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February 5, 2010
 
  CLICK TO READ ARTICLES.
  COOK CHILDREN’S JOINS ACAP – THIRD MEMBER IN TEXAS
Part of the Cook Children’s Health Care System’s family of companies, Cook Children’s Health Plan (CCHP) in Fort Worth, Texas has joined ACAP, becoming its 46TH health plan and third in Texas. Dave Lamkin is the CEO. Read More.

ACAP Enrollee speaks at PARTNERSHIP FOR MEDICAID hill briefing
The Partnership for Medicaid, a national coalition of health care, local government, and labor organizations, applauded the work of pro-health care reform lawmakers and urged them to continue their push for comprehensive legislation.

At a Capitol Hill briefing on January 27, the Partnership for Medicaid stressed that during these tough economic times and lengthy period of high unemployment, millions more lower-income and disabled Americans depend on the Medicaid system for their health care. Read More.
 
PUBLIC POLICY AND ADVOCACY
  HEALTH CARE REFORM STILL ALIVE AS ACAP PREPARES FOR FLY-IN

ACAP SIGNS GROUP LETTER TO CONGRESS PROMOTING CONTINUATION OF HEALTH CARE REFORM

 
EXCELLENCE AND ACCOUNTABILITY
 

AHRQ OFFERS FREE CONFERENCE ON CAHPS

ACAP TO PARTICIPATE IN EXPERT MEETING ON MEASURE CRITERIA FOR CHIPRA PEDIATRIC QUALITY MEASURES

ACAP PARTNERS IN PUBLIC-PRIVATE PARTNERSHIP TO ADDRESSS RISING U.S. INFANT MORTALITY RATE

2010 QUALITY NETWORKING SESSIONS WILL FOCUS ON CARE TRANSITIONS & REDUCING DISPARITIES
ACAP PLAN NEWS
  ACAP MEMBERS NETWORK HEALTH AND COMMONWEALTH CARE ALLIANCE LAUNCH CHRONIC DISEASE PROGRAM

MAURA BLUESTONE TO LEAD NY COALITION OF PUBLIC HEALTH PLANS

CARESOURCE MAKES NATIONAL LIST FOR STAFF DEVELOPMENT

LA CARE AWARDS GRANT TO LOCAL CLINIC

CAREOREGON, NETWORK HEALTH AND ACAP TO HEADLINE UPCOMING HEALTH INTEGRATED EXECUTIVE LEADERSHIP EVENT

ACAP SEEKING MEDICARE DIRECTOR

ACAP PARTICIPATES IN FAMILIES USA HEALTH ACTION 2010 CONFERENCE
MEETINGS
  CANCELLED: FEBRUARY FLY-IN AND POLICY FACE-TO-FACE

SPRING MEDICARE, BOARD AND COO MEETINGS: REGISTER AND RESERVE YOUR ROOM TODAY
IN OTHER NEWS
 

KAISER COMMISSION ISSUES POLICY BRIEF ON MEDICAID MANAGED CARE

NEW REPORT SHOWS THAT INCREASED COPAYMENTS ARE NOT ALWAYS LINKED TO SAVINGS FOR HEALTH PLANS

7TH ANNUAL WORLD HEALTH CARE CONGRESS

DOL, HHS, TREASURY ISSUE RULES REQUIRING PARITY IN TREATMENT OF MENTAL AND SUBSTANCE USE DISORDERS
 
 
   
 
UPCOMING ACAP CALLS
 

2/10 quality networking call at 3 pm et

 

2/12 cmo, Pharmacy and quality management roundtable call at 12 pm et

 

2/18 case management call at 3 pm et

 

2/19 quality management call at 1 pm et

 
 EVENTS CALENDAR
  CLICK TO VIEW...
 ACAP LINKS

SOCIAL NETWORKING

 
 


 

Affinity Health Plan
Alameda Alliance for Health
AmeriHealth Mercy Health Plan
 Boston Medical Center HealthNet Plan

CalOptima

CareOregon
 CareSource

CareSource MI
 CenCal Health

Children’s Community Health Plan in Wisconsin

Children's Mercy Family Health Partners
 Colorado Access
 Commonwealth Care Alliance

Community Health Choice
 Community Health Network of Connecticut
 Community Health Plan
 Contra Costa Health Plan

Cook Children's Health Plan
 Denver Health

Elderplan & Homefirst

Health Plan of San Mateo
 Health Plus
Health Right

Health Services for Children with Special Needs
Horizon NJ Health
 Hudson Health Plan
LA Care Health Plan

Inland Empire Health Plan

Maine Primary Care Association

Maryland Community Health System
MDwise
 Metropolitan Health Plan in Minnesota
Monroe Plan for Medical Care, Inc.
Neighborhood Health Plan of Massachusetts
Neighborhood Health Plan of Rhode Island
Network Health

Prestige Health Choice

San Francisco Health Plan

Santa Clara Family Health Plan

Texas Children's Health Plan
Total Care
University Physicians Health Plans

UPMC Health Plan
 Virginia Premier Health Plan, Inc.

VNS CHOICE
  COOK CHILDREN’S JOINS ACAP – THIRD MEMBER IN TEXAS
Part of the Cook Children’s Health Care System’s family of companies, Cook Children’s Health Plan (CCHP) in Fort Worth, Texas has joined ACAP, becoming its 46TH health plan and third in Texas. Dave Lamkin is the CEO.

The Cook Children’s Health Care System is one of the country’s leading integrated pediatric health care delivery systems. Based in Fort Worth, Texas, the non-profit organization includes a nationally recognized Medical Center, Physician Network, Home Health Company, Health Plan, Health Foundation and Health Care System.

The Health Plan is a nonprofit managed care organization established by the System in 1998 to arrange for the provision of health insurance benefits to underinsured and uninsured children within the 6-county area that comprises the primary service target of the System. CCHP provides Medicaid and CHIP coverage to more than 79,000 low-income people who qualify for government-sponsored programs such as Medicaid and the Children’s Health Insurance Program. The health plan’s board members include physicians, and leaders in the business and local communities served by the Health Care System.

CCHP maintains a robust network of health care providers, including contracts with over 2,000 primary care and specialist physicians, 30 hospitals, 7 behavioral health inpatient facilities, and 6 FQHCs/RHCs.

The Health Plan’s strategy is to achieve NCQA accreditation within the next two years. As part of that quality initiative, CCHP participates in HEDIS, and employs aggressive disease management programs for pregnant members, and for children with asthma and diabetes. Representative of its dedication to customer service, the Health Plan consistently scores in the 90th percentile in both provider and member satisfaction..

ACAP Enrollee speaks at PARTNERSHIP FOR MEDICAID hill briefing

The Partnership for Medicaid, a national coalition of health care, local government, and labor organizations, applauded the work of pro-health care reform lawmakers and urged them to continue their push for comprehensive legislation.

At a Capitol Hill briefing on January 27, the Partnership for Medicaid stressed that during these tough economic times and lengthy period of high unemployment, millions more lower-income and disabled Americans depend on the Medicaid system for their health care. The non-partisan coalition – an alliance of 18 organizations representing doctors, health care providers, safety net health plans, counties, and labor – praised Congress’ recognition of the importance of Medicaid when it voted to expand the program significantly in both the House and Senate health care reform bills.

The event featured three Members of Congress – Representatives Diana DeGette (D-Co), Chris Murphy (D-Co) and Paul Sarbanes (D-Md). All three spoke assertively about the importance of Medicaid within our health care system and gave strong indication to the audience that the will to pass a strong health reform bill is still very much alive.

The Partnership was also represented by five panel members, including:

  • ACAP Health Plan Enrollee Tomlyn Farley, Parent of Child Enrolled in Medicaid, Representative of Health Care Services for Children with Special Needs Plan (HSCSN);
  • Thomas Johnson, Chair of the Partnership for Medicaid and President & CEO of Medicaid Health Plans of America;
  • Dr. Rhonique Harris Representative of the National Association of Children’s Hospitals and Related Institutions;
  • Georges Benjamin, Executive Director, American Public Health Association; and
  • Dan Hawkins, Senior Vice President of Programs & Policy, National Association of Community Health Centers.
     

Each drove home the Partnership position that Medicaid is a critical program for millions of people, and told the crowd that an expansion of Medicaid is one of the most important motivations Congress should have to push forward with Health Care Reform.

ACAP extends special thanks to Ms. Farley and John Mathewson, Cecil Doggette and Oliver Roy of HSCSN. The event was organized by ACAP Policy Director Jenny Babcock with help from ACAP's Policy Intern Beth Wolf.

 

PUBLIC POLICY AND ADVOCACY
 

HEALTH CARE REFORM STILL ALIVE AS ACAP PREPARES FOR FLY-IN

As Washington pivots its focus to jobs and the economy, health reform continues to simmer – even if it’s on the back burner. Strategic and policy discussions continue as Congressional Democrats look for a way forward on health reform that will yield enough votes to pass their bills. However, contrary to popular and media opinion, health reform is anything but dead.

To prove that, Congress is contemplating a different tact on moving politically popular health reform policies piecemeal – one option that ACAP has discussed as a possibility over the past several weeks. It appears that the House is preparing to move forward at least two politically potent bills – one to allow commercial insurers to sell insurance across state lines (repealing the so-called “anti-trust provisions” of the federal McCarran-Ferguson Act) and the other to establish minimum medical loss ratios (MLRs) on health insurers. Although ACAP is not involved in the first issue, we are on record supporting a minimum 85 percent MLR for all health plans, including Medicaid and Medicare plans, provided that issues like care management be considered medical costs. It is likely that these bills could appear as early as this week in the House.

In addition, as the Senate prepares its own jobs legislation, there is also an outlook for continuing the stimulus package’s Medicaid fiscal relief to states. ACAP is strongly supporting an effort to extend the relief through June of 2011 and to ensure that ARRA’s provisions requiring the states to maintain their eligibility levels and provide prompt payment remain in place. Senators Reid and Rockefeller introduced legislation last week to do that and ACAP is a part of the effort to ensure that legislation is enacted.

On the eve of ACAP’s fly-in, ACAP is also evaluating the possibility of moving legislation to ensure that the Medicare Advantage SNP program is reauthorized. Although the House and Senate health reform packages both include an extension of the authority, their status in never-neverland could mean real problems for this program if it is allowed to expire at the end of the year. Although it is unlikely that Congress would allow that to happen, it should be remembered that it will likely have to move as part of a larger package – including, possibly, legislation to fix the Medicare physician payment cuts scheduled to go into effect in a month. ACAP continues to monitor this issue and has raised the possibility of attaching SNP reauthorization to the doc fix bill when it moves.

Normally, ACAP would also include a major summary of the President’s annual budget request to Congress. Unfortunately, the President’s budget this year is kind of a big nothing-burger. There is very little in the way of policy specifics because it is clear that they are in a major holding pattern waiting for health reform to pass Congress. Having said that, the President’s FY2011 budget did include policy which addresses, among other things, MA plan error rates, demonstration projects to improve coordination for dual eligibles, continuing the ARRA’s FMAP increase through June 2011, and seeking to cut waste and fraud in Medicaid, Medicare, and CHIP.

ACAP SIGNS GROUP LETTER TO CONGRESS PROMOTING CONTINUATION OF HEALTH CARE REFORM

ACAP has signed on to a letter circulated by the Children’s Health Group urging Congress to continue the work of health care reform and enact a bill to benefit families and children as soon as possible. ACAP promoted mention of the Medicaid expansion in the letter. Other signing organizations include the American Academy of Pediatrics, the Children’s Dental Health Project, Families USA, and the National Association of Children’s Hospitals. The full letter follows:

Dear Member of Congress:

Children and families are depending on you to get to the finish line on health reform. With state budgets in peril and services for children and families at risk, now more than ever we need you to continue your work and pass a health reform bill.

Thank you for all you have done for children and pregnant women through health reform thus far. The health reform proposals passed in 2009 by the House and in the Senate make great strides in improving the health and well being of children and families. For instance, the Senate bill includes funding to continue CHIP through a reasonable transition period while the Exchange gets off the ground. Preventive services are the foundation of care for children and the Senate bill would allow for appropriate coverage for age-appropriate preventive benefits, without requiring families to pay out of pocket. Access to an appropriately-trained pediatric workforce would improve as well. The House bill also includes significant steps forward for children, including Medicaid payment reform, strong medical home and system reform provisions, coverage of benefits needed by children with special health care needs (such as durable medical equipment, and rehabilitative and habilitative therapies) and commonsense structures that not only allow households with legal immigrants (which include many children) access to Exchange coverage, but also provide the subsidies needed to afford coverage. Both bills would prohibit children from being denied health care due to pre-existing conditions, prohibit annual and lifetime limits, require mental health and substance use parity, extend family coverage up to age 27, and substantially expand the Medicaid program for very low-income individuals. The bills also would improve the benefits available to children by mandating that the newly established benefit standards include pediatric oral health care, and both bills also strengthen access to maternity coverage and improve Medicaid coverage of tobacco cessation for pregnant women, helping to ensure that children get a healthy start.

We urge you to continue to move forward and enact a health reform bill that benefits children and families as soon as possible. Too many children and their families can not afford coverage, are denied the insurance that they need, or lack access to basic preventive services. We strongly urge you not to let a marathon end yards before the finish line. Children and families are depending on your finishing health reform; please complete the race.

Click Here to Make a Comment about this Posting on ACAP’s New Blog! You can post your comment by logging into ACAP’s New Website! Your comments will only be seen by ACAP Plan Members.

  

 

ACAP SHARING SERVICES
In the members support section of our website, there are several areas that we want to remind you to look at periodically, including a large section of shared documents, which includes disaster recovery plans, compliance documents, and job descriptions. We also have several surveys we have done of our plans. Please visit our Members Support section on our website. 
 
 
ACAP JOB BANK
 
ACAP plans can post job announcements in our job bank. Please see our website for more details. You can email job announcements to Stephen Cox at scox@communityplans.net.

 

  

ACAP BULLETIN BOARDS
The Bulletin Boards are an easy way to network with plans, post questions and receive quick responses. To subscribe, you must first sign into the Members Support section on the ACAP website and then navigate to the Bulletin Board topic of interest. From there you can click the "Subscribe" check box to receive the posts in emails. This is also where you can post questions/topics as well as responses. If you have any troubles please contact Stephen Cox at scox@communityplans.net for assistance.
   
EXCELLENCE AND ACCOUNTABILITY
 

AHRQ OFFERS FREE CONFERENCE ON CAHPS

On April 19th and 20th, the Agency for Healthcare Research and Quality is hosting a free conference to explore how health care organizations are using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys and the Surveys on Patient Safety Culture (SOPS) to assess and improve patient experience and patient safety.

The conference is being held in Baltimore. Agendas for the preconference sessions and the main meeting are now available at https://www.cahps-sopsugm.org/ugm/UGMAgenda.aspx.

ACAP TO PARTICIPATE IN EXPERT MEETING ON MEASURE CRITERIA FOR CHIPRA PEDIATRIC QUALITY MEASURES

The Agency for Healthcare Research and Quality, working in close partnership with the Centers for Medicare and Medicaid Services in response to requirements of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA, Public Law 111-3), plans to award cooperative agreements designed to advance and improve pediatric healthcare quality measures (visit http://grants.nih.gov/grants/guide/notice-files/NOT-HS-10-003.html.) The goal of the Pediatric healthcare Quality Measurement Program (PQMP) is to produce an improved core set of children's healthcare quality measures for use by public and private programs, health insurers, providers and patients, by January 1, 2013, as required by CHIPRA. To facilitate creation of an improved, standardized core set, awardees will be required to use a standardized consensus set of measure criteria.

In close collaboration with the Centers for Medicaid and Medicare Services and the CHIPRA Federal Quality Workgroup, AHRQ will be hosting an Expert meeting to identify measurement criteria for the CHIPRA Pediatric Quality Measures Program. Deborah Kilstein, ACAP Director for Quality Management and Operational Support has been invited to attend the expert meeting.

The meeting sessions are scheduled for Wednesday, Feb. 24, from 10 a.m.-5 p.m., Eastern Time, and Thursday, Feb. 25, from 8 a.m.-4 p.m., Eastern Time. Both sessions are open to the public. An opportunity for public comments will be provided on both days of the session. An agenda will be posted soon on the AHRQ CHIPRA Web site (http://www.ahrq.gov/chip/chipraact.htm.) The Web site also includes links to the CHIPRA Legislation, including the section on the Pediatric Quality Measures Program in Title IV (http://www.ahrq.gov/chip/chipraact.htm#Legislation.)

ACAP PARTNERS IN PUBLIC-PRIVATE PARTNERSHIP TO ADDRESSS RISING U.S. INFANT MORTALITY RATE

ACAP has agreed to participate as an outreach partner of text4baby –a new free mobile information service providing timely health information to pregnant women and new moms from pregnancy through a baby’s first year.

Women who sign up for the service by texting BABY to 511411 (or BEBE for Spanish) receive three free SMS text messages each week timed to their due date or baby’s date of birth. These messages focus on a variety of topics critical to maternal and child health, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health and safe sleep. Text4baby messages also connect women to prenatal and infant care services and other resources.

An educational program of the National Healthy Mothers, Healthy Babies Coalition (HMHB), text4baby delivers timely health tips via text message to those who need it most. It is made possible through an unprecedented public-private partnership which includes the White House Office on Science and Technology Policy, the U.S. Department of Health and Human Services, Voxiva, CTIA-The Wireless Foundation, Grey Healthcare Group (a WPP company) and founding corporate sponsor Johnson & Johnson. Premier sponsors include WellPoint, Pfizer and CareFirst BlueCross BlueShield and wireless carriers are distributing text messages at no charge to recipients. Implementation partners include BabyCenter, Danya International, Syniverse Technologies, Keynote Systems and The George Washington University.

“We believe the power of partnership and community can make an incredible difference in women’s and children’s lives,” said Judy Meehan, executive director of the National Healthy Mothers, Healthy Babies Coalition. “Text4baby brings HMHB’s mission to life and with the help of our partners, we believe we can be a strong catalyst for change.”

Each year in the U.S., more than 500,000 babies are born prematurely and an estimated 28,000 children die before their first birthday—signifying a public health crisis. The infant mortality rate in the U.S. is one of the highest in the industrialized world, and for the first time since the 1950s, that rate is on the rise.Research shows that while 90 percent of Americans have a mobile phone fewer have access to the Internet, and texting is more prevalent among women of childbearing age.

The text4baby wireless carriers are voluntarily providing the critical communications link of the initiative, distributing text messages to recipients at no charge. Participating carriers include: Alltel, AT&T, Cellular South, Cellcom, Centennial Cellular, Cincinnati Bell, Metro PCS, N-Telos, Sprint, T-Mobile, U.S. Cellular, Verizon and Virgin Mobile.

2010 QUALITY NETWORKING SESSIONS WILL FOCUS ON CARE TRANSITIONS & REDUCING DISPARITIES

As the name implies, the purpose of the sessions is to allow health plan quality staff to network around a particular quality improvement focus. In 2009, the sessions focused on management of care for people with diabetes and emergency room usage. Based on input of ACAP plans’ quality staff, this year the networking calls will focus on two issues of interest, care transitions and reducing health disparities. All calls will take place at 3 pm ET, dates for each are as follows:

  • Care Transition – February 10th, May 12th, August 11th, and November 10th
  • Reducing Disparities – March 17th, June 16th, September 15th, Face-to-Face session at quality meeting
  
 
 
   

ACAP PLAN NEWS
  ACAP MEMBERS NETWORK HEALTH AND COMMONWEALTH CARE ALLIANCE LAUNCH CHRONIC DISEASE PROGRAM

Local nonprofits Commonwealth Care Alliance and its affiliate, Prevention and Access to Care and Treatment, will join forces with Network Health to launch a chronic disease management program.

The goal of the Network Health Alliance is to improve delivery of care to patients with complex health needs and to reduce costs stemming from under or over-utilization of care.

Boston-based Commonwealth Care Alliance is a nonprofit care-delivery system committed to providing integrated health care and related social support services. Network Health, based in Medford, Mass., is one of five insurers that are part of Massachusetts’ subsidized Commonwealth Care program.

The first to join the new program: Cambridge Health Alliance patients who have two or more complex chronic health problems, such as heart disease and diabetes. The program will target lower-income people who qualify for the state’s Medicaid program or state-subsidized Commonwealth Care program.

 MAURA BLUESTONE TO LEAD NY COALITION OF PUBLIC HEALTH PLANS

The Coalition of New York State Public Health Plans has announced that Maura Bluestone will serve as the new chair of the Coalition. Bluestone has served as President and CEO of Affinity Health Plan for 24 years. Affinity serves members in New York City and the surrounding counties of Nassau, Suffolk, Rockland, Orange and Westchester.

Affinity is a founding member of the Coalition of New York State Public Health Plans. The Coalition includes nine plans serving more than 2 million, or two-thirds of, children and adults enrolled New York's public health insurance programs through the state's Medicaid managed care program, Family Health Plus and Child Health Plus.

"I look forward to continuing the great work of the Coalition health plans in improving access and quality of care for our most vulnerable populations," says Bluestone. "We will continue to work with providers, government agencies, community based organizations, advocacy groups and others to improve health, reduce costs and remove the barriers that still prevent some 2.6 million New Yorkers from getting comprehensive, affordable coverage."

Article: "Bluestone to Lead Coalition of New York State Public Health Plans"

CARESOURCE MAKES NATIONAL LIST FOR STAFF DEVELOPMENT

CareSource has earned national recognition for staff development. The Dayton-based public-sector managed care company was named one of Training Magazine’s Top 125 companies that excel at training practices, evaluation methods and training initiatives.

Listed at 78, CareSource joins the ranks of some of America’s largest companies including Microsoft Corp. and McDonalds USA. CareSource was honored at an awards gala held Monday in San Diego.

Pamela Morris, president and chief executive officer, said CEO, said the company’s CareSource University has played a key role in employee development. CareSource, which serves more than 800,000 customers in Ohio and Michigan, has roughly 900 employees, including about 800 in Dayton.

LA CARE AWARDS GRANT TO LOCAL CLINIC

A South Bay health clinic won a significant grant to expand a new system of tracking low-income patients with chronic conditions - which officials hope will be a model for the county. South Bay Family Health Care, which sees about 25,000 patients a year, received $100,000 from L.A. Care Health Plan to expand its "i2iTracks" chronic disease management system.

"This greatly improves our ability to make very sound judgments in treatments for our patients," said John Merryman, a spokesman for the clinic. "It's fairly unique for us to have this level of sophistication in patient care."

The electronic system allows physicians, nurses and health workers to input data on patients and group them together according to race, gender, age and a range of health problems. The data allows medical workers to figure out the best plan in treating a variety of patients with chronic conditions such as diabetes, asthma and hypertension.

The system, which has been phased in over the last year, recommends treatment plans to help patients manage conditions such as obesity and help curb poor lifestyle habits such as smoking and lack of nutrition and exercise.

The grant will allow the clinic to expand the system to all of its patients who receive care in Inglewood, Redondo Beach, Gardena and at a school-based clinic at Carson High School. In tracking the patients, the clinic also will be able to ensure that they are receiving routine.

CAREOREGON, NETWORK HEALTH AND ACAP TO HEADLINE UPCOMING HEALTH INTEGRATED EXECUTIVE LEADERSHIP EVENT

As the U.S. health insurance industry enters a new era, it faces new opportunities to thrive. Health plans that are best positioned to excel in the coming decade are those that effectively leverage partnerships, find innovative ways to manage their changing membership, and understand how pending reform, in whatever form, will redefine their services. Health plan executives and healthcare industry experts will participate in an active, two-day forum hosted by Health Integrated, a leading Health Management Solutions provider and ACAP Preferred Vendor, to discuss strategies to succeed in a challenging and changing healthcare marketplace. The event , “Thriving in the New Decade of Healthcare,” will take place April 15-16, in St. Petersburg, FL. ACAP member executives are encouraged to attend.

“The nation’s top health plans are focusing on implementing strategies that reduce costs and create greater value for their members and customers,” says Shan Padda, President and Chief Executive Officer, Health Integrated. Participants will share experiences of successful health management initiatives and explore innovative ways to improve member outcomes, reduce healthcare costs and become most competitive in their markets. Speakers include ACAP plan staff members Dr. Margie Rowland, CareOregon CMO, and Mary McKendry, Network Health Sr. Director of Clinical Affairs, as well as ACAP Policy Director Jenny Babcock. To see the agenda and to register, click here: https://www.regonline.com/ExecutiveLeadershipSeriesSpring10. You may also contact the event coordinator, Dawn Shivers, at 813-388-4061 or via email at dshivers@healthintegrated.com.

ACAP SEEKING MEDICARE DIRECTOR

A Director for Medicare is sought for the Association for Community Affiliated Plans, a non-profit trade association of 45 health plans focused on Medicaid and the Medicare SNP program. ACAP’s members currently include 21 operational Medicare SNPs and 10 plans involved in Managed Long Term Care. The Director of Medicare will be asked to oversee all of ACAP’s Medicare and Managed Long Term Care work, which includes operational support for member plans, policy analysis and lobbying. A full job posting can be found on the ACAP website.

ACAP PARTICIPATES IN FAMILIES USA HEALTH ACTION 2010 CONFERENCE

On January 28th, Deborah Kilstein, ACAP Director for Quality Management, along with Claudine Swartz, Assistant VP for Policy for the National Association of Public Hospitals, presented at the Families USA Health Action 2010 conference. The session was titled “More than a Card” and focused on the role Medicaid safety net health plans and public hospitals play in ensuring and improving access to care and the challenges of making sure that health insurance is a true gateway to health care services for low-income people.

Presentation: "More than a Card: The Role of Safety Net Health Plans"

MEETINGS

CANCELLED: FEBRUARY FLY-IN AND POLICY FACE-TO-FACE

Due to a weather forecast that has become increasingly severe, ACAP has reluctantly decided to cancel its Legislative Fly-In scheduled for next Monday and Tuesday, February 8 & 9, 2010. Experts are predicting up to 24 inches of snow through Saturday night, flights are already cancelled for Friday and into the weekend, and ACAP fears a substantial backlog at area airports will prevent many attendees from reaching Washington by Monday morning. Furthermore, there is some speculation the federal government may be closed early next week.

FLY-IN ATTENDEES: Please contact Jenny Babcock by phone (202-427-2116) or email (jbabcock@communityplans.net) so that she knows you received this message.

IMPORTANT NOTE ABOUT HOTEL ROOMS: ACAP will work with the Hotel George to cancel its entire block of discounted rooms. Please let Jenny Babcock know if for any reason you still want your block room at the George. If your room was reserved outside of the block, you will have to cancel it yourself.

ACAP will work towards rescheduling both the Fly-In and the Policy Face-to-Face for the Spring. To those ACAP members who agreed to present at the Face-to-Face, thank you very much and stay tuned for more information.

 SPRING MEDICARE, BOARD AND COO MEETINGS: REGISTER AND RESERVE YOUR ROOM TODAY

Hold the date for ACAP’s Spring 2010 Medicare, Board and COO Meetings taking place in San Francisco, CA. The Board Meeting will take place beginning mid-day Tuesday, March 9th and continue through Wednesday, March 10th. In conjunction, there will be two other meetings for ACAP Plan Staff. Before the Board Meeting, ACAP Medicare Directors and SNP staff will meet on March 8 & 9, 2010. Then ACAP COOs will come together after the Board Meeting on March 10 & 11. Registration is now available at: www.regonline.com/2010_acap_medicare_board_and_coo_meeting. Agendas for all three meetings are available on the ACAP website.

You can reserve your hotel room now at the Hotel Monaco San Francisco and, must do so by Friday, February 5th to receive the group rate of $139/night, by calling the hotel and mentioning “ACAP Group.” Please note that ACAP cannot guarantee hotel and group rate availability. If you have any questions please contact Stephen Cox at scox@communityplans.net.

Hotel Monaco San Francisco
501 Geary Street
San Francisco, CA 94102
Hotel: (415) 292-8183
Reservations: (800) 214-4220
 

  
 
Calendar

Look to the ACAP Calendar for Upcoming ACAP Calls, Meetings, and Events

February 8 & 9: Legislative fly-in, policy face-to-face, and hill briefing

 

February 10: quality networking call at 3 pm et on care transitions

 

February 12: joint cmo, pharmacy and quality management roundtable at 12 pm et on Psychotropic Drugs and Children

 

February 18: case management call at 3 pm et on stratification and participation criteria

 

February 19: quality management call at 1 pm et on proposed child health quality measures

 

March 8 - 11: spring Medicare, board and coo meetings

 
 
Other Upcoming Opportunities

 acap has partnered with avalere health - make sure to note that you are an ACAP MEMBEr when registering

February 19: Position Yourself / Oncology in Focus - Bundled Payments and Episodes of Care
 
ACAP Preferred Vendors

COMMONWEALTH PURCHASING GROUP

COMP CARE

Coordinated transportation solutions

DCA

FIRST RECOVERY GROUP

health integrated

inspiris

Medical Transportation management

MEDIMPACT

MEDMETRICS

navitus

Optimetra

POP HEALTH MAN

RBS Re

Summit re

US Advisors
 
IN OTHER NEWS
 

KAISER COMMISSION ISSUES POLICY BRIEF ON MEDICAID MANAGED CARE

The Kaiser Commission on Medicaid and the Uninsured recently issued a policy brief titled "Medicaid and Managed Care: Key Data, Trends, and Issues." This policy brief provides an overview of the Medicaid program’s increasing reliance on managed care to deliver services. It notes that the goal of this approach is to improve access to care and coordination of care by assuring that enrollees have a "medical home" with a primary care provider, and to rely more heavily on preventive and primary care. Adopting managed care also gives states more cost predictability and control over their Medicaid programs, and contracts with managed care plans offer states a mechanism, through quality measurement and improvement requirements, for holding plans accountable for the quality of care they provide to Medicaid enrollees.

Policy Brief: “Medicaid and Managed Care: Key Data, Trends, and Issues”

NEW REPORT SHOWS THAT INCREASED COPAYMENTS ARE NOT ALWAYS LINKED TO SAVINGS FOR HEALTH PLANS

A report recently published in the New England Journal of Medicine found that increased copayments can raise costs over the long term, particularly among older patients.

The study, “Increased Ambulatory Care Copayments and Hospitalizations among the Elderly,” was conducted by Brown University scholars and followed nearly 900,000 seniors who were enrolled in 36 Medicare managed care plans from 2001 to 2006. The study followed health plans as they almost doubled copays for doctor and specialist visits from just over $7 per visit to just over $14 per visit. The report demonstrated that while the average health plan would gain $7,150 for every 100 enrollees from collecting more copayments and from decreased use of outpatient services, the same plan would spend approximately $24,000 in additional hospital expenses.

The study found that for every 100 seniors who had higher copays, there were 20 fewer physician visits, two more hospital admissions and 13 more days of in-hospital care in the first year after the increases. The study found this trend to be more significant among African Americans, people living in low-income areas and seniors with chronic conditions.

The full study is available here: http://content.nejm.org/cgi/content/abstract/362/4/320.

7TH ANNUAL WORLD HEALTH CARE CONGRESS

The 7th Annual World Health Care Congress (WHCC) to be held April 12-14, 2010 in Washington, DC, will convene over 2,000 CEOs, senior executives and government officials from all sectors of health care including the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies.

ACAP members can save $200.00 off the current registration fee. To receive the reduced ACAP rate, contact WHCC at 800-767-9499 with code ESJ482 (not applicable on gov’t/military rates). Learn more at www.worldhealthcarecongress.com.

DOL, HHS, TREASURY ISSUE RULES REQUIRING PARITY IN TREATMENT OF MENTAL AND SUBSTANCE USE DISORDERS

On January 29, 2010, the US Departments of Labor, Health and Human Services (HHS), and the Treasury jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders. The rules apply to plans serving Medicaid and CHIP as well as to commercial plans.

The new rules prohibit group health insurance plans - typically offered by employers - from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

Parity law expanded. MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.

The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit.

Coverage. MHPAEA applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010.

Background. The Wellstone-Domenici Act is named for two dominant figures in the quest for equal treatment of benefits. The late Senator Paul Wellstone (D-Minn), who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Senator Pete Domenici (R-NM), who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Representative Patrick Kennedy (D-RI), and former Representative Jim Ramstad (R-Minn).

The issue of parity dates back more than 40 years to President John F. Kennedy, and also was supported by President Clinton and the late Senator Edward Kennedy.
"Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said US Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it's the right thing to do."

"The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said Secretary of Health and Human Services Kathleen Sebelius. "I applaud the longstanding and bipartisan effort that made these important new protections possible."

"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment," said Deputy Treasury Secretary Neal Wolin. "These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need."

Submitting comments. The interim final rules released today were developed based on the departments' review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited. Sections where further comments are being specifically sought include so-called "non quantitative" treatment limits such as those that pertain to the scope and duration of covered benefits, how covered drugs are determined (formularies) and the coverage of step-therapies. Comments are also being specifically requested on the regulation's section on "scope of benefits" or continuum of care.

Comments on the interim final regulation are due 90 days after the publication date. Comments may be emailed to the federal rulemaking portal at http://www.regulations.gov/. Comments directed to HHS should include the file code CMS-4140-IFC. Comments to the Department of Labor should be identified by RIN 1210-AB30. Comments to the Treasury's Internal Revenue Service should be identified by REG-120692-09. Comments may be sent to any of the three departments and will be shared with the other departments. Please do not submit duplicates.

The Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, scheduled for publication in the Federal Register on February 2, 2010, are available at http://hr.cch.com/cases/Health_Parity.pdf.