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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 量子资源s are ready to partner with you, from initial strategy-setting through听implementation.

Related Resources

Learn more about our Strategy & Transformation services

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 量子资源s:

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 量子资源ise 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 services

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 量子资源s:

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 量子资源ise 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 services, 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 services 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 services

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 量子资源s:

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 量子资源ise 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 services, 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 量子资源ise 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 services consulting services 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 services and engagement, provider network development and provider services, 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 services 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 services 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 量子资源s:

Sarah Arvey

Associate Principal

Sarah Arvey is a trained medical anthropologist and qualitative researcher with 量子资源ise 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 量子资源ise 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 services 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 量子资源ise from decades of working with states and federal agencies prior to joining HMA. We offer the range of services 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 量子资源ise 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
听
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.
听
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.
听
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 services and behavioral health linkages. HMA helps clients build administrative capacity, information technology, pre-release services, 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 services, behavioral health links, Enhanced Care Management (ECM), and Community Supports services.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 services 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 services 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 services (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 量子资源ise

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 量子资源s 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 services … 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 量子资源ise.

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 量子资源ise 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鈥檚量子资源 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 量子资源s 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 services 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 services

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 services and measure their impact and value

Improve the quality and accessibility of services you offer.

Identify potential partners with whom to collaborate to expand new and existing services

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 services 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 services 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 量子资源s 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 services

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

Program development, strategic planning, and technical assistance 量子资源s 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 量子资源 at HMA

HMA bring together 量子资源s from a full spectrum of reproductive health services 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 services, 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 量子资源ise.

Contact our 量子资源s:

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 量子资源ise in population听health, quality improvement, and practice operations to … Read more

HMA can help your community prioritize and plan Opioid Settlement Fund expenditures

HMA partners with state, county, and local government entities nationwide to strategically allocate opioid settlement funds, driving impactful solutions for opioid use disorder (OUD) and overdose prevention. Through collaboration with policymakers, engaged stakeholders, and community members, we help clients develop funding priorities that enhance public health outcomes and improve quality of life. Our team has extensive experience working with counties across the U.S. to design and implement effective OUD programs. By fostering partnerships with clients, community advisory boards, and local organizations, we co-create community engagement strategies, tools, and plans that ensure meaningful participation in decision-making and sustainable program success.

We have a successful track record developing strategic expenditure plans for opioid abatement settlement funds that align with key funding priorities to drive measurable improvements in quality of life for individuals experiencing OUD and to implement effective overdose prevention initiatives.

How HMA can help

Community-Driven Fund Allocation 鈥� Effective use of opioid settlement funds depends on robust community engagement and feedback, ensuring investments align with local needs and priorities.

Expert Facilitation of Consensus Building 鈥� HMA鈥檚 unique ability to navigate complex community dynamics enables us to diffuse tensions, validate diverse perspectives, and drive stakeholder alignment for impactful decision-making.

Data-Backed Strategic Planning 鈥� Our comprehensive data collection and analysis identify persistent challenges, best practices, and targeted actions across the continuum of care (prevention, intervention, and treatment), culminating in a final report that informs sustainable solutions.

Elevating Community Voices 鈥� We prioritize the insights of individuals with lived experience, healthcare providers, and tribal partners to ensure funding priorities reflect the real needs of those affected by OUD.

Blueprint for Sustainable Impact 鈥� The expenditure plan serves as a strategic manual for the effective use of opioid settlement funds, integrating state requirements with community-driven priorities to maximize long-term success.

OUR EXPERTISE

With deep 量子资源ise in opioid settlement fund expenditure planning and a proven track record of success, HMA is uniquely positioned to help organizations nationwide design and implement effective OUD programs. Our team brings unparalleled experience in strategic planning, community engagement, and policy development, ensuring that funding is maximized for sustainable impact. We leverage strong partnerships and customized engagement strategies to drive data-driven, community-centered decision-making.

For recent examples of our work:

Lake County, California

Cabbarus County, North Carolina

Contact our 量子资源s:

Charles Robbins

Principal

Charles Robbins has been transforming communities for the past three decades. His extensive community-based organization career spans healthcare, child welfare, … Read more

Increasing the Cultural and Linguistic Accessibility of Services

in Health and Healthcare frame how to improve healthcare quality and reduce disparities through a whole-person approach. Implementation of the CLAS standards demonstrates respect for individuals and responsiveness to their health needs, cultural beliefs and practices, preferred languages, and other communication needs. These standards guide the provision of high-quality care to people from all cultures and backgrounds, as well as persons with disabilities and rural populations. The 15 CLAS standards focus on governance, leadership, workforce, communication, language access, engagement, continuous improvement and accountability.

Quality

Provide services that are responsive to diverse backgrounds across the US

Equity

Reduce persistent health disparities experienced by racial, ethnic, linguistic, sexual, and gender minorities; persons with disabilities; and rural populations

Experiences of Care

Respect the whole individual and respond to the individual鈥檚 health needs and preferences

Cost

Reduce total cost of care by addressing health disparities

WHY CARE ABOUT CLAS?

In 2022, Forbes reported that health inequities cost the US health system $320 billion now and could reach $1 trillion by 2040

What We Do

Our 量子资源s work with states, Certified Community Behavioral Health Clinics (CCBHC), behavioral health organizations, health systems and providers, health plans, and public health organizations to develop CLAS programs, assess gaps in the cultural and linguistic accessibility of services across a system, and provide tailored technical assistance and trainings. Adherence to CLAS standards is required by the Substance Abuse and Mental Health Services Administration (SAMHSA) for initiatives like the CCBHC model due to its positive impact on programming, outcomes, and disparity reduction.

Our CLAS Work

Indiana Statewide Evaluation of Community Mental Health Center (CMHC) CLAS Compliance

HMA completed a comprehensive assessment of Indiana鈥檚 24 CMHCs to evaluate the strengths and needs regarding CLAS standards. We provided coaching, technical assistance, and webinars to support the CMHCs to set goals, build action plans, operationalize CLAS standards, and align CCBHC demonstration preparation and CLAS efforts.

Delaware Division of Substance Abuse and Mental Health (DSAMH) CLAS Training & Mini-Grants

HMA collaborated with DSAMH to develop a strategy to increase cultural responsiveness of substance use disorder (SUD) services. This included implementing a CLAS mini-grant program to provide technical assistance and training for SUD services. We developed and delivered a CLAS 鈥渢rain-the trainer鈥� curriculum for staff, focusing on culturally and linguistically responsive opioid use disorder (OUD) services for African American and Latine communities. We also created a CLAS standards assessment to frame community-based organization and provider improvement strategies.

CCBHC Transformation Projects Across the Country

Disparity reduction is key to the CCBHC model. Nationally, the HMA CLAS team offers technical assistance to states on how to embed CLAS standards into planning grant and demonstration grant applications. For states that have been awarded CCBHC funding, we can provide training on how to incorporate CLAS standards and disparity reduction strategies into various aspects of their operations. These include community needs assessments, advisory boards, policies and procedures, staff training, program operations, state administrative codes, quality improvement and assurance initiatives, as well as data collection and analysis processes.

Our CLAS Approach

HMA鈥檚 team tailors its support based on each client鈥檚 needs. HMA takes the following general approach to assess and implement CLAS standards:

Assess CLAS standard gaps at organization, system or state level focused on the three CLAS domains: Governance, Leadership and Workforce; Communication and Language Assistance; and Engagement, Continuous Improvement and Accountability

Provide tailored technical assistance and coaching to close gaps drawing on our team鈥檚 cultural and linguistic diversity and lived experiences with services that are inaccessible to persons with disabilities, as well as persons from racial, ethnic, linguistic, cultural, sexual, and gender minority groups

Design and facilitate training and webinars to address wide scale gaps. Webinar topics may include – using Continuous Quality Improvement (CQI) processes to reduce disparities; increasing language access through translation and interpretation best practices; how to use community needs assessments to identify disparities; and structuring advisory boards for maximum impact

Assist programs and states in developing a CQI strategy to monitor and adjust initiatives to ensure CLAS and disparity reduction initiatives are making demonstrable change

Contact Our Experts:

Nora Carreras

Associate Principal

Nora Carreras is a proven leader and team builder with 量子资源ise in social determinants of health (SDOH) and non-profit management. … Read more

Rachel Johnson-Yates

Associate Principal

Rachel Johnson-Yates is a licensed mental health and addiction counselor, public speaker, and educator with a demonstrated track record of … Read more

Leticia Reyes-Nash

Office Managing Principal

Leticia Reyes-Nash is an accomplished, innovative executive leader with 20 years of experience leading policy advocacy, projects, and community engagement, … Read more

Reem Sharaf

Senior Consultant

Reem Sharaf is a licensed clinical social worker and behavioral health leader with 15 years of experience in program development … Read more

Madeleine (Maddy) Shea

Principal

Maddy Shea has a passion for health equity and the federal, state and local cross-sectoral 量子资源ise to guide community health … Read more

Doris Tolliver

Managing Principal

Doris Tolliver is a strategic thinker specializing in racial and ethnic equity, organizational effectiveness, change management, and business strategy development. She … Read more

HMA works with states to add Respite Care programs

Expanding access to medical respite care for individuals who are unhoused or have no stable housing and are too ill to be discharged to the streets but not sick enough to stay in the hospital and require some supports to recover from their illness or injury.

Medical respite, or recuperative care, according to the National Institute of Medical Respite Care (NIMRC) is 鈥渁n intervention that provides post-acute medical care for individuals experiencing homelessness who are not sick enough to warrant hospitalization, but who are too frail or ill to recover safely in a shelter or on the streets.鈥�

Respite care benefits both providers and patients and saves money. According to a , respite care results in a 24% reduction in Medicaid cost per enrollee, 30% decrease in hospital admissions, 38% reduction in emergency department visits, and a 92% attendance rate at follow up appointments within 30 days of hospital discharge.

Medical respite is not a housing service. Housing support services like housing stability, shelter, and supportive housing are critical components of the housing support system. Medical respite is the bridge and a safe transition from the medical care system back to the community and other needed services and supports. By providing a safe bed, clean restrooms, nursing assistance, and healthy meals, medical respite services can improve health outcomes and begin a process of addressing other critical health-related social needs, such as stable housing.

HMA offers a full suite of professional health and human services consulting services to organizations across the country. In Minnesota, HMA helped write the legislation that helped Minnesota Medicaid give coverage for respite care and has 量子资源ise in creating this model that can be used in other states. Many states lack this benefit and even in Minnesota, where it is now covered, there is a shortage of providers.

Project Spotlight: Minnesota Recuperative Care Benefit

THE TASK:

Legislation was passed requiring Minnesota鈥檚 Department of Human Services (DHS) to create a recuperative care benefit through Medicaid. Stakeholder engagement to discuss Medicaid options and to define the benefit. Recuperative Care was not well developed in MN and there were few beds operating in the state.

HOW WE HELPED:

HMA engaged interested individuals as guided by DHS. This included interviewing individuals with lived experience. Our Medicaid and recuperative care SMEs walked everyone through understanding the service and defining the service. In addition, we educated interested parties about the pathways in Medicaid including a state plan amendment and the various waiver options. The group came to consensus with DHS on a state plan amendment. HMA wrote the legislative language and report to support this direction.

THE OUTCOME:

The legislative language was approved. The state plan amendment was submitted and approved by CMS. Recuperative care is now a Medicaid benefit in Minnesota.

HMA can help states, providers, and communities create this benefit, implement effective respite services, and adapt the set of national standards for Medical Respite given your state and community needs including:

Safe and quality accommodations

Environmental services

Care transitions into medical respite from other settings

Access to high quality post-acute clinical care

Care coordination and wrap-around services

Safe care transitions out of medical respite to the community

Quality improvement

HMA can also provide technical assistance, help with alternate payment models, workforce and strategic planning to support respite care.

Contact our 量子资源s:

Tia Cintron

Managing Director, Housing and Health Solutions

Tia Cintron听is a seasoned executive with over 35 years of experience in housing and healthcare. She has led impactful programs … Read more

Kenneth Cochran

Principal

Ken Cochran is a healthcare executive with more than 20 years of experience leveraging his clinical, business and academic background … Read more

Paul Fleissner

Managing Principal

Working to integrate services across systems and communities, Paul Fleissner is a seasoned executive who has developed programs and policies … Read more

Margaret Kirkegaard

Principal

Dr. Margaret Kirkegaard has extensive front line experience and an impressive breadth of knowledge about healthcare and its delivery. A … Read more

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

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Realize transaction-related cost synergies

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Achieving financial resilience in a time of turbulence

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Building Sustainable Health Systems

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Five Critical Priorities for Transformation

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HMA Spotlight

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

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HMA Helps NEMT Stakeholders Overcome Challenges

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 services (EMS)

Transportation insurance providers

Medicaid beneficiary and disability advocacy organizations

Investors/private equity firms

Studies
and Analyses

State Tracking
and Trends

Market and
Growth Analyses

Actuarial
Analyses

Quality
Improvement