MassHealth DSRIP Technical Assistance

Manatt Health Support for MassHealth Accountable Care Organizations (ACOs) and Community Partners (CPs)

General Intro

With a team of national healthcare delivery system reform experts, deep familiarity with the Massachusetts market and MassHealth’s DSRIP goals and objectives, and a record of implementing complex projects that result in on-the-ground solutions, Manatt Health is uniquely suited to provide MassHealth’s Accountable Care Organizations (ACOs) and Community Partners (CPs) with the technical assistance they need to be successful as part of the MassHealth DSRIP transformation.

Click on each Domain below for a sample of our experience providing technical assistance to states, health plans and health systems of a similar type, size and scope, and conducted in a culturally competent manner, as expected for prospective DSRIP TA work. Cultural competence is not only an essential value at Manatt, but also a fundamental requirement to successfully support our delivery system and state Medicaid system clients as they work to serve people from diverse backgrounds and individuals with complex care needs.

Deep Massachusetts Experience

Our deep experience with the Commonwealth’s healthcare market, which includes extensive work with state foundations, health plans, and health systems, coupled with the breadth and depth of our team, ensures that Manatt Health will be a strategic and valuable partner and bring innovative solutions to ACOs and CPs.

Senior Advisor Stephanie Anthony, former Deputy Medicaid Director, MA EOHHS.

For over 20 years, Manatt Health has served providers, physician groups and community-based organizations in Massachusetts, supporting delivery system innovation in a rapidly changing policy landscape (see our Domain qualifications). Our leaders have also helped shape the health policy conversation with leading publications, including:

  • Integrating MassHealth LTSS: Considerations for ACOs and MCOs, an issue brief authored for the Blue Cross Blue Shield of Massachusetts Foundation that prioritized issues for consideration as ACOs and MCOs prepared to integrate and fully manage comprehensive long-term services and supports over the course of Massachusetts’ five-year 1115 waiver extension.
  • Proposals to Cap State Medicaid Funding: Massachusetts Considerations, a chart pack commissioned by the Blue Cross Blue Shield of Massachusetts Foundation for the Massachusetts Coalition for Coverage that explained the structure of Medicaid financing, key provisions of the American Health Care Act, and the potential implications for Massachusetts, including the Commonwealth’s Medicaid expansion and 1115 waiver.
  • Massachusetts Long-Term Services and Supports, a report for the Massachusetts Medicaid Policy Institute, a program of the Blue Cross Blue Shield of Massachusetts Foundation, that illustrated a vision for MassHealth LTSS in addition to options for Massachusetts’ policymakers to consider as they addressed some of the obstacles faced by the state’s LTSS system.
  • Sharing Behavioral Health Information In Massachusetts: Obstacles and Potential Solutions, a report for the Blue Cross Blue Shield of Massachusetts Foundation reviewing the primary Massachusetts and federal privacy laws relevant to the exchange of information among physical and behavioral health providers. The report also proposed ways in which existing laws could be clarified or amended to improve the facilitation of information as well as potential operational strategies for minimizing the restrictive impact of existing privacy laws.
  • The Future of MassHealth: Five Priority Issues for the New Administration, a report prepared for the Massachusetts Medicaid Policy Institute that reviewed the issues, opportunities and policy options for MassHealth and identified five critical points that then-incoming governor Charlie Baker needed to address to ensure the long-term prosperity of the MassHealth program.

To learn more about how Manatt Health can help your organization navigate MassHealth’s DSRIP reforms, please contact us at pboozang@manatt.com.

National Delivery System Reform Perspective

With a diverse set of healthcare clients in more than 30 states, Manatt Health has a record of executing complex scopes of work informed by lessons learned in Medicaid programs across the nation.

Senior Managing Director Patricia M. Boozang, who has led projects with Commonwealth providers, the Massachusetts Health Connector and the Blue Cross Blue Shield of Massachusetts Foundation for over 20 years.

With a deep bench of national policy and delivery system reform experts, experience in the Massachusetts market—including with MassHealth’s DSRIP program—and a record of formulating and executing complex scopes of work for provider systems that result in immediate on-the-ground action, Manatt Health is uniquely suited to quickly and effectively respond to ACO and CP technical assistance requests. A sample of our national thought leadership includes:  

  • Strategies for Connecting Justice-Involved Populations to Health Coverage and Care, a 2018 report developed with the Urban Institute, which contains an array of strategies for connecting justice-involved people to Medicaid coverage and physical and behavioral healthcare services. Designed to address the specific healthcare needs unique to justice-involved people, the guide provides a comprehensive road map for state and local justice and healthcare officials aspiring to more efficiently enroll justice-involved people in Medicaid or other healthcare coverage and help them obtain coordinated care in the community.
  • Enabling Investments in Effective Social Interventions, a 2018 report authored for the Commonwealth Fund that explores practical strategies states can deploy to support Medicaid managed care plans and their network providers in addressing social issues. The report identifies six specific plans for policymakers based on a literature review and on interviews with state officials, health plan leaders, actuarial experts, and other stakeholders.  We identify options for states to consider whether they are interested in incorporating the cost of social interventions into Medicaid managed care rates.
  • Hospitals and Health Systems Prepare for Value-Driven Future, a report authored in December 2017 for the American Hospital Association, provides information to help hospitals and health systems evaluate which value-based payment (VBP) models can best support their organizations’ goals, and provides insights from seven hospitals and health systems participating in different VBP arrangements. The report also highlights critical issues for hospitals and health systems to consider when evaluating their VBP options.
  • New York City Population Health Improvement Program: Small Practice Project, a June 2018 report, written in collaboration with the United Hospital Fund and the New York State Department of Health, that outlines a potential solution to the challenge that faces small primary care practices attempting to adjust to the new reality of value based payments. The report provides a framework for small practices considering joining a shared service model and for larger “host” organizations considering initiating shared service arrangements to benefit small practices.
  • Strengthening Medicaid Long-Term Services and Supports in an Evolving Policy Environment, a program started in July 2017 with support from The SCAN Foundation, the Milbank Memorial Fund and the Center for Health Care Strategies, that created a state Medicaid Long-Term Services and Supports (LTSS) reform toolkit. The resource contains a targeted menu of LTSS reform strategies adopted by state innovators that may be replicated by other states. The group disseminated the toolkit nationally and works with select states committed to pursuing comprehensive LTSS reform by providing technical assistance in designing or adapting strategies outlined in the toolkit.
  • Sharing Behavioral Health Information Amid the Opioid Crisis, a June 2018 report prepared in collaboration with the eHealth Initiative and Foundation after an executive advisory board meeting that explored the role of privacy and security in the context of the opioid crisis. Experts and industry leaders from Walgreens, Surescripts, CRISP, OhioHealth, Senator Shelley Moore Capito’s office, and the Substance Abuse and Mental Health Services Administration (SAMHSA) provided information on the policies and technologies that affect the use of behavioral health information in patient care and discussed ways to address challenges. This brief is the result of that conversation and aims to provide potential solutions for tackling the opioid crisis.

To learn more about how Manatt Health can help your organization navigate MassHealth’s DSRIP reforms, please contact us at pboozang@manatt.com.

Domain 1: Actuarial and Financial

Overview:  Manatt Health has extensive experience working individually and in partnership with actuarial firms to support provider organizations’ transition to value-based payment (VBP) arrangements. Manatt helps organizations assess and stratify their patient populations, define their value proposition, and understand their market position and their current capabilities and gaps for VBP readiness. Manatt provides technical assistance to help clients develop a business strategy, payment and funds flow models (incorporating multiple assumptions, including network membership, geographic distribution, patient population(s), geographical distribution and risk arrangements), and preliminary financial plans and implementation timetables. Depending on data availability, Manatt has used its analytics capabilities to work with provider organizations to develop payment and funds flow models; determine indicators of social needs; understand Medicaid beneficiary utilization of primary care, behavioral health, dental and specialty services utilization across population subgroups; understand current patient “attachment” to the integrated delivery system; and develop strategies to improve risk stratification.

Qualifications:

Coalition of New York State Public Health Plans (PHPs) – Medicaid Financial Planning and Rate-Setting Technical Support. Manatt founded and directs the Coalition, the ten members of which are nonprofit, public-focused health plans that collectively serve over 2.5 million of the state’s public health program beneficiaries. All Coalition plans are sponsored by or affiliated with public and not-for-profit hospitals, community health centers and physicians. Through the Coalition, Manatt works directly with the Department of Health and the Department of Financial Services, and their actuaries, on a host of health plan rate-setting issues across Medicaid, Child Health Plus, the Essential Plan and marketplace products. In particular, Manatt has negotiated adjustments to the rate-setting methodology – including changes to the risk score approach – as well as changes to the underlying assumptions that build up the base rates in each rating region. Manatt has also built a web-based tool that reports the plan financial data and leverages analysis on certain plan metrics, such as measuring medical loss ratio. Finally, Manatt performs a variety of analyses on plan financial data to inform advocacy with the state.

Coordinated Behavioral Care – Business Strategy for VBP Contracting. Manatt was retained by the Coordinated Behavioral Care (CBC) Independent Practice Association (IPA) to develop a business strategy, financial plan and implementation timetable to bring its constellation of behavioral health services into value-based purchasing (VBP) contracts in New York. Manatt assessed the CBC IPA’s potential value proposition and market position, identified potential infrastructure investments and operating resources necessary for revenue growth, and developed a financial model, financial projections and implementation timetables for identified infrastructure and operational efforts. Manatt also assessed the CBC IPA’s current capabilities with respect to VBP readiness in multiple Domains (personnel, IT, data analytics, governance, clinical integration); ability to assume financial and clinical risk; financial resources available for investment in VBP infrastructure requirements; and strategic goals based on its vision of a desired future state. We then worked with leadership to develop an overarching strategy and specific tactics to close or narrow the gap between the current and future states and developed a high-level financial pro forma to test the future state’s potential sustainability.

Large Public Health System – Analytic Support to Understand Patient Population and Social Needs. Manatt developed groundbreaking analytics to determine, at the ZIP code level, indicators of social needs and to understand Medicaid beneficiary utilization of primary care, behavioral health, and dental and specialty services across population subgroups within the system’s primary service areas. Further, we developed an analytic model and approach to understand current patient “attachment” to the integrated delivery system and utilization by Medicaid patients of other longitudinal health services outside the delivery system, and developed a set of strategies to improve capacity to risk stratify patient and manage patient care. Manatt also worked closely with the system’s finance team to develop complex financial models (as the system did not have a cost-accounting system, they did not have a way to analyze cost of care or unit or service line costs) to analyze the impact of transformation initiatives, VBP opportunities and other market factors on the system’s financial position.

Highlighted Subject Matter Experts

Benjamin K. Chu, M.D.

Managing Director

Email | Bio

Benjamin K. Chu, M.D.,  Managing Director.  Physician and integrated health system CEO. Expertise encompasses direct patient care, population health, public policy and reform, medical education, health system administration, health insurance, culture change and leadership development.

Joseph D. Ray

Managing Director

Email | Bio

Joseph Ray, Managing Director.  20+ years’ experience. Works in implementation of technology-enabled care delivery reforms. Skilled facilitator who leads learning collaborations and TA initiatives, develops cost and revenue models specifically related to VBP implementation, and identifies funding streams and implementation considerations.

Emily R. Carrier

Senior Manager

Email | Bio

Emily Carrier, M.D., Senior Manager.  Former Director, Division of Special Populations and Projects in the Seamless Care Models Group at CMMI, where she developed and oversaw alternative payment programs targeted at specific beneficiary populations with intense care needs such as beneficiaries with end-stage renal disease and the dually eligible.

Anthony J. Fiori

Managing Director

Email | Bio

Anthony J. Fiori, Managing Director.  15+ years’ experience. Nationally recognized expert on health reform regulatory and financial issues (with a focus on Medicaid MCOs) and health system performance improvement tactics.

Domain 2: Care Coordination/Integration

Overview:  Manatt has experience advising on—and, accordingly, a familiarity with—the imperatives driving a wide range of Medicaid managed care stakeholders including hospitals, Federally Qualified Health Centers (FQHCs), behavioral health organizations and physicians, and the opportunities and challenges in providing care for underserved and vulnerable populations. Manatt offers a systemic approach to identifying emerging best practices across the country to pursue Medicaid delivery system reform goals, including expansion of alternative payment models; integration of interventions that address social determinants of health; and use of best practice care management protocols, health information technology and consumer-facing technologies to better coordinate care. Manatt professionals have hands-on experience overseeing and advising multiple states on Medicaid managed care procurements, including successful integration of long-term services and supports (LTSS), integrating behavioral health and medical services, developing new models for management of service and persistent mental illness, and fostering provider-led care delivery solutions such as accountable care organizations and other value-based care collaborative arrangements.

Qualifications:

New York Providers, Delivery System Reform Incentive Payment (DSRIP)—Legal, Policy, Technical and Strategic DSRIP Assistance. Manatt has extensive on-the-ground experience implementing delivery system reform waivers. Manatt is providing legal, policy, technical and strategic assistance to several of the major hospitals (and related networks of providers) working on implementation of New York’s Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program, which is part of a Medicaid 1115 waiver, provides up to $6.4 billion in funds for safety net hospitals and their community provider partners to transform the way care is delivered to Medicaid beneficiaries; reduces avoidable hospitalizations by 25 percent; and creates sustainable delivery system reforms that are integrated into the structure of Medicaid managed care. Five New York-based healthcare providers engaged Manatt to guide their DSRIP efforts: Maimonides Medical Center, Lutheran Medical Center, SBH Health System, Westchester Medical Center and New York City Health & Hospitals Corporation. Manatt assisted in the design of system transformation, clinical, and population health initiatives to help providers meet DSRIP’s performance-based metrics. Manatt also provides technical and legal assistance on the numerous corollary issues that arise out of such initiatives, including the appropriate governance structure for the provider partnerships, how to engage community partners, what alternative services (such as housing) can be funded under Medicaid, how to structure funds flow to support community-based organizations, and how to consider care management across the continuum of care, including LTSS.

Washington State DSRIP Implementation, King County Accountable Community of Health (ACH)—Medicaid Delivery System Reform Technical Assistance. Manatt is working with the state of Washington’s largest ACH to implement regional Medicaid delivery system improvement projects across a diverse collaboration of unaffiliated providers of medical, behavioral health and community services. Manatt is providing technical assistance to King County ACH in its efforts to align with and augment the impact of related initiatives and its plan for sustainability beyond the demonstration period. In addition, Manatt is helping the ACH develop its approach to current state assessments, defining target populations and making evidence-based protocol selections. Manatt is also working with the ACH on funding allocation strategies to incentivize performance against goals and engage providers across the continuum of care. Further, Manatt is developing templates for provider contracts and developing options for longer-term sustainability.

Kindred Healthcare, Inc.—Development of Care Management Model for PAC services. Manatt supported a consulting engagement to assess Kindred Healthcare’s care management capabilities and resources to develop and implement a care management model for post-acute care (PAC) services. Manatt assessed Kindred’s capabilities in a number of areas, including population-based data analytics, intensive hospital discharge planning, care coordination and care management, and ongoing quality measurement and reporting around patient outcomes and satisfaction. As part of the engagement, Manatt developed a gap analysis of Kindred’s care management capacity and a strategic road map to operationalize a cohesive care management model.

State of New Hampshire DSRIP—1115 Medicaid Waiver Technical Assistance. Manatt assisted the New Hampshire Department of Health and Human Services in the design and implementation of its 1115 Medicaid waiver to transform the state’s delivery system for Medicaid beneficiaries with mental health and substance use disorders. Manatt worked with a team of state staff to write and secure approval from CMS of the operational and financial protocol for the waiver; to develop the application for integrated delivery networks (IDNs); to design the menu of clinical projects available to IDNs to support improved access to and integration of BH and substance use services with medical care; and to set the formula used to distribute both initial capacity-building funds and fiscal incentives for performance.  

Highlighted Subject Matter Experts

Patricia M. Boozang

Senior Managing Director

Email | Bio

Patricia Boozang, Senior Managing Director. Skilled at managing complex projects involving a mix of public agencies and private stakeholders. Advises clients on the implementation of coverage, delivery system, and payment reforms across government and private health insurance programs. Her clients include federal agencies, foundations, states, healthcare delivery systems and health plans.

Benjamin K. Chu, M.D.

Managing Director

Email | Bio

Benjamin K. Chu, M.D.,  Managing Director.  Nationally recognized leader in population health management. Physician and integrated health system CEO (including EVP, Kaiser Foundation Hospitals and Health Plans, and group president of two regions). Expertise encompasses direct patient care, population health, public policy and reform, medical education, health system administration, health insurance, culture change, and leadership development.

Mary E. Keegan

Senior Advisor

Email | Bio

Mary Keegan,  Senior Advisor.  30+ years’ experience. Works in safety net leadership and focuses on program development, delivery transformation, and aligning community-based providers, LTSS and BH providers with medical systems organized around value-based care and care continuum modeling. Hands-on experience with intake and screening tools and with FQHC and community provider intake processes.

Stephanie Anthony

Senior Advisor

Email | Bio

Stephanie Anthony, Senior Advisor. 20+ years’ experience. Focuses on Medicaid and LTSS transformation. Prior to joining Manatt, helped Massachusetts become the first state to implement a demonstration program of integrated care for individuals with dual eligibility for Medicare and Medicaid via her role at the University of Massachusetts Medical School’s (UMMS’s) Center for Health Law and Economics. Prior to her tenure at UMMS, Stephanie was deputy Medicaid director in the Massachusetts Executive Office of Health and Human Services.

Eric I. Bartholet

Managing Director

Email | Bio

Eric Bartholet, Managing Director.  30+ years’ experience. Leads a wide variety of projects involving strategic planning and program management. Examples include IT strategic planning, DSRIP program management, value-management program development and organization and governance redesign. He served as the interim Vice President of Strategy and Business Development for a leading children’s healthcare system as it developed its care management and VBP approach.

Domain 5: DSRIP Flexible Services

Overview:  Faced with mounting evidence of the impact of social factors—such as income, access to food and housing, and employment status—on health outcomes, Medicaid agencies are looking for ways to integrate social interventions into their coverage, payment and delivery models. In support of this objective, federal regulations and guidance have opened the door to Medicaid becoming a strong partner in community efforts to address social determinants of health. Manatt has been working with both states and collaborations of provider organizations to develop programs, pathways, and financing to integrate services and supports that take a more holistic approach to beneficiary care through both targeted interventions tied to care management programs and more large-scale policy and social reforms. Manatt has also published toolkits and case studies to help guide implementation efforts. Manatt has worked with providers implementing DSRIP programs in New York, New Hampshire and Washington, and is helping states develop pilot programs and approaches to integrating nontraditional services via Medicaid Section 1115 Waivers.

Qualifications:

God’s Love We Deliver—Community-Based Social and Alternative Services Integration Into the DSRIP Program. Manatt assisted God’s Love We Deliver in connection with developing a strategy to cover food and nutrition services in lieu of coverage rules and provided strategy advice/technical assistance on how to build value propositions to engage with the DSRIP-formed provider entities and how to consider these services in value-based purchasing strategies.

St. Mary’s Healthcare System for Children—Developing Service Partnership for Medically Fragile Children. Manatt advised St. Mary’s Healthcare System for Children (SMHC) in connection with documenting the need for services for medically fragile young adults (MFYAs). Manatt worked with SMHC to develop a strategy to pursue partnerships with one or more geriatric nursing homes to develop and manage appropriate residential long-term care for medically fragile children (MFC) “aging out” of pediatric care settings. To begin to identify and perform outreach to specific aging-out individuals who might be suitable for these newly developed MFYA residential units, Manatt provided deep-dive data analytics to develop a detailed segmentation of the demographic characteristics, small-area geography of residence, and utilization history for identified MFC/MFYA individuals in New York State; and helped identify potential long-term care and care management providers serving high-need adolescents.

Camden Coalition (New Jersey)—Technical Assistance for Coalition of Providers. Manatt provides ongoing consulting support and technical assistance for this nationally recognized coalition of providers in New Jersey that aims at improving healthcare predominantly by trying to address Social Determinant of Health (SDOH)-related needs of high-cost individuals and using hot-spotting and social service outreach methodologies to identify and engage with high-need patients.

Milbank Memorial Fund’s Reforming States Group—“Medicaid Coverage of Social Interventions: A Road Map for States.” Manatt Health, with support from the New York State Health Foundation, prepared an issue brief for The Milbank Memorial Fund’s Reforming States Group that will serve as a practical guide for policymakers who want to know when and how states can use Medicaid to facilitate access to social services. The issue brief offers a roadmap of the legal authorities upon which policymakers can rely to extend Medicaid coverage to social interventions and provides examples from states that are already using Medicaid in creative ways to help vulnerable populations access needed social supports.

Commonwealth Fund—Addressing Social Determinants of Health and Addressing Patients’ Social Needs. Manatt prepared two papers building the case for incorporating social supports into emerging payment and delivery models that hold providers accountable for patient outcomes and costs as well as population health. These papers evaluate the impact of social determinants of health on both outcomes and costs, highlight successful demonstrations that connect patients to social supports, and build the case for integrating these interventions into emerging clinical practice and payment models. The work includes a cost-benefit analysis to enunciate a business case for including interventions that address social determinants of health into clinical settings.

North Carolina

Highlighted Subject Matter Experts

Patricia M. Boozang

Senior Managing Director

Email | Bio

Patricia Boozang, Senior Managing Director. Skilled at managing complex projects involving a mix of public agencies and private stakeholders. Advises clients on the implementation of coverage, delivery system, and payment reforms across government and private health insurance programs. Her clients include federal agencies, foundations, states, healthcare delivery systems and health plans.

Cindy Mann

Partner

Email | Bio

Cindy Mann, Partner.  30+ years’ experience. Works in federal and state Medicaid policy. Former Deputy Administrator and Director of the Center for Medicaid and CHIP Services at the U.S. Department of Health & Human Services, led the administration of Medicaid, CHIP and the Basic Health Program. Also developed and executed national policies and initiatives regarding long-term services and supports, as well as broader delivery system and payment system reform under Medicaid.

Jocelyn A. Guyer

Managing Director

Email | Bio

Jocelyn Guyer, Managing Director.  20+ years’ experience. Works in Medicaid, the uninsured and the healthcare safety net. Nationally recognized leader on improving service delivery and access to care for vulnerable populations via Medicaid waivers. Founding member and co-executive director of the Center for Children and Families, a health policy center at Georgetown University. Former Associate Director, the Kaiser Commission on Medicaid and the Uninsured.

Deborah Bachrach

Partner

Email | Bio

Deborah Bachrach, Partner.  30+ years’ experience. Former Medicaid Director and Deputy Commissioner of Health for the New York State Department of Health’s Office of Health Insurance Programs, where she managed coverage, care and payment policies for more than 4 million children and adults enrolled in the state’s Medicaid and Child Health Insurance programs. Nationally recognized expert in designing and implementing innovative programs to improve efficiency and quality via Medicaid transformation strategies.

Benjamin K. Chu, M.D.

Managing Director

Email | Bio

Benjamin K. Chu, M.D., Managing Director.  30+ years’ experience. Dr. Chu brings a deep knowledge of healthcare through his work in clinical, academic, nonprofit and executive leadership positions with the nation’s top health systems. Former Executive Vice President for Kaiser Foundation and Health Plan Inc., and group president of Kaiser Permanente’s Southern California and Georgia regions, serving the medical, behavioral, post-acute and social care needs of more than 4.5 million members.

Domain 6: Health Information Technology (HIT)/ Health Information Exchange (HIE)

Overview:  Manatt has deep expertise in the health IT environment from both a public policy and private sector perspective. Our extensive experience in developing and implementing health IT initiatives on the national, state, local and provider-specific levels uniquely qualifies us to provide solutions that are both creative and practical. We understand the complex information needs of healthcare stakeholders and assist them, as well as their industry partners, in achieving health IT goals, accelerating growth and influencing both public policy and private marketplace developments. We have expansive knowledge of the federal requirements for certified electronic health information technology (certified EHR technology) and its use; we also understand the opportunities and limitations of the EHR, which is just one tool in a myriad of health IT solutions providers use to advance their care delivery, reporting and connectivity goals. We are nationally known for our work in health information exchange, with a deep understanding of the opportunities and challenges across enterprise HIE solutions with respect to regional and statewide efforts and the technical, policy, governance and legal considerations that providers must contend with for effective interoperability. We also have extensive experience in telemedicine, supporting providers, payers and other entities with comprehensive overviews of the telemedicine and telehealth landscape, including analyses of market drivers, available technologies and early-adaptor profiles, as well as tactical action steps.

Qualifications:

Data Privacy and Security. Manatt is nationally known for its data privacy and security practice and does extensive work in the realm of data privacy and security for provider organizations, developing policies, procedures, data use agreements, business associate agreements and HIPAA compliance plans for the exchange of protected health information. Manatt also has extensive experience in patient access and use of data and the intersection of emerging technologies—including wearables, mobile devices and APIs—and has a deep understanding of provider considerations in protecting and transmitting that data. Manatt professionals have a particular knowledge of and focus on supporting community health centers and other safety net providers in health information exchange initiatives.

The Children's Hospital of Philadelphia—IT Strategy Implementation Support: The Children’s Hospital of Philadelphia (CHOP), IT Strategy Implementation Support. Manatt supported CHOP in developing a unifying approach for data, analytics and health IT that organized resources and processes in support of a more cohesive enterprise-level IT strategy to achieve clinical care, research and administrative goals. The engagement produced an enterprise vision for health IT and data analytics; a governance model that aligns data and analytics resources with strategic priorities and resolves issues; an organization model that is sized appropriately and is efficient and effective in delivering data and analytics solutions across the enterprise; and an IT end-user data and analytics service model that clarifies roles and responsibilities and provides streamlined access to data and analytics capabilities. Manatt worked with CHOP leaders to draft a technology plan that delivers the required infrastructure and tools, a budget that provides the necessary investments in people and technology, and a road map that prioritizes and sequences implementation initiatives.

U.S. Department of Health and Human Services, Office of the National Coordinator (ONC) for Health Information Technology—IT Infrastructure Planning Technical Support. Manatt analyzed the health information technology (HIT) infrastructure needed to support the federal government’s vision for healthcare delivery system reform, in particular the baseline technology functions and capabilities that providers need in order to be successful participants in three types of alternative payment models: accountable care organizations, bundled payments and advanced primary care approaches (e.g., Patient-Centered Medical Homes).

Large Multistate Health System—Meaningful Use and MACRA Implementation.Manatt provided strategic advisory services and served as the project management office for development and rollout of a systemwide approach to Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reporting, including both the Merit-based Incentive Program (MIPs) and the Advanced Payment Models (APMs). Part of this work included a systemwide framework for quality measurement selection and reporting under MIPs and assessment of electronic clinical quality measure (eCQM) availability across multiple electronic health record vendor platforms. In addition, Manatt provided technical assistance for measure selection and performance under the ACI/PI category (use of certified EHR technology), assessed alignment with hospital Meaningful Use participation, and provided guidance on requirements related to use of certified EHR technology differences between MIPs and the APM options under MACRA. Manatt has provided ongoing technical assistance across hospital, critical access hospital (CAH) and eligible professional (EP) settings related to the Meaningful Use programs since 2009 (now called “Promoting Interoperability”).

Highlighted Subject Matter Experts

William S. Bernstein

Partner

Email | Bio

William Bernstein, Chair.  30+ years’ experience. Focuses on funding delivery system transformation and innovative models to address the needs of vulnerable populations and the underinsured. Nationally recognized expert in the policy, governance, financial and technical requirements to support health information exchange (HIE) and how the approach to HIE is changing in integrated delivery systems as technology advances.

Eric I. Bartholet

Managing Director

Email | Bio

Eric Bartholet, Managing Director.  30+ years’ experience. Broad range of implications stemming from healthcare reform, with a particular emphasis on strategy and IT/informatics planning for large integrated delivery systems. Prior to joining Manatt, Eric was a partner in the Health Delivery Planning and Operations Group of Computer Sciences Corporation’s Global Healthcare Solutions, where he concentrated on IT strategy, planning and organizational design.

Lammot du Pont

Senior Advisor

Email | Bio

Lammot du Pont, Senior Advisor.  20+ years’ experience. Works in funding and management of the implementation of complex health IT programs. Develops strategic and implementation plans for health information exchange for federal and state agencies, health information organizations, technology firms and integrated delivery networks. Formerly at the U.S. Office of the National Coordinator (ONC) for Health Information Technology where he worked on the effort to develop a nationwide health information network with an interoperable, standards-based architecture for the secure exchange of healthcare information.

Brenda Pawlak

Managing Director

Email | Bio

Brenda Pawlak, Managing Director.  15+ years’ experience. Works in health provider strategic planning, with a particular focus on health IT-enabled care delivery reform. Leads Manatt’s Meaningful Use and ACI work. Advises providers and vendors on federal certification requirements for certified EHR technology.

Joseph D. Ray

Managing Director

Email | Bio

Joseph Ray, Managing Director.  20+ years’ experience. Leads health IT planning efforts, develops cost and revenue models, identifies funding streams, and shapes strategies. Joseph has facilitated federal learning collaboratives with numerous state participants around health information exchange development and Medicaid IT. Extensive experience in assisting healthcare organizations and communities in leveraging health information to improve operational efficiencies and health quality outcomes.

Domain 7: Performance Improvement

Overview:  Manatt’s healthcare team has extensive experience in provider system strategic planning, implementing new business models for the organization and payment of health services, developing plans for the broad use of health information technology to support new care delivery systems, developing care management infrastructure, and aligning clinical and social programs with care delivery goals. Manatt has provided technical assistance to collaborative regional provider efforts (through both formal entities and less formal community-resource planning constructs) to implement Medicaid reforms under Section 1115 DSRIP programs in other states (including New York, New Hampshire and Washington). Manatt professionals have direct experience with standing up new care models under the Centers for Medicare and Medicaid Innovation Center (CMMI), evaluating program effectiveness and providing technical assistance to new care entities such as ACOs. Our extensive experience with Medicaid transformation efforts has given us a deep understanding of the opportunities and challenges in providing care for underserved and vulnerable populations and the sensitivities inherent in developing new care models and seeking to engage multiple providers along the continuum of care as well as engaging patients in need and their families.

Qualifications:

Boston Medical Center—Medicaid Transformation Strategic Planning. Manatt supported Boston Medical Center (BMC), the largest safety net hospital system in New England, in the development of a strategy for ongoing sustainability and safety net leadership in light of substantial state Medicaid reform. Manatt performed analytics to assess strategic opportunities and approaches and led stakeholder engagement efforts to ensure implementation of each component of the strategy. In the third phase, Manatt supported BMC in developing a comprehensive strategy to address changing market conditions, particularly Massachusetts Medicaid payment and delivery system reforms. Manatt provided subject matter expertise and advisory services in Medicaid ACO development and implementation, including partner provider engagement, operational structure, and Request for Responses (RFR) readiness; ACO IT strategy and vendor selection; strategic response to proposed reforms to Medicaid supplemental payment pools and broader Medicaid payment and delivery systems; and vision and strategy development around partnerships for long-term services and supports. In the fourth phase, Manatt will continue to provide strategic advice and counsel to BMC leadership as it refines the overall BMC strategy, with a focus on how MassHealth and federal reform efforts impact that strategy.

Association of American Medical Colleges (AAMC)—Health Reform Readiness Support. Manatt supports the AAMC in developing tools and resources for members to assess their institutional readiness for health reform, share best practices and demonstrate leadership in healthcare transformation initiatives. Manatt developed an extensive assessment tool for institutions to evaluate their readiness in a number of reform focus areas, including payment and care delivery models, health information technology, and patient engagement. Manatt’s work includes the development of accountable care organization (ACO) readiness tools for academic medical centers.

Community Care of North Carolina—Develop Care Delivery and Payment Model. Manatt developed an innovative new care delivery and payment model that integrates community pharmacy-provided cognitive medication management strategies into existing patient-centered care teams (e.g., medical homes and neighborhoods), while incentivizing the pharmacist to address gaps in care. Work included developing payment models, developing and securing funding streams from payers, securing technology investment, and performing detailed financial modeling. The program was awarded one of the largest CMS Center for Medicare and Medicaid Innovation (CMMI) Health Care Innovation Award demonstration grants.

Duke Medicine—Development of TeleHealth Strategy. Manatt is assisting Duke in the development of a telehealth strategy, with a particular focus on the development of provider-to-provider Telestroke models, including TeleStroke and TeleCardiology to increase access to highly needed specialists, including in more rural communities.

SKIP of New York (Medicaid Service Coordinator)—Medicaid Technical Support: Manatt assisted SKIP of New York in navigating its role as a Medicaid Service Coordination Provider in light of the new changing Health Home landscape. Manatt served as technical advisor and counsel to the client as it engaged with the New York State Office for People with Developmental Disabilities and the New York State Department of Health on the development of a children’s health home.

North Carolina Department of Health and Human Services—Quality Strategy Development. Manatt is engaged in developing the state’s Medicaid Managed Care Quality Strategy, including developing the state’s quality aims and goals, developing the programs that will be used to drive meaningful and targeted quality improvement, and identifying the measures that will be used to assess their performance. In addition to the overall design of these initiatives, Manatt is supporting the development of the operational requirements necessary for the state and new managed care plans to implement this quality strategy.

New York State Coalition of New York State Public Health Plans—Medicaid Technical Assistance. Manatt founded and directs the Coalition of New York State (NYS) Public Health Plans (PHP Coalition), the ten members of which collectively serve over 2.5 million of the state’s public health program beneficiaries. On its behalf, we engage with senior leaders at the state Department of Health and Financial Services (which covers health insurers) on issues related to inpatient and outpatient reimbursement reform; the implementation of public-private health insurance products, such as the Family Health Plus Employer Buy-In; and stakeholder-driven feedback on regulations, contracts and state guidance regarding healthcare plan programs and operations. In connection with the state’s Medicaid redesign, we advanced the Coalition’s interests regarding the state’s development of a quality assurance reporting requirements program and other quality incentive programs that were developed to achieve state quality goals and objectives, and we have participated in multiple workgroups to implement the state’s value-based purchasing road map, which includes the state’s new quality strategy and associated metrics.

Washington State DSRIP Implementation, King County Accountable Community of Health—Delivery System Technical Assistance. Manatt is working with the state of Washington’s largest ACH to implement regional Medicaid delivery system improvement projects across a diverse collaboration of unaffiliated providers of medical, BH and community services. Manatt is providing technical assistance to King County ACH in its efforts to align with and augment the impact of related initiatives and its plan for sustainability beyond the demonstration period, based on Manatt’s detailed knowledge of the Washington DSRIP program and our experience with DSRIP in other states. Manatt is helping the ACH develop its approach to current state assessments, defining target populations and making evidence-based protocol selections. Manatt is also working with the ACH on funding allocation strategies to incentivize performance against goals and engage providers across the continuum of care. Manatt is also developing templates for provider contracts and developing options for longer-term sustainability.

Highlighted Subject Matter Experts

William S. Bernstein

Partner

Email | Bio

Bill Bernstein, Partner; Chair, Manatt Health.  30+ years’ experience. A focus on funding delivery system transformation and innovative models to address the needs of vulnerable populations and the underinsured.

Thomas Enders

Senior Managing Director

Email | Bio

Tom Enders, Senior Managing Director.  30+ years’ experience. Leading strategy consultant to the country’s AMCs and medical schools, integrated delivery networks, children’s hospitals and health systems. A skilled facilitator, with areas of focus including strategic and financial planning, organization development, formation and management of new delivery systems models (including ACOs), Medicaid policy and provider delivery transformation.

Benjamin K. Chu, M.D.

Managing Director

Email | Bio

Benjamin K. Chu, M.D., Managing Director.  30+ years’ experience. Dr. Chu brings a deep knowledge of healthcare through his work in clinical, academic, nonprofit and executive leadership positions with the nation’s top health systems. Formerly Executive Vice President for Kaiser Foundation and Health Plan Inc., and group president of Kaiser Permanente’s Southern California and Georgia regions, serving the medical, behavioral, post-acute and social care needs of more than 4.5 million members.

Anthony J. Fiori

Managing Director

Email | Bio

Tony Fiori, Managing Director.  15+ years’ experience. Nationally recognized expert on health reform regulatory and financial issues (with a focus on Medicaid MCOs) and health system performance improvement tactics.

Domain 8: Population Health

Overview:  Manatt is engaged with a wide variety of provider organizations, including ACOs and regional collaborations of medical, behavioral health, LTSS and social services providers, around strategic planning to support organizational efforts to compete on value and quality. Manatt provides technical assistance to define strategic objectives, and develop resource plans and sustainability modeling, including identifying, defining, and creating a framework of the competencies all risk-bearing entities need to succeed and specific strategies, tactics and investments needed against defined timelines to close the gap from current-state to the future-state vision. Our professionals have led integrated delivery systems (such as Kaiser), led the development and implementation of new models of care under the Centers for Medicare and Medicaid Innovation Center (CMMI), and developed cutting-edge analytics to better understand the care utilization and unmet needs of Medicaid populations and the uninsured.

Manatt has an in-house team of data analytics capabilities and data assets to support both policy and business strategy development. Manatt has experts leading analytic projects, including landscape assessments (service line, profitability and market analyses); modeling of supply and demand, and of capacity and space, as well as financial modeling; and pro forma development, provider network evaluations, and policy impact analysis (i.e., alternate payment model (APM) modeling). Manatt also has large-scale in-house data assets. Further, Manatt has an intimate knowledge of the Massachusetts all-payer claims database.

Qualifications:

Kindred Healthcare, Inc.Development of Care Management Model for PAC services. Manatt supported a consulting engagement to assess Kindred Healthcare’s care management capabilities and resources to develop and implement a care management model for post-acute care (PAC) services. Manatt assessed Kindred’s capabilities in a number of areas, including population-based data analytics, intensive hospital discharge planning, care coordination and care management, and ongoing quality measurement and reporting around patient outcomes and satisfaction. As part of the engagement, Manatt developed a gap analysis of Kindred’s care management capacity and a strategic road map to operationalize a cohesive care management model.

New York City Health + Hospitals (Large Municipal Public Health System)—Data Analytics Support for Health System Transformation. In addition to the specific engagement listed above, Manatt provided extensive data analytics to assist in the continued transformation of the city’s public healthcare system. Manatt conducted a strategic review and assessment of options to accelerate this transformation and to leverage Health + Hospitals’ considerable assets for long-term fiscal sustainability. Manatt analyzed overall trends in healthcare utilization, financing and payment, specific to the New York City metro-area market and local safety-net healthcare providers using a variety of sources that included client-specific patient and claims-level data, statewide utilization data, disproportionate share hospital (DSH) audit and hospital cost reports, plan-level data on managed care enrollment and spending, and neighborhood-level Census Bureau data on insurance status and other population characteristics; analyzed the distribution of available federal, state and city funds, within the numerous facilities that comprise NYC Health + Hospitals and across others in the state as appropriate (e.g., examining the distribution of uninsured and other uncompensated care); assessed the current and foreseeable impact of the ACA, Medicaid reforms, and New York’s DSRIP Program; conducted modeling on the impact of impending supplemental payment cuts and potential mitigation opportunities, including Designated State Health Program (DSHP) and uncompensated care pool approaches used in other states; and assessed NYC Health + Hospitals’ current operational environment through analyses of market shares and trends by product lines, including inpatient capacity, ambulatory capacity, occupancy rates, patient mixes, quality indicators and staffing.

St. Mary’s Healthcare System for Children—Developing Service Partnership for Medically Fragile Children.  Manatt advised St. Mary’s Healthcare System for Children (SMHC) in connection with documenting the need for services of medically fragile young adults (MFYAs). Manatt worked with SMHC to develop a strategy to pursue partnerships with one or more geriatric nursing homes to develop and manage appropriate residential long-term care for medically fragile children (MFC) “aging out” of pediatric care settings. To begin to identify and perform outreach to specific aging-out individuals who might be suitable for these newly developed MFYA residential units, Manatt provided deep-dive data analytics to develop a detailed segmentation of the demographic characteristics, small-area geography of residence, and utilization history for identified MFC/MFYA individuals in New York State and helped identify potential long-term care and care management providers serving high-need adolescents.

Highlighted Subject Matter Experts

Benjamin K. Chu, M.D.

Managing Director

Email | Bio

Benjamin K. Chu, M.D.,  Managing Director.  Nationally recognized leader in population health management. Physician and integrated health system CEO (including EVP, Kaiser Foundation Hospitals and Health Plans, and group president of two regions). Expertise encompasses direct patient care, population health, public policy and reform, medical education, health system administration, health insurance, culture change, and leadership development.

Mary E. Keegan

Senior Advisor

Email | Bio

Mary Keegan, Senior Advisor.  30+ years’ experience. Works in safety net leadership. Focuses on program development, delivery transformation, aligning community-based providers, LTSS and BH providers with medical systems organized around value-based care and care continuum modeling. Hands-on experience with intake and screening tools and FQHC and community provider intake processes.

Eric I. Bartholet

Managing Director

Email | Bio

Eric Bartholet, Managing Director.  30+ years’ experience. Broad range of implications stemming from healthcare reform, with a particular emphasis on strategy and IT/informatics planning for large integrated delivery systems. Prior to joining Manatt, Eric was a partner in the Health Delivery Planning and Operations Group of Computer Sciences Corporation (CSC)’s Global Healthcare Solutions, where he concentrated on IT strategy, planning and organizational design.

Laura H. Braslow

Director

Email | Bio

Laura Braslow, Director Analytics.  15+ years’ experience. Works in complex health data analysis and specializes in leveraging data analytics to support delivery system reform, with fluencies in large data sets and comprehensive utilization and cost analysis.

Contact

Patricia M. Boozang

Senior Managing Director

Email | Bio

Patricia Boozang, Senior Managing Director at Manatt Health, will serve as the primary point of contact for prospective clients, partnering with one or more of Manatt’s Domain-specific subject matter experts to deliver on client needs. Patricia has over 20 years of experience with Medicaid waiver design and implementation, with a specific focus on developing and integrating programs related to Medicaid ACO implementation, Medicaid managed care and Social Determinants of Health. She regularly oversees complex, multistream delivery system transformation and statewide reform engagements. Patricia will manage Manatt Health’s response to all scope requests that arise, and will ensure the successful execution of projects after launch.