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Commitment. Innovation. Results.
HPM’s key service offerings, include, but are not limited to
The HPM team understands the complexities of organizing integrated care for the Medicaid population, dually eligible individuals, and Medicare Advantage beneficiaries. We have assisted states and private sector organizations in writing demonstration applications, D-SNP Models of Care, Request for Proposals and grants.
Innovative Medicaid Managed Care Program Design, Development and Evaluation
HPM’s sample engagements illustrate our broad experience in Medicaid Managed Care.
From strategic planning, business development and project design to quality improvement initiatives and efforts to address disparities in health care delivery, HPM provides clients with support that improves outcomes, efficiency, satisfaction and cost-effectiveness of care. We consistently combine research and evidence-based knowledge, client-specific data, best practices and our appreciation for our clients’ organizations into our work to offer you value. Our clients consistently work with senior members of our team.
Managed and authored a highly competitive winning Behavioral Health (BH) RFP to deliver care coordination services to the Medicaid population. Re-designed major aspects of the program to offer a competitive bid in collaboration with the BH Centers’ staff.
For a major hospital system in New York State, HPM managed the development and implementation of evidence-based, data-driven care coordination and transitions of care programs under a DSRIP waiver.
For a health care foundation developed a tactical approach to health care disparities. HPM developed an evidence-based, data-driven tool kit to educate providers and MCOs about inequities in health care delivery including data-driven strategies to uncover and address inequities.
For a Community-Based Organization (CBO), HPM created cross-sector relationships between this local organization and seven major ACOs by negotiating fully-CMS compliant contracts to deliver medically tailored meals, based on clinically negotiated criteria, to Medicare Advantage and ACO consumers. This effort bridged new relationships between the CBO and the insurance industry, making a new type of HRSN available to chronically ill consumers.
For a multiple Behavioral Health (BH), Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs) and D-SNPs, we have developed integrated models of care to serve individuals at high-risk and high-cost for poor outcomes as a result of their health care needs.
For a Federally Qualified Health Center (FQHC), HPM successfully evaluated the organization’s strategic plan, developed a new five-year plan and assisted the organization in moving forward. We further conducted a plan to move forward post-COVID, taking advantage of opportunities to re-organize and leverage health center resources as part of the end of the Public Health Emergency.
For multiple behavioral health (BH) organizations, HPM developed best practice Transitions of Care (TOC) models of care. Designed integrated care management models with ACOs to enhance a states’ BH care management program.
For the State of Michigan, HPM participated as a subject matter expert and generated recommendations to limit the spread of COVID-19 in nursing homes at a critical time in the COVID-19 pandemic.
HPM conducted best practice research on LTSS programs including waiver options and made recommendations to reconfigure a states’ LTSS service delivery system.
HPM provided technical assistance to help a state integrate primary and BH care working with clinical leaders at a major teaching hospital.
HPM facilitated the development of a new Primary Care Case Management Program (PCCM) including a care management model, value-based purchasing strategies and incentive-based metrics under the leadership of a senior state official and 22 physician leaders.
RFP/Application Pre-bid Strategy Development, Writing and Mock Reviews
HPM’s support consistently results in winning RFPs and applications for clients.
HPM supports the design, development, and writing of applications to win new business for MCOs, ACOs, SNPs, BH organizations, LTSS organizations and CBOs. Our knowledge of proposal, application and grant writing, combined with our ability to assist with competitive strategy, can help you increase your win rate and process.
To develop winning bids and applications, HPM offers:
For a SNP start-up, HPM facilitated a complex process with clinicians and executives and designed all four sections of a Model of Care (MOC) for submission to CMS which resulted in a 3-year contract award.
For a state-wide Medicaid MCO that serves dually eligible individuals with disabilities under age 65, HPM facilitated input at all levels and designed and documented a winning RFP submission.
For a MCO, the HPM team collaboratively designed, developed and documented three ACO bids, all of which were awarded contracts. HPM negotiated delivery system design and care coordination models with each of the three ACOs and documented models accordingly.
For multiple BH organizations, HPM designed winning proposals for BH organizations to participate in the Massachusetts Community Partner Program. HPM facilitated and influenced the development of clinical, governance, operational and other elements of program design for these successful proposals. HPM was invited to develop proposals for v 2.0 of the BH Community Partner Program with a complete re-design of this effort and wrote another winning proposal in a highly competitive environment where 40% of all bidders were not awarded contracts.
Financial Analysis, Planning and Support including Value Based Payment (VBP) Design, Revenue Cycle Management and Contracting
HPM’s team is skilled at understanding the interaction between program design and finance with significant and practical VBP expertise.
HPM works with clients to help them understand and act on the financial implications of integrated care program development and implementation and value based incentives. Our team includes financial experts who collaborate with program designers to fully understand different elements of financial planning at the organizational, staff and network levels.
For an integrated provider network, HPM led a clinical workgroup to create a value based funds flow model and a performance incentive plan as part of a population health model.
For a large cardiovascular Medical Services Organization, HPM led the financial turnaround via revenue cycle related improvements. HPM further revised clinical and referral workflows and updated payor network agreements.
For multiple BH organizations, HPM assisted BH organizations to maximize revenue based on unique payer requirements across all settings (inpatient, outpatient, FQHC, PHP, county).
For a Medicaid MCO, HPM developed a financial model with multiple scenarios and assumptions to evaluate and bid on all costs associated with a start-up MCO program for dually eligible individuals including staffing, administration, Medical Loss Ratio and potential for risk and value-based incentive reimbursement.
For a large Regional Health Network, HPM developed and implemented an integration strategy under which the network entered its first advanced payment structures.
For a start-up provider organization, HPM developed financial and operating projections including budgets and capital expenditures for new BH services lines and programs.
For an FQHC, HPM evaluated the Total Cost of Care (TCOC), utilization, quality metrics and interpretation of contract terms to demonstrate and recommend risk-based annual performance calculations.
For multiple FQHCs,, HPM is evaluating commercial contracts to determine the revenue impact of the age and terms of such agreements. HPM will further renegotiate contracts for the FQHCs to obtain current financial and operational terms for their commercial business.
HPM further evaluated the Total Cost of Care (TCOC), utilization, quality metrics and interpretation of contract terms to demonstrate and recommend risk-based annual performance calculations.
Long Term Services and Supports
HPM’s team is skilled at understanding the interaction between program design and finance with significant and practical VBP expertise.
HPM works with clients to identify, plan and design Long Term Services and Supports under various types of waivers, based on population neesd. Our firm works with populations of individuals with physical, intellectual, developmental and behavioral health challenges. Our approach is data-driven and evidence-based and seeks to identify the most appropriate LTSS for different populations and their families to thrive in their communities in a manner that is both person-centered for the individual and cost-effective for states. Our team includes a data scientist who analyzes the impact of different benefit designs, in-lieu of benefits and use of different waivers to achieve goals and objectives. In particular, HPM has expertise in planning innovative care management and care coordination design for individuals with Intellectual and Developmental Disabilities (I/DD).
For an MCO in a largely rural state and their I/DD partners, developed a ground-breaking Model of Care for individuals with I/DD. Evaluated regulatory frameworks, gathered stakeholder input and worked across sectors to negotiate options to deliver person-centered, integrated care to this hard-to-serve population with a focus on bridging relationships across CBOs and the MCO. Negotiated multiple terms and agreemnents to incrementally obtain gain agreement on new care coordination methods from both the MCO and the I/DD provider community.
For a large MCO in an urban area, lead the design of and authored a successul RFP bid to serve dually eligible individuals with disabilities. Developed an integrated model with payment incentives. Responsible for all aspects of bid development including LTSS/HCBS design, care coordination with Agency on Aging (AAA) providers and financial incentives.
Authored two D-SNP Models of Care (MOC). Played a key role in developing the Models and integrating existing care delivery mechanisms within Medicare Advantage a nd Medicaid products with the Models. Advised the client on all aspects of LTSS, HRSN and other needs of dually eligible individuals.
Participated in multiple LTSS projects in a mid-western state to review best practices nationally a redesign the states’ LTSS program. Authored a Comprehensive Assessment and provided design elements for the State to adopt going forward.