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HMA Insights: Your source for healthcare news, ideas and analysis.

HMA Insights 鈥� including our new podcast 鈥� puts the vast depth of HMA鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Solutions

Achieving financial resilience in a time of turbulence

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HMA Spotlight

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Review / categorize all vendor spend to find areas with unnecessary costs, overlapping services, or outdated pricing.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.

Cost Saving with HMA Strategy

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?

Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.

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 experts:

Headshot of Rebecca Nielsen

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
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Alex Rich

Senior Advisor

Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more
Webinar

Medicaid, Money & Mission: Unlocking Community Reinvestment Opportunities in Georgia

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This webinar was July 22, 2025.

This is a powerful and practical town hall designed to inform Georgia鈥檚 community-based organizations (CBOs) with the knowledge to access new funding opportunities through the new community reinvestment requirements in Georgia Medicaid. Learn how HMA can help you to build strategic partnerships with managed care organizations (MCOs) to support your mission鈥攁nd position your organization for success amid upcoming federal Medicaid work requirements.

Learning Ojectives:

  • What the current federal landscape means for CBOs
  • What community reinvestment means under Georgia Medicaid
  • What Medicaid work requirements could mean for the people you serve
  • How to prepare your organization to respond, engage, and grow

Featured Speaker:

Lynnette Rhodes, Chief Health Policy Officer Georgia Department of Community Health

Blog

From State Discussions to National Policies: Healthcare in Focus

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Since January 1, 2025,  (SOR), an HMA Company, has hosted eight conferences across states. SOR conferences give providers, health plans, lawmakers, and other stakeholders from all areas of healthcare the opportunity to have real-time discussions about pressing healthcare issues. These events provide a forum to bring together leaders with different perspectives and areas of expertise to discuss, digest, and synthesize issues and challenges at the state and local levels. These discussions allow states and their partners to improve healthcare delivery and prepare for changes before they happen.

This article explores common themes and issues addressed during the state-specific meetings.

Common Trends and State Priorities

Although each state has unique challenges and priorities, there is clear overlap in the issues being addressed. The exchange of ideas and best practices at these meetings is fostering a collaborative approach to tackling some of the most pressing challenges facing our nation today. Key themes include:

  • Improving healthcare accessibility and affordability.聽Many states are grappling with similar issues, such as the rising costs of medical services and federal policy changes that will have varying implications for the healthcare sector, especially publicly financed health insurance programs. From new rules coming out of the Centers for Medicare & Medicaid Services (CMS) to the 鈥淥ne, Big Beautiful Bill Act,鈥� which calls for reducing Medicaid funding and federal work requirements, healthcare industry leaders have been considering how these provisions will affect public healthcare programs. It was evident that these issues are at the forefront of state priorities, as leaders from different regions shared their strategies and experiences.
  • Assessing the evolving landscape for artificial intelligence (AI) and other technologies. Stakeholders discussed the state-specific landscape and opportunities for technologies such as AI, health data information, wearable health tools, and other digital health solutions. They explored opportunities to improve access to services and achieve efficiencies, while seeking to understand the potential limitations of advancements in technology.
  • Addressing the opioid crisis.聽States are taking various approaches to combat the opioid epidemic, from increasing funding for addiction treatment programs to implementing stricter regulations on prescription medications. The urgency of this issue was palpable, with speakers and participants sharing personal stories and data to underscore the impact of the crisis on their communities. Many panel discussions also focused on approaches to improve behavioral health coverage parity, access to 988 services, and care coordination.
  • Attracting and retaining all types of clinicians. Each state has designated health professional shortage areas and is thinking creatively about how recruit and keep healthcare practitioners. For example, many sessions at the SOR events explored where states are investing in educational programs to train the next generation of healthcare professionals. Loan repayment programs are also being expanded to incentivize clinicians to work in underserved areas. In addition, states are streamlining licensure processes to make it easier for healthcare providers to practice across state lines.

The conferences also provided a platform to discuss a range of other healthcare and health-related issues. Payment reform was a hot topic, with states exploring ways to make healthcare more affordable and efficient. Attendees were engaged in discussions about the impact of the federal Medicaid policy changes to coverage for health-related social needs (HRSNs), and the importance of community level strategies to address factors like housing, food security, and transportation. Maternal healthcare, the reentry population, the aging population, and rural health were other significant topics, each contextualized by the state-specific challenges and innovative solutions being explored.

What to Watch

The federal health policy landscape will continue to change over the coming months, which will greatly affect how states approach healthcare, especially Medicaid services. The policy changes and the downstream implications for state and local governments and their partners will be at the heart of discussions at the upcoming 黑料网 (HMA) National Conference, Adapting for Success in a Changing Healthcare Landscape, and State of Reform conferences. Key topics include:

  • The federal budget. On July 1, 2025, the Senate approved a tax and spending package that would cut over $1 trillion from healthcare, including $940 billion from Medicaid over 10 years. The bill introduces work requirements, provider tax limits, and stricter eligibility checks and is projected to increase the number of uninsured people by nearly 12 million, according to the Congressional Budget Office. The bill鈥檚 provisions will likely significantly disrupt the federal share of Medicaid funding so states will need to prepare and decide how to fund optional programs. Stakeholders will also want to prepare for the churn among their clients and expected drop in enrollment in publicly financed programs.
  • Medicaid work requirements. The federal work requirements in the House-passed and Senate-passed budget bills will require states to make policy and operational changes, including new systems and processes that meet the new federal mandates. State officials will have to tailor their work requirement programs to meet the capabilities and interests of the people who live in their respective states.
  • The impact of CMS actions. The Trump Administration鈥檚 new regulations and executive actions, particularly those announced by the Centers for Medicare & Medicaid Services (CMS), will affect states in various ways. The聽聽changing portfolio, for example, may provide states with new opportunities to participate in care delivery models. CMS鈥檚 decision to聽聽of new or existing requests for federal matching funds through Section 1115 demonstration waivers for designated state health programs and designated state investment programs may influence how states fund and deliver HRSN services.

Connect with Us

Join a range of healthcare stakeholders, including HMA experts, at one of the upcoming . These events provide a unique opportunity to delve into state and local-specific discussions, allowing for a deeper understanding of regional healthcare challenges and solutions.

We also invite you to continue these important conversations at the national level at HMA鈥檚 2025 conference, , which will take place October 14鈭�16 in New Orleans, LA. This conference will focus on both state and federal issues, fostering collaboration and learning among state and federal agencies, payers, health systems, providers, and other key stakeholders.

For more information on the HMA conference, contact Andrea Maresca. For more information on State of Reform, contact SOR program director Katharine Weiss.

Blog

What the Senate’s Budget Approval Means for the Future

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On July 1, 2025, the US Senate voted 51鈥�50, to advance its version of , continuing the budget reconciliation process. Like the bill that the House passed in May, the Senate language calls for making significant changes to the Medicare, Medicaid, Affordable Care Act (ACA) Marketplace programs, as well as health savings accounts (HSAs) and publicly funded programs such as the Supplemental Nutrition Assistance Program.

Relative to the House bill, however, the Senate differs substantially in approach and scope. Thus, the bill has been sent back to the House for consideration. Speaker of the House Mike Johnson (R-LA) intends to accelerate voting with the goal of clearing the legislation in the House by July 4, 2025.

Key Differences Between House and Senate Bills

Notable differences between the House and Senate packages pertain to the following:

  • Medicaid Provider Payments: The Senate version includes more restrictive changes to federal Medicaid provider taxes and state-directed payment policies. These changes are expected to affect hospitals that rely on Medicaid supplemental payments. The Senate bill also would create a $50 billion Rural Health Transformation Program to mitigate financial strain on healthcare providers in rural communities. The provision includes several stipulations regarding distributions, allocations, eligibility standards, and permissible uses of the funds, which will likely prompt considerable ongoing engagement from stakeholders if signed into law, particularly among hospitals and clinics that will face substantial headwinds under other components of the legislation.
  • ACA Marketplaces: Like the House bill, the Senate version includes provisions to recapture full ACA subsidy amounts, restrict subsidy eligibility for certain immigrant populations, and require verification of ACA subsidy eligibility. The Senate bill neither appropriates funding for cost sharing reduction subsidies nor includes provisions regarding the Marketplace Integrity and Affordability rule, which the Centers for Medicare & Medicaid Services (CMS) finalized on June 20, 2025. In addition, the Senate bill offers several smaller flexibilities intended to increase usage of HSAs but does not include the full suite of HSA changes included in the House bill. The Senate language also does not call for expanding individual coverage health reimbursement arrangements (ICHRAs).
  • More Limited Medicare Package: Although the Senate language restores the ORPHAN Cures Act and adds a modest one-year payment increase under the Medicare Physician Fee Schedule (PFS), the bill omits a number of significant Medicare policies included in the House version, including a much broader PFS investment tied to the Medicare Economic Index, as well as multiple pharmacy benefit manager (PBM) reforms under Medicare Part D. The Senate legislation also excludes two Medicaid PBM provisions that the House had included.

Estimates from the Congressional Budget Office

The Congressional Budget Office (CBO) has provided several  of the cost and coverage impacts of the healthcare and tax provisions in multiple versions of the reconciliation legislation. CBO has provided cost estimates for the , as well as the Senate  but has yet to release information on the final Senate version. Of note, CBO estimated the following:

  • The Medicaid, Medicare, and ACA related provisions in the Senate substitute amendment would reduce healthcare spending by approximately $1.15 trillion over the next 10 years.
  • The House bill would, by 2034, add 10.9 million people to the number of uninsured individuals in the United States.

What to Watch

Stakeholders should plan for the financial, policy, and operational impacts of the many provisions that could be enacted, including:

  • New administrative requirements for enrollment that will place additional obligations on individuals seeking coverage and which will require more state resources to implement and manage. Community engagement and work requirements are scheduled to take effect December 31, 2026.
  • Downward Medicaid financial pressures due to fewer federal funds, which will stress state budgets and states鈥� ability to maintain existing programs. This situation could lead some states to scale back eligibility for Medicaid, limitenrollment for optional programs, or some combination of these. Additionally, states could be expected to address increases in uncompensated care among their providers.
  • A pause on implementation of previously finalized regulations that streamlined the Medicaid enrollment process for individuals.

The combination of the House and Senate reconciliation bills and the recently finalized Marketplace Program Integrity and Affordability rule indicate an uncertain future for cost sharing subsides and enhanced premium tax credits in Marketplace programs. Healthcare stakeholders should prepare for the impact of the expiration of the enhanced premium tax credits would have on benefit packages, enrollee risk profiles, uncompensated care, and other key issues affecting access, cost, and outcomes.

Connect with Us

To learn more about the these policy changes and the impact on your organization,聽contact our featured experts below.

State of Rhode Island: Advancing Health System Resilience Through Capacity Assessment

State of Rhode Island: Advancing Health System Resilience Through Capacity Assessment

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THE CLIENT

The Rhode Island Attorney General鈥檚 Office (the Office) engaged 黑料网 (HMA) to assess the current capacity of the state鈥檚 healthcare delivery system and identify policy considerations to ensure access, quality, and sustainability across hospital, long-term care, and primary care settings.

BACKGROUND

Amid growing public concern about emergency department crowding, long-term care access, and delays in primary care, the Office commissioned a statewide assessment to understand systemwide strain and inform proactive policymaking. The goal was to quantify key pressure points across care sectors and identify interrelated trends that affect patient access and outcomes.

APPROACH

HMA conducted a cross-sector analysis of Rhode Island鈥檚 healthcare system to identify systemic challenges and capacity constraints, using both quantitative and qualitative methods to surface actionable insights. The team: + Examined emergency department utilization trends and care delays + Analyzed hospital occupancy and discharge flow challenges tied to long-term care availability + Evaluated long-term care ownership models and capacity shortfalls + Reviewed primary care availability, access, and workforce trends + Synthesized findings into a concise, policy-focused report with clear implications for state leaders and health system partners

Key considerations included:

  • Interdependencies between hospital, long-term care, and primary care sectors
  • The role of workforce shortages in limiting access and care coordination
  • Discrepancies between the number of available providers and lived patient experiences
  • Opportunities to strengthen data collection and analytic infrastructure

TESTIMONIAL

鈥淗MA鈥檚 systemwide capacity assessment helped us identify where gaps existed and provided a roadmap for actionable policy solutions. It鈥檚 already shaping the way we think about coordinated care delivery and long-term resilience planning.鈥�

Julia Harvey, Special Assistant Attorney General, Health Care Advocate, The State of Rhode Island | Office of the Attorney General

RESULTS

HMA鈥檚 assessment provided a timely and impactful snapshot of Rhode Island鈥檚 health care delivery system, highlighting key findings that underscored the urgency of statewide coordination and investment:

Emergency Departments: Overburdened due to delayed discharges and lack of post-acute capacity, limiting timely care

Long-Term Care: Insufficient beds and staffing, with for-profit ownership dominating the sector, reducing flexibility during public health crises

Primary Care: Workforce data overstated capacity; access barriers remained high despite apparent provider density

The report emphasized that these challenges are interconnected and that piecemeal solutions may exacerbate strain elsewhere in the system. The Office is now using the assessment to prioritize policy interventions, guide workforce investments, and design an integrated approach to capacity monitoring.

HMA鈥檚 work laid the foundation for a strategic shift toward whole-system resilience, data-driven resource planning, and a more patient-centered delivery model in Rhode Island.

Webinar

Webinar Replay – Digital Quality Measures: Opportunities to Electronically Share Digital Quality Measurement Data With Stakeholders

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This webinar was held on July 16, 2025.

As federal and state governments continue to evolve regulations and reimbursement models, healthcare providers are under increasing pressure to do more with fewer resources. Digital innovation, particularly through digital quality measures or dQMs, is a key strategy for easing administrative burdens while enhancing care delivery. This webinar explored how emerging policies and regulations are shaping the digital quality landscape鈥攁nd what healthcare organizations can do now to prepare for continued transformation.

Learning Objectives:

  • Understand the current and emerging federal and state legislative landscape impacting digital quality measures and their role in shaping healthcare operations.
  • Identify key benefits and challenges of implementing digital quality measures, including their potential to reduce administrative burden and support real-time data sharing.
  • Explore actionable strategies for healthcare organizations to proactively align with evolving mandates and leverage digital quality measures to improve outcomes and remain competitive.

Featured Speakers:

Eric Schneider, MD, M.Sc., Executive Vice President, Quality Measurement and Research Group National Committee for Quality Assurance (NCQA)

Blog

Forty Years Supporting Medicaid at HMA

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This month鈥檚 Vital Viewpoints podcast features a special conversation with Jay Rosen, founder, president, and chairman of 黑料网 (HMA), as he reflects on the evolution of Medicaid and the 40th anniversary of HMA鈥檚 founding. From his early days shaping Michigan鈥檚 Medicaid program in Michigan’s Office of Health and Medical Affairs, to building a national firm dedicated to public sector healthcare, Jay鈥檚 story is one of purpose, persistence, and visionary leadership. Over four decades, Jay has guided HMA鈥檚 strategic vision, growth, client service, and innovation in publicly funded healthcare.

Jay began his career at a time when Medicaid was still finding its footing. In the 1970s and early 1980s, states were grappling with how to operationalize a new federal promise鈥攈ealthcare for low-income and aging Americans. Jay saw firsthand the complexity and urgency of that challenge. But he also saw opportunity: to build something better, smarter, and more accountable. That vision led to a fateful meeting at a Big Boy diner in East Lansing, Michigan, where Jay, Paul Allen (Michigan鈥檚 then Medicaid director), Elliot Wicks, and Jay Endsley laid the groundwork for what would become HMA on June 13, 1985, the date HMA was founded.

The 1980s saw extreme economic distress in the U.S., with healthcare costs rising by 1,520% annually. Pressure on the federal government to reduce financial support for public sector health programs meant state governments had to lead the way. Managed care emerged as a novel idea, using risk-bearing intermediaries between the state as a payer and providers/consumers. Michigan was an early adopter of managed care.

Over the next four decades, managed care programs evolved to bring more accountability in Medicaid, transforming the state鈥檚 role from administrator to regulator. The state agency could focus on using its levers to improve performance of public programs. Reporting requirements, data-driven decision making, quality measurement and other innovative tools were introduced.

鈥淥ne-third of the country is on Medicaid, covering 90 million people, including the most expensive, vulnerable populations. Medicaid operates well despite financial challenges, addressing significant societal obligations,鈥� says Rosen.

Now, as we celebrate the 60th anniversary of Medicaid in July, the program faces new operational and financial pressures, but also new tools — like AI and digital health technologies to meet the moment. Innovation in Medicaid isn鈥檛 optional, it鈥檚 essential. 聽HMA experts work with states and other organizations to harness these tools and stay current with these new initiatives.

Hear more from Jay in this month鈥檚 podcast episode, 鈥�Medicaid At (Another) Crossroads: The Future of Public Healthcare Coverage鈥�.  And as you look ahead to the future of Medicaid, trust HMA to be your partner for the next 40 years to come. #HMAknowsMedicaid

Blog

HMAIS Report Examines Medicaid Financial Accountability Policies and Emerging Strategies

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This week, 黑料网 Information Services (HMAIS) released a new report that provides a detailed, state-by-state analysis of how Medicaid managed care programs are implementing and enforcing medical loss ratio (MLR) requirements. The comprehensive report, Medicaid Financial Accountability and Risk Sharing Arrangement Report, looks at 43 states and the District of Columbia, drawing from the most recent publicly available rate certifications and model contracts.

The report鈥攁vailable exclusively to HMAIS subscribers鈥� supports policy analysts, actuaries, and other interested Medicaid stakeholders with comparative analysis and identification of emerging trends, outliers, and best practices in managed care oversight.

Key Highlights in the 2025 Report

The HMAIS team examined rate certifications and model contracts, primarily covering rate periods ending in or extending through 2025. The report also reflects recent federal policy changes, including the  requiring the inclusion of state-directed payments in MLR calculations鈥攁n update that is already influencing how states structure their payment, reporting, and oversight processes.

Each state profile outlines key elements of the following:

  • MLR thresholds and remittance obligations
  • Risk corridors and reinsurance strategies
  • Other risk mitigation strategies, including high-cost drug pools and retroactive eligibility adjustments

Key findings include:

  • Standardization is at 85 percent: Most states with risk-based programs (22) enforce the federal minimum MLR of 85 percent.
  • Stricter Thresholds: 11 states have adopted thresholds above 85 percent, with some reaching as high as 91.3 percent (Mississippi).
  • Most states require managed care organizations to remit funds if they fall below the MLR threshold. Enforcement varies, however, with strict enforcement in states like Georgia, Indiana, and Iowa, which require 100 percent of the shortfall to be returned, and more flexible policies in other states.
  • The analysis finds states are modifying certain traditional policies and tools to strengthen financial accountability mechanisms and evolve policies to address the changing federal policy landscape. For example, in lieu of remittances, Oregon and Tennessee allow plans to reinvest funds in the community.

Connect With Us

As states continue to refine their approaches to financial accountability and program integrity and design innovative approaches to address enrollee healthcare needs, the HMAIS report offers a timely and actionable reference point.

This report is just one component of the broader HMAIS subscription platform, which offers exclusive access to:

  • Searchable files that enable comparative analysis of key state program information and data
  • Timely updates on Medicaid policy developments
  • Downloadable state-by-state and industry files

For health plans, state agencies, provider organizations, partners, and advocacy groups, subscribing to HMAIS means staying ahead of regulatory changes, identifying emerging trends, and making informed decisions about strategy, compliance, and program design. For more information about the new report, contact featured HMAIS team member below.

Webinar

Webinar Replay – The Future of the ACA Individual Market: Policy Shifts and the Proposals Before Congress

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This webinar was held on July 10, 2025.

Watch for an in-depth discussion on the future of the individual market and the impacts of potential Congressional and regulatory changes to the Affordable Care Act (ACA). This webinar explored findings from a new Wakely report which estimates that ACA enrollment could decrease by 11 to 13 million as a result of these pending changes, representing a 47% to 57% decline. The report also projects that market average premiums could increase between 7% and 11.5% on top of claims trend. The report鈥檚 analysis considers a range of influential factors, including provisions in the House budget reconciliation bill, the Marketplace Integrity and Affordability regulation, and the scheduled expiration of enhanced premium tax credits in 2026. HMA, Wakely, and Leavitt Partners experts unpacked the current federal and state policy landscape and their potential effects on coverage access, affordability, and the long-term viability of the individual market.

Learning Objectives:

  • Interpret the projected coverage and premium impacts
  • Understand the role of expiring premium tax credits
  • Assess potential responses and strategies

Download the webinar transcript here.

Download the webinar Q&A here.

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