locally can count on market-specific dynamics being better reflected in decision-making with an SBM.
Establishing a SBM is not an easy or straightforward decision, but state policymakers and MCOs should consider the benefits that have accrued to other states and the role that SBMs can serve in addressing local health priorities.
If you have questions about how 红领巾瓜报 can support your state or MCO related to SBMs, please contact our featured experts.
Zeroing in on Medicare Advantage policies set to transform the SNP landscape beginning in 2025
Regulatory policy changes finalized by CMS aim to increase the percentage of dual-eligible individuals enrolled in integrated plans
This week, our In Focus section delves into important and complex regulatory policy changes that affect coverage and services for the 12.9 million individuals who are dually enrolled in both Medicare and Medicaid. These 鈥攚hich were finalized as part of a broader that the Centers for Medicare & Medicaid Services (CMS) released on April 4, 2023鈥攁re designed to increase the percentage of dually eligible people who are enrolled in integrated Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs). The modifications will be phased in gradually, with certain provisions affecting D-SNPs starting in 2025. These adjustments forge a stronger connection between state-level policy and operational decisions, shaping the future landscape of D-SNPs.
Overview
Amid rapid growth of D-SNP plan offerings and increased enrollment of dually eligible individuals into D-SNPs, CMS has finalized an interconnected set of regulatory policy changes to increase enrollment in integrated plans while simplifying coverage and plan options for this population.
By promoting enrollment in integrated plans, CMS seeks to improve the care experience and outcomes for dually eligible individuals, with the ultimate goal of making integrated plan enrollment the standard. Integrated D-SNP plans, which consolidate Medicare and Medicaid services under one managed care organization, offer uniform consumer protections (including unified grievance and appeals process), integrated plan materials, and more coordinated care.
Key policy changes include:
- Replacing the current quarterly special enrollment period (SEP) with a monthly SEP for dually eligible and other low-income subsidy (LIS) individuals to enroll into a standalone prescription drug plan (PDP)
- Establishing a new integrated care SEP that will enable dually eligible individuals to choose an integrated D-SNP plan on a monthly basis
- Restricting enrollment in certain D-SNPs to individuals also enrolled in an affiliated Medicaid managed care organization (MCO)
- Limiting the number of D-SNPs an MA organization can offer in the same service area as an affiliated Medicaid MCO to reduce and simplify plan offerings for dually eligible individuals.
What Issue is CMS Trying to Solve?
CMS intends to make it easier for dually eligible people make enrollment decisions. Simplified plan options and more integrated care could prevent beneficiaries from inadvertently selecting plans that fail to provide the comprehensive Medicare and Medicaid benefits they need.
This shift toward aligned enrollment could improve beneficiary experiences, enhance outcomes, and streamline administrative processes for CMS. The introduction of a monthly SEP specifically for dually eligible individuals enrolled in Medicaid managed care plans underscores CMS鈥檚 commitment to facilitating enrollment in affiliated D-SNP plans throughout the year. 红领巾瓜报 (红领巾瓜报) experts expect these changes to affect the sales cycle for dual eligibles and potentially increase member satisfaction, expand access to care, and improve overall health outcomes for this population.
Timeline of Regulatory Changes
Considerations for Health Plans
The impact on individual health plans hinges on state-specific approaches to dually eligible beneficiaries and D-SNPs, as well as each plan鈥檚 strategy for integrating Medicare and Medicaid services. 红领巾瓜报 experts identified the following key factors as essential for understanding and monitoring these interconnected dynamics:
- Does the state administer managed Medicaid, and if so, does it include the dually eligible population?
- Does the Medicare D-SNP (or an affiliated/ related company) hold a state Medicaid contract that covers dually eligible individuals?
- What is the state鈥檚 vision regarding duals and D-SNPs?
- Does the state require its Medicaid contractors to offer a D-SNP?
- Does the state currently or plan to restrict D-SNPs to their Medicaid contractors?
- Is the state moving toward an exclusively aligned enrollment model?
What鈥檚 Next
The changes in D-SNPs present opportunities and risks for beneficiaries, MA and Medicaid health plans, and states. Successful navigation of these changes requires proactive planning and anticipation of forthcoming federal and state regulations. Health plans operating within the D-SNP space must actively engage with state Medicaid agencies to understand and potentially help shape this evolving environment. For example, health plan strategies may include:
- Understanding the state鈥檚 priorities and its current and planned approach to integrated care for dually eligible individuals
- Participating in and/or advocating for stakeholder meetings with the state regarding dually eligible members and D-SNPs to ensure the opportunity to shape regulations
- Developing internal integration strategies that align product design, operations, quality, clinical, and member experience capabilities for D-SNPs and Medicaid
- Strategically planning actions, such as participating in Medicaid procurements, to achieve the plan鈥檚 objectives
Connect with Us
These regulatory changes significantly affect dually eligible beneficiaries, states, and both Medicare and Medicaid health plans. Though some changes may disrupt the duals鈥� market, others align state objectives with plan strategies. Ultimately, dually eligible individuals with full benefits will gain the most, experiencing improved opportunities to choose suitable plans, access necessary care, and achieve optimal health outcomes and well-being.
For further insights into these upcoming changes, view the聽D-SNP Growth and Integration: Key Implications of the 2025 CMS Final Rule聽webinar, featuring our experts below. Join them and other experts at 红领巾瓜报鈥檚 Fall Conference to stay informed about the strategic directions plans and states are pursuing.
Unlocking Solutions in the Medicaid, Medicare, and Marketplace programs
红领巾瓜报 is hosting its 2024 Fall Conference October 7鈭�9 in Chicago, IL. promises to enhance your ability to navigate and shape healthcare programs and systems, focusing on improving health and well-being.
In a landscape dominated by endless video meetings, the offers a refreshing change. Join us for an enriching experience featuring:
- Engagement with healthcare experts and thought leaders who are actively collaborating with stakeholders
- Participation in face-to-face discussions to exchange ideas and receive valuable feedback
- Opportunities to connect with peers who are committed to strengthening public programs and enhancing health outcomes
Keynote Address and Sessions
, from the Advanced Research Projects Agency for Health (ARPA-H), will deliver the Keynote Address. He and other speakers will inspire attendees to explore innovative healthcare programs and their potential impacts on healthcare delivery, reimbursement, and health outcomes.
The conference will feature a diverse array of speakers and participants, including C-suite executives from national, regional, and local health plans. Federal and state leaders joining panels will include:
- State Medicaid directors from New York, Iowa, New Mexico and Alabama
- State insurance commissioners
- Behavioral health agency officials
- State housing agencies
- Leaders from the US Interagency Council on Homelessness
The conference will include a revamped pre-conference workshop on October 7, featuring hands-on exercises and interactive sessions led by 红领巾瓜报 leaders. Sessions will include a value-based care contracting exercise, a value-based purchasing assessment discussion for providers, tips and tricks on navigating Medicaid section 1115 demonstrations, AI applications in healthcare, and more.
View the , including speakers confirmed to date.
Registration
Early bird registration聽is open until July 31. Don鈥檛 miss this opportunity to gain actionable knowledge, forge valuable connections, and discover fresh insights and best practices.聽Register now聽to secure your spot at the forefront of healthcare innovation.聽
Let鈥檚 Stop Doing Stupid Things: How Can We Scale Digital Healthcare Innovation to Ease the Burden on Patients and Providers?
Ryan Howells is a leading expert in digital health policy and interoperability from Leavitt Partners, an 红领巾瓜报 company. Ryan has been a catalyst for change since the early days of the internet to his current role in advancing consumer-directed health data exchange through application programming interfaces (API). In this episode, he discusses the evolution of digital health, the challenges of data accessibility, and the transformative potential of AI in healthcare. Whether you’re a healthcare professional or simply interested in healthcare innovation, this podcast offers practical solutions and visionary insights that can help reimagine the way we deliver and experience healthcare.
红领巾瓜报鈥檚 Medicare team unites consultants from multiple 红领巾瓜报 companies to assist clients in all aspects of Medicare
As 红领巾瓜报 has grown, we have added significant breadth and depth to our Medicare team to better offer our clients comprehensive expertise on Medicare, Medicare Advantage, Dual-Eligibles, payment systems, pricing, and more. When looking for a partner to help navigate the complexities and changes of Medicare, our clients know that by engaging 红领巾瓜报 experts they are engaging former CMS officials, former plan executives, payment system and coding experts, policy analysts, and many others. We draw on the resources of experts from our 红领巾瓜报 companies to provide comprehensive and end-to-end solutions, including and for actuarial services, and for political and policy engagement. Together we bring considerable expertise in all things Medicare and can leverage our more than 700 consulting colleagues across 红领巾瓜报.
Our world-class Medicare team partners with clients to meet their needs, address their challenges and improve their bottom line. We provide a variety of services such as:
- Significant support for Medicare Advantage (MA) plans and stakeholders seeking to understand MA policy and operational issues including strategy, market assessment, models of care, evaluation, and audit support.
- Support MA special needs plans (D-SNP, I-SNP, C-SNP, etc.) and programs for dual eligible beneficiaries.
- Medicare regulatory, analytics and thought leadership consulting services for MA plans, providers, suppliers, value-based organizations, associations, and foundations.
- Design, implementation, evaluation and analysis of Medicare value-based payment systems and policy issues.
- Program of All-Inclusive Care for the Elderly (PACE) strategy and operations.
- Strategic advice, policy development, and budgetary analysis for clients seeking assistance with Medicare reform efforts.
- Medicare coverage and reimbursement for device, drug and biotechnology manufacturers and other stakeholders in the life sciences community.
- Assistance for clients seeking to commercialize new technologies.
- MA and fee-for-service claims analysis and actuarial services with support from actuaries within 红领巾瓜报 plus actuaries from Wakely Consulting Group and Cirdan Health Systems and Consulting.
- Consulting and federal policy analysis, including Congressional Budget Office (CBO) scoring and legislative policy development with our colleagues from Leavitt Partners.
In 2021, 红领巾瓜报 acquired The Moran Company (TMC), which provides extensive expertise in the design, implementation, and evaluation of various healthcare payment systems, with a particular focus on the Medicare program. As we approach the 26th anniversary of TMC鈥檚 founding and the third anniversary of joining the 红领巾瓜报 portfolio, we want to honor the history and contributions of The Moran Company and remember the late Donald Moran who founded TMC in July 1998. He spent almost 50 years in the health policy community, including many years in government service, serving as executive associate director for Budget and Legislation at the U.S. Office of Management and Budget during the Reagan Administration.
Many of our TMC colleagues worked with Moran for more than a decade, benefiting from his mentoring and exhaustive knowledge of the industry. Since joining, TMC consultants have worked closely with our 红领巾瓜报 colleagues and the Medicare team in particular.
As of July 1, we are retiring the Moran brand and logo and fully integrating the company into 红领巾瓜报 as part of the Medicare team. We may be dropping the Moran brand name, but not the approach and diligence for which TMC is well known. In particular, 红领巾瓜报 will continue to use the same methodologies for Congressional Budget Office scores and Medicare data analyses that have characterized Moran鈥檚 work for more than 25 years.
View some of our recent work from our combined team:
Case Studies
- Appropriate payment for transformative therapies to secure patient access to CAR Ts
- Patient journey analysis for a new oncology drug
- Helping life science manufacturers navigate Medicare payment systems
Reports
Webinar
红领巾瓜报 helps Justice Involved/Behavioral Health services implement the Sequential Intercept Model (SIM)
The Sequential Intercept Model (SIM) provides a framework to help local governments divert individuals with behavioral health issues from the criminal justice system into community resources.
The model serves communities by helping them identify opportunities for diversion programs, known as 鈥渋ntercepts鈥�, with the highest potential for success based on community strengths and needs. Created by Policy Research Associates in 2004 and promoted by SAMHSA鈥檚 GAINS Center, SIM identifies critical diversion points tailored to each community’s strengths and needs.
Key Benefits of Implementing SIM
Guides ongoing stakeholder meetings and county programming by establishing a common language for justice and diversion programs to support sustainability and adaptability over time.
Supports community analysis and integration of new policies by providing a clear visualization of system resources and gaps.
Facilitates collaboration and ensure efficient use of resources by enhancing communication and relationships across systems.
Collects local data for system analysis to identify grant opportunities and funding for critical intercept program development.
Development of a SIM report that highlights current state, gap, and opportunities for improvement.
Educates county leaders on best practices to help assess new programs and identify areas for improvement.
Addressing Community Challenges
SIM supports development of community prevention programs that lower the chance of initial involvement into criminal justice for many, helping provide the needed level of treatment support. The framework further allows jurisdictions to develop meaningful and effective programs to address issues faced by justice-involved individuals, such as unstable housing and income, high overdose risks, and the impact of evolving policies. Many existing programs lack sustainability due to reliance on temporary funding, and traditional planning has been reactive rather than proactive. SIM offers a comprehensive framework for communities to support individuals with behavioral health issues, improving safety and resource efficiency.
红领巾瓜报’s services include:
- Facilitating stakeholder meetings and data collection.
- Mapping current systems and identifying key intercepts.
- Developing SIM reports to highlight gaps and opportunities.
- Leading strategic planning for program development.
- Setting measurable goals and evaluation plans.
If you are ready to talk about implementing a SIM and the next steps for your organization, reach out to our experts today.
Contact our experts:
Jessica Perillo
Senior Consultant
红领巾瓜报 helps organizations prioritize, identify, win, and implement grant funding
Grants from both government and foundations can be an essential component of a provider鈥檚 growth strategy. Every year billions of dollars are distributed to support program growth, quality improvement, training, and other essential needs. 红领巾瓜报 works with a wide variety of healthcare clients, including Federally Qualified Health Centers (FQHCs), community-based organizations, hospitals, provider practices, behavioral health, and managed care organizations.
How 红领巾瓜报 can help
is a subscription service that provides clients with a customized and curated list of grant opportunities. Finding the right opportunities and applying for grants that are aligned with your organization鈥檚 strategic growth interests can be an essential catalyst for organizational development, service continuum growth, and quality improvements. 红领巾瓜报鈥檚 Grant Prospector monitors over 200 government agencies and nearly 100 foundations and sends appropriate opportunities to subscribers weekly.
红领巾瓜报鈥檚 experience has taught us that grants can be a wonderful way to grow an organization if (and only if) the organization is strategic about what grants it pursues and what services it uses grant funding to build. Your strategy should guide your grant pursuits, not the other way around. 红领巾瓜报 can help your organization devise a strategy for organizational growth using grants as a catalyst for long-term sustainability.
红领巾瓜报鈥檚 deep pool of grant writers enables us to assign teams with precision, ensuring our clients have access to specific relevant expertise. 红领巾瓜报鈥檚 grant writing services are most valuable when a provider needs help designing a program model, complying with complex grant requirements, and navigating strategic challenges in grant writing.
During the 2023 round of CCBHC expansion grants, 红领巾瓜报 clients invested $956,000 in 红领巾瓜报 grant-writing support. Those clients won 20 awards totaling $80,000,000, for a return on investment of 8,272%.
For clients who prefer to write their own grants, 红领巾瓜报 can provide subject matter expertise to enable strategic decision-making and program design. 红领巾瓜报 consultants can join early calls to help the client design a program model that complies with the grant requirements, ensures operational sustainability, and addresses the complexities of the procurement.
For clients who prefer to write their own grant applications, 红领巾瓜报 can provide a mock scoring service. 红领巾瓜报鈥檚 reviewers provide a detailed review and score for the submission, enabling the client to identify any place where points are likely to be deducted. We advise sending a draft to 红领巾瓜报 at least a week or two before the application is due so that 红领巾瓜报鈥檚 feedback can be integrated before submission.
Many grant applications require a detailed assessment of the community鈥檚 need for the services being funded. Our experts can help gather both quantitative data and qualitative stakeholder input to ensure that the client鈥檚 grant application targets the populations, communities, and gaps in service for which grant funds will be most impactful.
红领巾瓜报鈥檚 accounting and actuarial colleagues can provide budget and cost report development support when the demands of a grant application outstrip the capabilities and/or bandwidth of the client鈥檚 finance team.
Many grants come with complex implementation and reporting challenges. 红领巾瓜报鈥檚 experts have the benefit of the experience of hundreds of grant implementations, which enables us to help our clients comply with myriad implementation and reporting requirements. 红领巾瓜报鈥檚 project managers help our clients ensure that grants get implemented on time, on budget, and in compliance with funders鈥� requirements.
红领巾瓜报 has a team of experienced program evaluators who help our clients implement with fidelity, assess impact and outcomes, and comply with grant evaluation requirements. Our evaluators are facile with program outcome data as well as the demands of rigorous stakeholder input.
fundraising resources
more grant funding insights from hma
Reach out to our experts for more information on how 红领巾瓜报 can help your organization鈥檚 grant and funding strategies.
Contact our experts:
红领巾瓜报 knows rural.
Some live in rural areas in the U.S. Many rural residents must navigate healthcare system challenges people living in urban and suburban areas generally do not face. Developing and supporting rural health programs requires understanding the unique characteristics of rural settings and how these dynamics influence healthcare policy, providers, payers, consumers, and health equity.
红领巾瓜报 understands the multilevel challenges for delivery of quality healthcare and social services to rural populations. From workforce concerns to access issues such as lack of services, transportation difficulties, and socio-economic barriers, we know the difficulties that often keep rural providers and organizations from achieving their full potential to serve and support their communities鈥� needs.
Changing dynamics in many rural areas also create the need for building awareness and understanding of issues of equity and reducing disparities and how to effectively address them in rural communities. 红领巾瓜报 has the hands-on knowledge for practical solutions.
红领巾瓜报 brings together industry-leading policy, program, financial, community, and clinical experts to provide comprehensive solutions that make healthcare and human services work better for people living in rural and frontier areas across the country. With deep experience and through skilled analysis, guidance and technical know-how, our consultants help a wide range of clients successfully navigate the healthcare space. Our team is more than 900 members strong and growing, with expertise that spans the healthcare industry and stretches across the nation.
We offer a full suite of professional health and human services consulting services to clients serving rural and frontier communities, such as:
Critical Access and PPS Hospitals
Federally Qualified Health Centers, 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
Our national, multisector, multisystem experience in healthcare and human services enhances our ability to support rural clients in making sustainable, positive impacts in their local communities. Whether your project has run into a snag in the final stages or hasn鈥檛 even gotten off the ground, we can provide the expertise and guidance to help you make it a success.
Our areas of expertise include:
Analytics
Behavioral Health
Care Integration
Clinical Services
Community Strategies
Crisis Systems & 988
Government Programs & the Uninsured
Healthcare Actuarial Services
Healthcare Delivery Development & Redesign
Healthcare IT Advisory Services
Investment Services
Justice-Involved Healthcare
Long-Term Services & Supports
Managed Care
Opioid Crisis Response
Public Health
Quality and Accreditation Services
Value-Based Care
Workforce development
PROJECT SPOTLIGHT
Health Equity & Access for Rural Dually Eligible Individuals (HEARD) Toolkit
With funding from Arnold Ventures, 红领巾瓜报 created the HEARD Toolkit, a robust discussion of the access challenges facing dually eligible individuals in rural areas and a portfolio of actionable solutions to address these challenges. Dually eligible individuals in rural areas reside at the intersection of a major public health crisis and a fragmented Medicaid and Medicare delivery system. They experience poor access to services and to integrated care programs (ICPs) to address their whole person needs.
红领巾瓜报 designed this Toolkit to help policymakers address access issue dually eligible individuals in rural areas have to navigate every day. For example, addressing access must encompass getting to a comprehensive Medicaid and Medicare services continuum that includes home- and community-based services (HBCS), as well as ICPs. A primary focus on equity can help states, local communities, payers, and providers begin to address issues of access for these very vulnerable individuals in rural communities. The Toolkit provides examples and ideas for rural providers and communities to address equity and improve services and supports for dually eligible individuals.
For example, 红领巾瓜报 can assist rural communities and the organizations that support their needs with:
Rural-specific workforce solutions
Programs addressing Social Determinants of Health/Health-related Social Needs
Payment system reforms
Development of integrated care programs for Dual Eligibles
Substance Use Disorder/Opioid Use Disorder prevention, treatment, and recovery services
Behavioral health services and supports
Justice-involved carceral healthcare and transitions
Long-term services and supports and home and community-based services
红领巾瓜报 understands the multilevel challenges for delivery of quality health care and social services to rural populations. From workforce and care access issues to transportation difficulties and technology barriers, to socio-economic differences, we can help rural providers and organizations overcome challenges and achieve their goals to serve and support their communities鈥� needs.
Other Rural Health Project Examples:
红领巾瓜报 is supporting review and reform of the primary care payment environment in New Mexico working under a contract with Mercer. New Mexico鈥檚 Medicaid program had identified multiple challenges the primary care providers faced across the state, including rural sustainability and fiscal soundness. 红领巾瓜报鈥檚 approach includes coupling data analysis with stakeholder engagement. Our work to date includes designing, testing, and evaluating new primary care alternative payment models (APMs); fiscal, policy, and/or programmatic implementation recommendations related to the multi-payor roll-out of a primary care APM; and supporting primary care practitioners related to NM Medicaid APM implementation. Additional project work will include more provider specific analysis, recruitment for pilot testing and provide education, analysis and training for providers, health plans and state regulators.
红领巾瓜报 is working with the Colorado Department of Health Care Policy and Financing (HCPF) to perform a dynamic heat mapping as the first phase of a three-phase project that includes an environmental scan of home and community-based services (HCBS)/Medicaid. 红领巾瓜报 is creating a tool that HCPF can leverage to update and track progress to close provider gaps. In subsequent work 红领巾瓜报 will identify potential geographic regions which would benefit from reimbursement structure changes, including geographic adjustment factors to apply to preexisting fee-for-service rates or other mechanisms to effectively address identified care gaps. Based on these results, 红领巾瓜报 will recommend strategies and best practices to expand the provider network in rural areas to avoid care deserts and assure access to services for all Medicaid members.
Over the past six years, 红领巾瓜报 has supported tribal communities in Montana with an array of data and evaluation expertise specific to behavioral health system assessments and evaluation activities. To date, we have conducted feasibility assessments for tribes considering options to 638 their behavioral health services, evaluated high-fidelity wraparound services in tribal communities through the Montana Systems of Care program, supported efforts to discern a concept design for a joint tribally operated Substance Use Disorder (SUD) Continuum of Care, and assisted tribally operated clinics in best practices in opioid prescribing and addiction treatment.
The Georgia Health Policy Center provides technical assistance for grantees of HRSA鈥檚 Rural Health Programs. 红领巾瓜报 created a and additional tools, including a webinar, designed to inform and support rural provider leadership on Value-Based Care. The primer serves as a self-paced guide helping organizations consider national trends and experiences, assess their current state and readiness, understand benefits and barriers of Value-Based Care. The primer and tools are used by the technical assistance team and rural health grantees.
红领巾瓜报 has worked with HSHS for over 10 years, providing a wide range of services including:
Grant surveillance related to strategic plans, project management, grant program development, and narrative writing for multiple state and federal grants including USDA, HRSA, and SAMHSA.
Expanding access to medication assisted treatment (MAT) in emergency departments by activating a team of 红领巾瓜报 experts to implement a global assessment of readiness to adopt MAT, create a comprehensive training curriculum, assist with development of policies, workflows and standardized orders; and provide technical assistance required to address stigma and implement change. 红领巾瓜报 also aided in writing the successful proposal for state funding for this project.
Stakeholder engagement for a hub-and-spoke model of telehealth network, assessed strategic priorities across multiple diverse stakeholders, and developed a strategic plan for HSHS鈥� Wisconsin rural healthcare provider telehealth network.
Development of the Illinois Telehealth network composed of 21 rural healthcare providers across Illinois. 红领巾瓜报 provided technical expertise on the adoption of telehealth services and the development of clinical protocols and led strategic planning efforts. The network now functions to support the members in disseminating best practices, implementing telehealth service lines, sharing clinical protocols, removing barriers, and promoting evaluation.
红领巾瓜报 is currently assisting HSHS鈥� rural behavioral health team in devising new models of community-based withdrawal management processes consistent with recent changes in Wisconsin鈥檚 regulations. 红领巾瓜报 experts on residential substance use disorder and integrated care provide technical assistance, training, and evidence-based policy development.
红领巾瓜报 supported the Texas Department of Agriculture, State Office of Rural Health (SORH) by leading SORH鈥檚 three-year strategic plan and design future programs. For the needs assessment, 红领巾瓜报 conducted a systematic assessment that included an environmental scan of rural health key issues and trends, online survey of rural Critical Access Hospitals (CAHs) and prospective payment systems (PPS) hospitals in Texas identify needs and gaps, and an analysis of publicly available data to identify health needs and differences between rural and urban residents. Informed by this assessment and close collaboration with SORH staff, 红领巾瓜报 developed a strategic plan to guide the next three years of SORH鈥檚 programming, as well as created work and evaluation plans for the SORH and Flex grant programs. Other tasks included assessment of Texas rural hospital telemedicine readiness, recommendations for value-based payment models for rural hospitals, and opportunities to support rural hospitals in reducing health disparities.
Our depth and breadth of experience has helped a diverse range of healthcare industry leaders focused on rural and frontier areas. What can we do for you?
Contact our experts:
Shannon Brown Joseph
Senior Consultant
Rebecca Kellenberg
Principal
Jill Kemper
Senior Consultant
Margaret Kirkegaard
Principal
Sarah Oachs
Associate Principal
The Health Equity & Access for Rural Dually Eligible Individuals Toolkit: Raising Rural Voices
A public health crisis is growing more acute in rural America, disproportionately impacting individuals with both Medicaid and Medicare (the 鈥渄ually eligible鈥�). Dually eligible individuals residing in rural areas represent about 5 percent of all rural residents. They reside at the intersection of a public health crisis and a fragmented Medicaid and Medicare care delivery system. , this small population is at risk of falling through the cracks of this crisis and suffering a steep rural mortality penalty.
With support from Arnold Ventures, 红领巾瓜报 prepared 鈥淭he Health Equity & Access for Rural Dually Eligible Individuals (HEARD) Toolkit: Raising Rural Voices from New Mexico, North Dakota, and Tennessee to Create Action. The toolkit contains eight actionable solutions for federal and state policymakers to use and tailor to states鈥� needs. Ellen Breslin, Samantha Di Paola, and Susan McGeehan authored the toolkit, with research contributions from Rebecca Kellenberg and Andrea Maresca.