HPM offers deep analytic capability, with strong experience cleaning and reviewing claims, encounter, quality and other data sources to identify, measure and address root causes of challenges in healthcare delivery for Medicaid and dually eligible consumers.
The HPM teams’ work is evidence-based and data-driven. HPM conducts a wide variety of research to support clients including best practice literature reviews, workflow analysis, focus group forums, expert interviews, and best practice program reviews.
The HPM teams’ service offerings, include, but are not limited to:
As a CalAIM vendor, HPM provides Technical Assistance and consulting services to CalAIM primary care providers, Community-Based Organizations, Federally Qualified Health Centers and others who serve the Medicaid and dually eligible populations. We have also provided technical assistance nationally in New York State and Massachusetts among other locations.
Innovative Medicaid Managed Care Program Design, Development and Evaluation
HPM’s sample engagements illustrate our ability to deliver value for your purchasing dollar, using our many years of 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 supports our clients’ ability to achieve improved outcomes, efficiency, satisfaction and cost-effectiveness of care. We consistently combine data analysis, best practice research, evidence-based knowledge, and our understanding of our clients’ organizations to optimize the value of our services.
Senior members of the HPM team consistently work with our clients; you can rely on consistency in your selection of HPM as your consultant and who performs work to meet your needs. HPM offers value for your purchasing dollar.
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 DSRIP.
For a Community-Based Organization (CBO), HPM created cross-sector relationships with seven major ACOs. Negotiated contracts to deliver medically tailored meals, based on clinically negotiated criteria, to Medicaid and dually eligible consumers. This effort bridged new relationships with industry and created new funding streams for the CBO.
For a multiple Behavioral Health (BH), Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs) and D-SNPs and states, we developed integrated models of care management including physical, medical, behavioral and social supports as well as Transition of Care models, 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, in collaboration with the CEO and the Board, an FQHC’s strategic plan. We recommended a new five-year plan and assisted the organization in moving forward in implementing HPM’s recommendations.
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 to design and document a D-SNP Model of Care (MOC), resulting in a 3-year contract award.
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 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 for an initial bid and a re-bid that required substantial redesign.
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 helps clients understand and act on the financial implications of integrated Value-based Payment (VBP). We help clients understand VBP options and model 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 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 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 improvements and calculations.
For multiple FQHCs, HPM evaluated commercial contracts to determine the revenue impact of the age and terms of such agreements. HPM renegotiated contracts with significant revenue gains.
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 needs. Our approach 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. 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, urban MCO, lead the design of, and authored, a successful 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 Agencies on Aging (AAA) and financial incentives.