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Best
Practices/Plan Operations
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Best Practices Conference Calls
2005
2004
2003
2002
2001
The call in number is 1-719-457-0336
Passcode: 109833
(All calls at 3
pm EST, 2 pm Central, 1 pm Mountain, 12 pm Pacific,
and 10 am Hawaii,
unless otherwise noted)
Calls in 2005
-
November
10, 2005 (4 PM)- "Lessons Learned from NHP's Employee Satisfaction
Survey"
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June 30,
2005 (2PM) -- "Improving Encounter Data Collection"
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May 11,
2005 -- "The Value of the CAHPS Survey"
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March
15, 2005 -- "CareSource’s ER Diversion Program"
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February
8, 2005 -- "NICU Management"
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January 13, 2005
--
“Establishing Effective IT Linkages with Community Health Centers”
November 10, 2005
at 4 PM Eastern-
“Lessons Learned from NHP’s Employee Satisfaction Survey”
The next ACAP Best
Practices call is November 10, 2005 at 4 PM Eastern time (3 pm
Central, 2 pm Mountain, 1 pm Pacific, 11 am Hawaii).
Anna Trask, Senior
Training & OD Consultant at Neighborhood Health Plan of
Massachusetts, will review NHPMA’s
employee satisfaction survey.
Last Spring, NHPMA contracted with the Gallup organization to
conduct an employee satisfaction/engagement survey. Ms. Trask will
discuss NHPMA’s experience with launching and collecting data,
reporting results back to the company, and a first round of action
steps and conversations that have been generated from the results.
June 30, 2005 at 2 PM Eastern --
"Improving Encounter Data Collection"
The
next ACAP Best Practices call is June 30th at
2 pm Eastern time (Note this
different from our usual schedule- 1 pm Central, 12 pm Mountain, 11 am
Pacific, 8 am Hawaii).
Gary Feldbau, MD,
Medical Director, and Marsha Simmons, Clinic Process Consultant/Senior
Project Manager, of Community Health Plan of Washington will discuss
CHPW’s ongoing initiatives to improve encounter data collection across its
provider network. After working with consultants to identify key issues
arising from clinic audits and physician interviews, CHPW developed a
multi-faceted program to identify and resolve encounter data reporting
problems. Plan staff work clinic by clinic to address specific challenges
and to improve accuracy and timeliness of encounter data submission.
To call in please dial 1-719-457-0336 and
enter the passcode: 109833.
May 11,
2005 -- "The Value of the CAHPS Survey"
Materials:
Lisa Franchetti & Mary Evans, NHPRI:
Member
Satisfaction Presentation
National CAHPS® Benchmarking Database,
2005 Online Data Submission System Demonstration
On May 11 at 3 pm EST (2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii), Lisa Franchetti, Quality Management Project Coordinator at
Neighborhood Health
Plan of Rhode Island will discuss her health plan’s participation in the CAHPS survey.
While many ACAP plans participate in CAHPS via their state
survey of Medicaid enrollees, NHPRI conducts its own CAHPS survey each
year. By participating in the survey independently, NHPRI is able to ask
questions relevant to the needs of its members, analyze complete survey
results, and implement changes to improve customer satisfaction in a
timely manner. Lisa will discuss the value of independent participation
and talk about how NHPRI uses its CAHPS data to improve customer service.
To dial in to the call, please call 1-719-457-0336. The passcode is
109833.
March
15, 2005 -- "Emergency Department Diversion"
Diane Smeltzer, CareSource:
ED Diversion Presentation
On March 15th at 4 pm EST (3 pm CST, 2 pm MST, 1 pm PST, 11 am
Hawaii), Diane Smeltzer, Vice President of Care Management and Nancy
Murphy, Director of Care Management, will discuss CareSource’s Emergency
Department Diversion Program. (*Note- this call is at a different time
from our usual schedule).
In this presentation, they will outline:
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CareSource’s initial ED rates and the need for an ED Diversion program
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Key
Components of the ED Diversion program and how it has evolved over time
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Results and
expansion efforts into other markets
To dial in to the call, please call 1-719-457-0336. The passcode is
109833.
February
8, 2005 -- "NICU Management"
Jim Glauber, Medical Director, NHP:
NICU
presentation
Peggy Waters, RNC, and Jason Nigrosh, Director of Quality:
Network Health NICU presentation
On February 8 at 3 pm EST (2 pm Central, 1 pm Mountain, 12 pm Pacific, 10
am Hawaii), Jim Glauber, MD of Neighborhood Health Plan of Massachusetts
and Peggy Waters, RNC, and Jason Nigrosh, Director of Quality for Network Health will discuss their plans’
respective approaches to NICU management.
Neighborhood Health Plan recently outsourced its NICU management to a
vendor and will discuss the build vs. buy decision as well as a basic
overview of their NICU management model. Network Health will discuss its
in-house NICU case management program and how it provides NICU families
with support and links to community resources both in the hospital and
upon discharge. Plan materials will be posted in the Best Practices
section of ACAP’s website prior to the call.
To dial in to the call, please call 1-719-457-0336. The passcode is
109833.
January 13, 2005
--
“Establishing Effective IT Linkages with Community Health Centers”
RECAP: On this webcast conference call,
Doug Bach and Marty Mattei discussed Colorado Access’ efforts to work
with its providers, including their CHCs, to enhance technology and
information exchange. Twenty people participated in the webcast call.
The presenters discussed the value of working with providers to
implement Electronic Medical Records (EMRs) and a provider portal.
Colorado access also recently implemented a formulary hosting service,
which is a data tool that helps doctors get real time formulary and
prescription information.
Click here for a copy of their
presentation:
IT Linkages with Community Health Centers
Jan. 13th Agenda:
•
How does technology
impact a Health Plan in:
--
Lowering administration
expenses through reduction of manual processes
--
Improving communication
with provider
-- Gathering clinical
data
•
How does technology
impact a provider group in:
--
Streamlining the front
and back office operations
--
Improving communication
with payer
--
Data reporting
Back to Top
Calls in 2004
- November
10 --
Performance
Measurement as a Lever for Quality Management --
Karen Llanos and
Nikki Highsmith of the Center for Health Care Strategies will give an
update on trends in quality-related performance measurement techniques
being used by states (to measure plans) and trends in expectations that
states have for health plan performance measurement of providers.
- September 14 --
Gregory K. Nersessian
of Lehman Brothers Equity Research will speak to the ACAP plans on the
investor owned Medicaid Managed Care plans. He will discuss market
trends, including profitability, acquisitions and movement into new
states.
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July 26 --
Linda Strother of
Neighborhood Health Plan of Massachusetts will discuss her role as
NHP’s Parent Consultant. In this role, Ms. Strother provides support to
parents and families of children with special needs, distributes
educational materials, facilitates connections with community supports
and special education, and assists members with navigation through the
health care system. Additionally, Ms. Strother has experience as a
parent of child with special needs and speaks four languages. Her
knowledge and experience in special needs advocacy are an asset to NHP
and help her effectively communicate with health plan staff, educators,
social workers, and parents of children with special needs.
- May 19, 2004 -- Peggy Leonard, Vice-President for Clinical
Services at Hudson Health Plan, will discuss
Operation Diabetes. Operation Diabetes. This
initiative was designed to improve the quality of diabetes care by
heightening member and provider awareness of diabetes screenings.
Financial incentives are offered to both members and providers to
enhance compliance with routine diabetes screening. Ms. Leonard will
discuss operational components of setting up the program as well as
preliminary quality scores and the cost-effectiveness of the program.
- March 17, 2004 -- ACAP will hold a call on
Network Health’s Social Case Management
Program.
This program assists members that have complex medical and social needs.
Social case managers assist members in working through non-medical
barriers to health care. This can include (but is not limited to)
assistance with medication management, transportation, housing, fuel
assistance, SSI and benefit applications, community resources etc.
Social case managers meet with members in the home, hospital, rehab, or
the local donut shop, depending on what works best for the member.
Presenters:
Lauren Falls, LICSW is a Clinical Affairs Operations Manager
Eleanor Fothergill, RN is a Manager, Clinical Programs, Case
Management
Robert Janett, MD, is a Medical Director The Presenters will focus
on the following questions:
-
What is the Social
Case Management program?
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How did it get
started?
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Do you have any
results (costs, outcomes, Quality of Life measures, etc)?
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What aspects of the
program turned out to be different than originally expected and how
did you adjust?
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Do you have a
consumer story to share?
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Where do you see the
program in 5 years?
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What advice would
you have for a health plan that wanted to start a similar program?
- February 3, 2004 -- ACAPheld a
best practice call on
several plans’ BCAP
projects for serving adults with chronic illnesses.
Speakers included:
Issues covered
included:
-
What
was the goal of the BCAP pilot project and how did this fit in with
existing efforts for the plan’s special needs populations?
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What were the findings
& key lessons learned from the pilot project?
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Are the plans
continuing the project and if so, how did they find a way to fold it
into every day operations?
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What are the health plans'
quality management goals for continuing to serve special needs
populations?
- January 7, 2004 --
ACAPwill have a best practices call on
how plans can work to influence state and federal policy. Elizabeth
Swain of Community Health Plan of Washington will talk about her work
with the Save Health Care in Washington (www.savehealthcareinwa.org)
campaign she spearheaded. Topics will include: how to get funding for
this kind of project, how to build coalitions in the absence of a
statewide presence, what tools are available for focusing on grass roots
advocacy, the role of research in the effort and the role of media.
For more information, please
contact Elizabeth Swain at ESwain@chpw.org
Back to
Top
Best Practice
Calls in 2003
- December 18, 2003 --
ACAPwill hold a conference call to discuss an
ACAPproposal which would allow Medicaid focused plans to participate in
premium assistance programs under Medicaid and SCHIP. Currently the
premium assistance programs as implemented focus on enrolling Medicaid/SCHIP
enrollees into their employers' insurance plans to reduce the costs to
the state. Thus, no Medicaid-only plan could participate.
Joan Alker from Georgetown University will discuss her
recent report
for the Kaiser Family Foundation on premium assistance programs across
the country. Meg Murray of ACAPwill then discuss the
ACAPproposal to allow Medicaid focused plans to target employees
in firms that do not currently offer insurance.
Click here for a ppt description of the proposal.
- December 10, 2003 @
12 PM EST (9 AM PST) -- Open
Scheduling: Speakers from the Community Health Plan of WA (CHPW) will
discuss their experiences in working with their CHCs to establish open
scheduling within the CHCs as a method to improve customer relations.
Mark Murray, a consultant who worked with CHPW, will open the discussion
with background on the
Advanced Access model. Sara Davila will speak from the CHPW
perspective. Judy McCracken from the Moses Lake Community Health Center
will talk about their experiences with this at the CHC.
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November 24, 2003 -- Two new reports that compare
ACAPHEDIS
results to other Medicaid plans and ACAPCAHPS results to other
Medicaid plans have been released. Lee Partridge, who has been tracking
the HEDIS scores of Medicaid plans for several years, has written a
paper for ACAPon the 2001 results. She will discuss her findings.
2003 CAHPS
Benchmarking Data for ACAPPlans
ACAPPerformance on Selected
2001 HEDIS Measures
Link to APHSA
Medicaid HEDIS Database Project
Beth Marootian, from NHPRI, will discuss her plan's findings on HEDIS
performance of CHCs versus their other providers.
NHPRI HEDIS
findings
Meg Murray will review a recent analysis which compares selected
ACAPplans to each other and to industry averages.
Lisa Ruben will describe the proposed PBS special Remaking
American Medicine and PBS's sponsorship proposal to AHCAHP. The
producers are seeking suggestions for show segments to be filmed over
the coming year.
Remaking American
Medicine brochure
- October 27, 2003 -- Toolkit for Children with Special Health Care
Needs -- Lynda Honberg from HRSA will discuss their recently released
toolkit on Improving Services for Children with Special Health Care
Needs in Managed Care Plans.
A recent survey
of over 3,000 households revealed indicates that almost 13% of all
children have special health care needs. Who are these children? Why
should health plans be interested in this population of children? And
what opportunities are there to improve the care health plans provide to
them? During this conference call,
Lynda Honberg from the
Maternal and Child Health Bureau of HRSA
will discuss the federal
initiative to improve systems of care for children with special health
care need. She will also discuss Shared Responsibilities, a new toolkit
designed to assist health plans to improve services for children with
special health care needs. The toolkit include sample methods for
identifying children with special health care needs, surveys for
gathering information from families, providers and health plans, and
measures for assessing a health plan’s capacity to serve this group of
children.
-
September 15, 2003 --
Marketing Under the BBA --
Juli Harkins
from CMS will speak to the ACAPplans on an overview of the Balanced
Budget Amendment
regulation on marketing, innovative things that CMS has seen
states/plans do, and practices that CMS has ruled that plans can't
do. Sherry Rohlfing from Colorado Access will discuss what types of
marketing her plan has done.
Text of BBA Marketing Regulation
Text of U.S. Code Marketing
Regulation
- September 3, 2003 --
Caring for Foster Children -- Ken
Pariseau of Neighborhood Health Plan of Rhode Island will discuss NHP's
program for providing health care services to children in the foster
care system. Cyndy Demarest of Priority Partners will discuss their work
with children in the foster system. Maria Wolverton of Georgetown
University's Center for Child and Human Development will discuss the
study a three-year study the study
conducted to identify and describe promising approaches for meeting the
health care needs of children in the foster care systems.
The study results are available on the Center's
website.
AlohaCare Telemedicine Policy
-
AlohaCare
Registration form for Distant site practitioner
-
AlohaCare
Registration form for Distant site equipment
-
AlohaCare
Registration form for Originating site
- July 21, 2003 -- Anne Tumlinson of Health Strategies Consultancy
will be discussing her recent paper for the Center for Health Care
Strategies.
Her paper is entitled Limitations in Medicare Managed Care Options
for Integration with Medicaid and can be found at
http://www.chcs.org/publications/pdf/ips/dualeligibles.pdf.
Focusing specifically on the problems states and health plans face
when attempting to create a Medicare managed care program that can be
integrated with Medicaid managed long-term care, this paper describes
the issues that arise when two options--the Program for All-Inclusive
Care for the Elderly (PACE) and Medicare demonstration waiver
authority-- are used to create integrated programs.
Anne
Tumlinson's Best Practices Call Presentation
- June 10 -- 2:30 pm EST-- Community Access Program --
Julie Rocchio of the National Association of Public Hospitals will
provide background on the CAP program and Rhonda Woods of NACHC will
discuss the Healthy Communities Access Coalition that supports CAP
grantees. Sue Oberbeck of Rhode Island and Cathy Clancy and Jason Almonte
of Hudson Health Source will discuss their experiences with the program.
Early Accomplishments of
CAP Grantees
FY 04 Healthy Communities
Access Program Update
Click here for information on the
Healthy Communities Action Coaltion (HCAC)
- May 6 -- Exclusivity Arrangements between Plans and CHCs
Abie Castillo will discuss Community Health Plan of WA's exclusivity
arrangements with their CHCs. Robert Belfort of Manatt, Phelps and
Phillips will discuss the legal issues involved in this type of
arrangement.
Exclusivity Contracting
- April 3 -- 24 hour Nurse Triage Lines -- Beth Gandara from Care Oregon will
discuss their use of this product.
Care Oregon Telephone Triage Experience
Results of
ACAPTriage Survey
Back to
Top
Best Practice Calls in 2002
- September 25, 2002 -- Rick Nowakowski from Community Choice MI will speak
about the struggles and solutions that they have had w/ contracting with
specialists.
- October 16, 2002 -- Media Strategy -- Elizabeth Swain from Community Health
Plan of WA and Kathleen O'Connor O’Connor Health Care Communications will lead a
discuss about their work for CHPW on media strategy. Kathleen O'Connor is a a a
public relations professional and consultant who has been
watching the opportunities for Medicaid managed care organizations to tell their
story, and realizes how little has been out there about the benefit of these
programs not only to the members who are enrolled in them, but for the quality
of care and the cost savings for the states. She has her own communications
business for nearly 20 years and knows the health care publications, editors and
reporters. Her web address is
http://www.oconnorhealthanalyst.com/index.html
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August 7, 2002 -- Disease Management -- Beth
Marootian from
NHPRI will discuss a project that her plan undertook with Glaxo to
improve the functional status
of their
beneficiaries with asthma.
- June 25, 2002 -- BCAP III Results --Four of our plans have been
involved in the BCAP III which is focusing on asthma (Care Oregon, CHP of WA,
Affinity and Health Plus). The June best practices call will be devoted to their
sharing of what they are doing and what results they have seen so far. For a
brief overview of what they planned to do, see the BCAP website at
http://www.chcs.org/ManagedCare/bcap-asthma-participants.html
- March 26, 2002 -- Nancy Turnbull and Susan Epstein from New England
SERVE will speak to the plans about methods to increase
consumer input into the decision making
process.
- February 26, 2002 -- Freda Mitchem from NACHC will speak to the
ACAPplans
about the 340 B drug program and how plans might encourage their CHCs to enter
the program. CHCs do not have to have a pharmacy on site in order to take
advantage of the program. Plans are encouraged to include their CHCs in this
call.
- January 16, 2002 -- CIOs from seven ACHAHP plans met to listen to
Barry Meiselman from Affinity Health Plan (previously the Bronx Health Plan)
discuss the creation of both their internet and intranet presence. The CIOs
also discussed how to set up a disaster recovery plan, including a discussion of
various vendors. CareOregon offered to help the CIOs group purchase an online
version of the Healthwise health promotion book. NHP of RI reported that,
contrary to expectations, a recent focus group study found that over 50% of the
NHP of RI beneficiaries had access to the web.
Back to
Top
2001 Best Practice Calls
- December 12, 2001 -- Cheryl Camillo of CMS will be our featured speaker for
the December monthly best practices conference call. She is the author of CMS
document which outlines best practices for state in terms of reducing churning.
It can be found at http://www.hcfa.gov/init/outreach/progress.pdf.
On our call,
she will discuss what plans can do to reduce the churning levels among their
beneficiaries. Plans will also be encouraged to share what they are currently
doing. We will also discuss a draft concept paper for a ACAPresearch
project.
- August 21, 2001 -- CIOs conference call on HIPAA implementation. Craig
Johnson from Neighborhood Health Plan of Massachusetts and Elaine Taylor from
Neighborhood Health Plan of Rhode Island will discuss their RFP process for a
HIPAA gap analysis. Rob Falk and Hemi Tewarson from
Powell Goldstein will discuss the process of HIPAA privacy regulation
implementation in plans and CHCs. Also to be discussed is whether ACAPshould
sign onto a draft letter
from a
coalition of providers and plans to slow down HIPAA implementation.
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