HPM offers deep analytic capability, with strong experience cleaning and reviewing claims, encounter, quality and other data sources to identify, measure and address cost and quality drivers for Medicaid and dually eligible consumers. We perform regulatory analysis and consistently offer compliant program and policy designs.
The HPM teams’ service offerings, include, but are not limited to:
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, our track record and our affordable rates, relative to larger firms.
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, member and provider satisfaction and cost-effectiveness of care.
The HPM Team includes all senior consultants who offer services at affordable rates, especially compared to large firms which offer comparable services. HPM offers value for your purchasing dollar.
For hospital systems in New York State, HPM developed and implemented rural and urban 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. We negotiated eight managed care contracts to deliver medically tailored meals to Medicaid and dually eligible consumers, based on clinically appropriate criteria. This effort bridged new industry relationships and funding streams for the CBO.
For a multiple Behavioral Health (BH), Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), D-SNPs and states, we developed integrated models of care management including physical, medical, behavioral and social supports as well as Transitions of Care models, achieving improved outcomes and cost effectiveness.
For multiple rural Federally Qualified Health Centers (FQHCs), HPM successfully developed integrated care management models including physical and behavioral health care combined with closed-loop social supports. Design solutions included synthesized reviews of current or planned operations, population needs, barriers to care by geographic area and research on best practice options to improve access and outcomes of care.
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 proposal writing skills, combined with our ability to assist with competitive strategy, has helped our clients increase their win rates including a $6.8 Billion D-SNP bid (in transition from a FIDA demonstration project) and multiple others. Our win rate is consistent.
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 Medicaid MCO, the HPM team collaboratively designed, developed and documented three ACO Request for Proposals (RFPs), all of which were awarded three-year contracts. HPM negotiated delivery system design and care coordination models with each of the three ACOs and documented models accordingly. Design efforts further included all RFP sections and domains.
For multiple BH organizations, HPM designed winning proposals to participate in the Massachusetts Behavioral Health 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 design work for each of three separate organizations.
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 multiple FQHCs, 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 Intellectual and Developmental Disabilities (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 agreements 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.