The staff at Burns & Associates have experience in various aspects of health care delivery and payment reform across the full continuum of care including medical, pharmacy and long term services and supports.
Read more about the services we offer.
Financing
- Budget Development and Program Financing »
B&A staff have considerable experience in forecasting the costs of health care programs. Our tailored approach builds financial models specific for each client based upon the needs of the program. B&A can also help states develop policies to support maximum use of federal match rate opportunities. See Projects
- Disproportionate Share and Upper Payment Limit Program Financing »
B&A staff have experience in working with state agencies making DSH and UPL payments as well as private sector clients receiving these payments. We examine the formulas used to make payments and run models that simulate alternative formulas based upon policy changes requested by the client. B&A assists in facilitating discussions between parties as to the advantages of specific DSH and UPL policies based on federal law. See Projects
- HIFA and Other Waivers »
Peter Burns is one of the leading experts in the nation for assisting states in seeking approval of their HIFA waivers. B&A staff assist states in all aspects of the application process—including development of a concept paper, meeting with stakeholders on the design of the waiver, analyzing historical policies and costs that impact the waiver application, developing budget neutrality models, writing the waiver application, and negotiating with CMS.
Mr. Burns is the co-author (with Dr. Gretchen Engquist) of an issue brief published by the State Coverage Initiative titled Health Insurance Flexibility and Accountability Initiative: Opportunities and Issues for States. See Projects
Quality and Planning
- Strategic Planning »
B&A is proficient in strategic planning activities including policy analysis and financial modeling. Our team strives to build consensus. Our approach involves stakeholder engagement to find areas of agreement among stakeholders. We take a customized approach to each strategic planning exercise, recognizing that the dynamics involved vary for each state or plan and must be addressed in a unique manner. See Projects
- Data and Analytics »
B&A staff includes a team of talented programmers and policy analysts. B&A uses financial modeling, health services research and policy analysis to inform policy making and program design. The team also are adept at analytics in support of value-based program designs like quality metric calculations and performance scoring. While the team uses data from an array of sources as needed, the team specializes in working with Medicaid, Medicare and state level all payer claims data. See Projects
- Rate Setting »
B&A staff have considerable experience in developing new reimbursement systems as well as updating or rebasing existing payment systems. Our staff have set rates paid to physicians, inpatient hospitals, outpatient hospitals, nursing facilities, federally qualified health centers (FQHCs), home health, transportation providers and intermediate care facilities. B&A is also working with states on value-based payment approaches for primary care, community mental health centers (CMHCs), and accountable care organizations (ACOs).
B&A staff has also conducted independent evaluations of existing reimbursement methodologies to assist states in developing options to reform their systems or to ensure compliance with federal access to service requirements. See Projects
- External Quality Reviews and Other Independent Evaluations »
B&A staff have worked in the past on evaluating specific aspects of a state’s Medicaid program as well as a full evaluation of its entire program. Activities include analyzing existing policies, evaluating expenditures at the service or eligibility category level, interviewing state staff and other stakeholders, and researching best practices in other states. We summarize our findings in a report which we walk through with the client, highlighting both the aspects of the program that are successful and those that could be improved. For the latter, we provide specific recommendations for improvement and the level of effort required to implement the recommendations. See Projects
- Conduct Focus Groups »
B&A is proficient in strategic planning activities including policy analysis and financial modeling. Our team strives to build consensus. Our approach involves stakeholder engagement to find areas of agreement among stakeholders. We take a customized approach to each strategic planning exercise, recognizing that the dynamics involved vary for each state or plan and must be addressed in a unique manner. See Projects
- Develop & Conduct Member & Provider Surveys »
B&A staff have experience in creating and administering surveys for various stakeholders. We develop customized cost surveys for state agencies to collect from their providers, specifically for community-based services. We also develop satisfaction surveys for state agencies to administer to their stakeholders (e.g. program members, providers, health plans). We assist states in the technical aspects of administering the survey (by phone, mail, and online) as well as analyzing the results in a summarized manner for decision makers. See Projects
Payment Reform
- Strategic Planning »
B&A is proficient in strategic planning activities including policy analysis and financial modeling. Our team strives to build consensus. Our approach involves stakeholder engagement to find areas of agreement among stakeholders. We take a customized approach to each strategic planning exercise, recognizing that the dynamics involved vary for each state or plan and must be addressed in a unique manner. See Projects
- Budget Development and Program Financing »
B&A staff have considerable experience in forecasting the costs of health care programs. Our tailored approach builds financial models specific for each client based upon the needs of the program. B&A can also help states develop policies to support maximum use of federal match rate opportunities. See Projects
- Rate Setting »
B&A staff have considerable experience in developing new reimbursement systems as well as updating or rebasing existing payment systems. Our staff have set rates paid to physicians, inpatient hospitals, outpatient hospitals, nursing facilities, federally qualified health centers (FQHCs), home health, transportation providers and intermediate care facilities. B&A is also working with states on value-based payment approaches for primary care, community mental health centers (CMHCs), and accountable care organizations (ACOs).
B&A staff has also conducted independent evaluations of existing reimbursement methodologies to assist states in developing options to reform their systems or to ensure compliance with federal access to service requirements. See Projects
- Data and Analytics »
B&A staff includes a team of talented programmers and policy analysts. B&A uses financial modeling, health services research and policy analysis to inform policy making and program design. The team also are adept at analytics in support of value-based program designs like quality metric calculations and performance scoring. While the team uses data from an array of sources as needed, the team specializes in working with Medicaid, Medicare and state level all payer claims data. See Projects
- Program Design and Operations »
B&A supports the full range of program implementation from conceptualization to evaluation. Our team have a successful track record of helping states put programs into operation. Our team has a range of program expertise including value-based purchasing design and new care delivery models. See Projects
- Public/Private Insurance Initiatives »
B&A staff have worked with states to navigate with payers and providers in implementation of multi-payer programs. Staff expertise includes the redesign of primary care, accountable care organization and other value-based incentive programs, all payer rate setting, subsidy design, reinsurance and high-risk pools. Our team approach is customized to what state officials and stakeholders are seeking from the initiative. See Projects
HCBS Waiver Programs
- Supports Intensity Scale and other Assessment Tools »
B&A staff have expertise in creating and modifying assessment tools for the elderly, physicially disabled, and developmentally disabled populations. For the development of new tools, we typically convene a panel to finalize the tool and then conduct a pilot. Regression analyses are conducted to assess the inter-rater reliability of both pilot and full-scale implementations.
B&A has also developed tools to tie payments for individual budgets in HCBS programs to the assessment of client needs. See Projects
- Service Definitions »
- HCBS Rate Setting »
B&A is a leader nationally in the development of HCBS rates for both agency and individual providers of services for the developmentally disabled, the elderly and physically disabled, and persons with mental health needs. Often, our rate setting projects include conducting a provider survey of historical costs and utilization. Rates are not constricted to this data source due to limitations often seen in the data. Rather, it is used to reinforce the rates set using current market-based data that is specific to each state and specific to each HCBS service.
B&A will discuss with the outset the intent of the rebase and the level that the state wants to reimburse for specific items (e.g. employee benefits, admin costs, travel). These assumptions inform the customized approach to the rate development process. See Projects
- Individualized Budgeting »
The B&A team has assisted in the development of individualized budget programs in Arizona, Louisiana, Ohio, Oregon and, currently, in Rhode Island. Each state has a unique approach to the development of individual budgets for HCBS programs. B&A staff discuss the conceptual framework with each state, recognizing existing or potential data limitations. Our funding levels a developed through regression analyses to ensure statistical validity. See Projects
- Converting Data Systems »
- Implement Fiscal Intermediaries »
Fiscal intermediaries are becoming common in the facilitation of consumer-directed HCBS programs. Early on, Gretchen Engquist assisted in the implementation of cash and counseling programs and FI implementations. She co-conducted a national survey for the Assistant Secretary of Planning and Evaluation (ASPE) for the Department of Health and Human Services of consumer-directed programs serving people with disabilities and seniors and co-authored the final report, “ASPE Consumer-Directed Support Service Program Inventory.”
Current B&A staff have written RFPs to procure FIs, conducted the readiness reviews, and assisted in developing the operational protocols from the state’s side to interface with the FI. See Projects
Operations
- ACA Implementation »
- Litigation Support »
B&A staff can serve as arbitrators in settlements as well as technical resources for the legal team working on the lawsuit. We can assist in developing supporting cost evaluations or analysis of particular Medicaid laws and regulations. We have successfully assisted parties in the past come to settlement on long-standing disputes over payments to hospitals for indigent care and in support of states’ rate setting methodologies for hospital services. See Projects
- Program Design and Operations »
B&A supports the full range of program implementation from conceptualization to evaluation. Our team have a successful track record of helping states put programs into operation. Our team has a range of program expertise including value-based purchasing design and new care delivery models. See Projects
- Develop RFPs »
B&A has assisted states in writing RFPs for a variety of Medicaid services. We provide technical assistance in developing the parameters of the scope of work required for the vendors that will be responding to the RFP as well as researching legal matters that should be included in the RFP. In addition to writing draft RFPs for state staff to review, we assist in answering questions from the bidders conference as well as developing tools for evaluating the submitted proposals. See Projects
- Program Monitoring »
B&A staff have been asked to provide both continuous monitoring for Medicaid programs as well as one-time efforts to improve operational performance. This has included developing monitoring manuals for budgeting, service utilization, and members’ access to services. B&A also conducts focus studies to address state concerns on specific program operations.See Projects
- Public/Private Insurance Initiatives »
B&A staff have worked with states to navigate with payers and providers in implementation of multi-payer programs. Staff expertise includes the redesign of primary care, accountable care organization and other value-based incentive programs, all payer rate setting, subsidy design, reinsurance and high-risk pools. Our team approach is customized to what state officials and stakeholders are seeking from the initiative. See Projects
- Readiness Reviews »
Another aspect of the procurement process which B&A has experience is in preparing for and conducting readiness reviews. We customize the readiness review protocol for each engagement, gaining input from state staff on the areas that they would like particular focus. In addition to conducting the reviews, we write up our findings in a report to the client, assist in giving feedback to the entity being reviewed, and conduct re-reviews when necessary. See Projects