Commitment. Innovation. Results.

Services & Sample Engagements

HPM offers services and expertise in care integration, population health, health equity and disparities in care delivery, quality improvement, healthcare financing and administration. Our services cross the full continuum of physical health, behavioral health (BH), Long-Term Services and Supports (LTSS) and social support services driven by Social Determinants of Health (SDOH). 

HPM’s key service offerings, include, but are not limited to:

  • Innovative Medicaid Managed Care Organization program design, development and evaluation including, but not limited to, creative strategic and operational initiatives across a range of clients and settings;
  • Request For Proposals (RFP)/Application pre-bid strategy development, proposal writing and mock reviews; and
  • Financial analysis, planning and support including value based payment (VBP) design, revenue cycle management, network contracting and other financial issues that impact financial health and sustainability. 

The HPM team understands the complexities of organizing integrated care for the Medicaid population, dually eligible individuals, and Medicare Advantage beneficiaries.

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.

In the Private Sector

For a Performing Provider System (PPS) in New York State, HPM managed the development and implementation of evidence-based, data-driven care coordination and transitions of care programs within multiple health systems under a DSRIP waiver.

For a health care foundation focused on disparities in health care delivery, HPM developed an evidence-based, data-driven tool kit to educate providers and MCOs about inequities in health care delivery among people of color. 

For a Community-Based Organization (CBO), HPM developed relationships between, and negotiated contracts that were compliant with state and federal regulations with five ACOs and a major Medicare Advantage plan. 

For a national home health corporation, HPM developed a comprehensive tool kit and trained  franchisees to review Medicare Advantage and other data to enter into MA plan contract negotiations.

For a Federally Qualified Health Center (FQHC), HPM successfully evaluated the organization’s strategic plan and developed a new five-year plan based on an a rigorous performance review and extensive internal and external stakeholder input from senior staff, the board and stakeholders.

For multiple behavioral health (BH) organizations, HPM developed best practice Transitions of Care (TOC) strategies; increased enrollment and related revenues; and integrated internal and other state programs. 

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 pandemic.  

For Medicaid and Other State Agencies

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:

  • Pre-bid competitive analysis and support
  • Care management program design and development and subject matter expertise across RFP domains
  • Writing and project management support
  • Complex team facilitation with clinicians and professionals
  • Mock reviews and scoring with proposed improvements

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. 

For three 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.

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.