Continental Breakfast

Location: Washington Ballroom Foyer

Sponsored by: MedMetrics

Purpose of the CEO Summit and Introductions

Meg Murray, Executive Director, ACAP
Darnell Dent, Chief Executive Officer, Community Health Plan of Washington

The Financial and Operational Status of Medicaid Focused Health Plans

Bob Hurley, Associate Professor, Virginia Commonwealth University

Virginia Commonwealth University, in conjunction with Bailit Health Purchasers with support from the Center for Health Care Strategies, is continuing its multi-year examination of plan participation in the Medicaid program. This study--the fourth in a series--focuses on understanding the impacts multi-state, investor-owned firms have had on the Medicaid managed care marketplace. The study includes an overview of plan participation across the country; analysis of publicly available financial and non-financial performance data from plans; in depth examination of state-level procurement and contracting experience in 7 states; and telephone interviews with 25 selected national experts and thought leaders in this area. The study aims to provide a balanced and authoritative look at an important trend and to understand what implications it may have for the future of Medicaid managed care.

Moderator: Jim Parrott, Virginia Premier

ACAP's Legislative Agenda

Chris Koppen, ACAP lobbyist

Meg Murray, ACAP

Meg Murray and Chris Koppen will discuss ACAP's legislative agenda for 2006-2007 including:

• Managed Care Expansion
• Churning Proposals
• Health IT
• Drug Rebate Proposal
• HEDIS Benchmarking
• Actuarial Soundness

Break

DRA Implementation by the States or Now What??

Jennifer Michael, National Governors Association

Ms. Michael will discuss how states are implementing the changes allowed by the DRA, including:

• Benchmark Benefit Package
• Medicaid Transformation Grants
• Citizenship Requirements
• MCO Provider Tax
• Non-participating provider payment issue

Moderator: Leona Butler, Santa Clara Family Health Plan

Medicaid Health Plans' Role in Covering the Uninsured

Deborah Enos, Neighborhood Health Plan of Massachusetts 

Jean Haynes, BMC Health Net

Christina Severin, Network Heatlh

The Massachusetts legislature recently approved a bill, supported by Governor Mitt Romney (R), that would require all residents to purchase health insurance by July 1, 2007, or face legal penalties. Their choices would be expanded to include a range of new and inexpensive policies -- ranging from about $250 per month to nearly free -- from private insurers subsidized by the state. Governor Romney said the bill, modeled on the state's policy of requiring auto insurance, is intended to end an era in which 550,000 people go without insurance and their hospital and doctor visits are paid for in part with public funds. The CEOs of three Massachusetts plans will discuss the impact the reform will have on their plans and their role in its passage.

Luncheon/Award Presentation - The Future of Health Care in the 21st Century

Location: The Promenade

ACAP will honor Senator DeWine with an award for his outstanding support of the Medicaid program. Following the award, Senator Dewine will discuss his views of the future of health care in the 21st century, including his views on entitlements, covering the uninsured, and Congress' role in supporting the use of technology in the delivery of health care.

The Honorable Mike DeWine- Ohio (R) (invited)

Moderator: Pam Morris, Care Source

Sponsored by: The Lewin Group

Safety Net Supporter Award

This award honors an ACAP plan partner who has worked tirelessly to improve the health of low-income and other vulnerable populations. This year's recipient, Mardy Sandler of the BabyLove Program was selected for her demonstrated leadership in developing a unique outreach program for low-income pregnant women in the Rochester, NY community.

Mardy Sandler, LMSW, BabyLove

Moderator: Sylvia Kelly, Community Health Network of Connecticut

Consumer Directed Purchasing in Medicaid

Chuck Milligan, The Center for Health Program Development and Management University of Maryland, Baltimore County

Mr. Milligan will discuss his recent work on Medicaid consumer-directed health accounts, including his recent briefing paper entitled Turning Medicaid Beneficiaries into Purchasers of Health Care: Critical Success Factors for Medicaid Consumer-Directed Health Purchasing. He has identified  four factors as critical to the success of any state consumer directed health purchasing initiative, including:

• Protecting access to care
• Developing policies that anticipate how consumer-directed health accounts will affect the behavior of insurers, providers and employers
• Reformulating the roles of state agencies
• Developing and implementing new “risk management” approaches

Moderator: Ruben Cowart, Total Care

Do Provider Incentives Work for All Providers?

Jean Fraser, CEO, San Francisco Health Plan

Pay for Performance programs have been much discussed, both as a way for states to improve plan performance, and as a tool for plans to incent providers. Yet often rewards are geared toward providers with the highest performance scores. This session will devote discussion to innovative tools that plans have used to identify providers with lower performance scores or where there is greatest opportunity for improvement and develop programs specifically targeted to this subset of providers.

Moderator: Maura Bluestone, Affinity Health Plan

Break

Integrating the Regulation of Medicaid and Medicare to Better Serve Dual Eligible Beneficiaries

Moderator: Don Hall, Colorado Access

Open Discussion on Actuarial Soundness

ACAP led a coalition of health plans  in the creation of letter to the Congress requesting Congressional leaders to ask HHS to evaluate how actuarial soundness is working in the states.  While Medicaid health plans are very supportive of CMS’s Checklist  for Actuarially Sound rates as a critical step towards federal oversight, guidance and standardization of the states’ Medicaid managed care capitation rate development process, plans remain concerned that CMS approval of the methodology for setting the capitation rates does not assure that the rates are, in fact, actuarially sound enough to cover the costs of providing care to the Medicaid beneficiaries.

This session will be an open discussion among the health plans about how the process for setting actuarial sound rates is  working in their states.

Moderator: Tom Early, HealthPlus

Adjourn

Reception

Location: M St. Grille

Sponsored By: Adaptis and QCSI

Wednesday, July 26, 2006

Continental Breakfast

Location: Washington Ballroom Foyer

Sponsored by: CommonWealth Purchasing Group, LLC

Savings From Further Managed Care Expansions

Joel Menges, Lewin Group

ACAP, along with the Medicaid Health Plans of America, released a study by The Lewin Group that asserts that there is tremendous room for expansion of capitation contracting in the Medicaid program. Lewin found that nationally, only 16% of Medicaid expenditures were capitated in FY 2003, and that optimal use of this model would yield savings of $83 billion across ten years.

Moderator: John McComas, AlohaCare

Health IT: Is it Really Here?

Michael Zamore 
Policy Advisor
Office of Congressman Patrick Kennedy

Technological advances in health care are bringing dramatic improvements in efficiency, quality, and effectiveness.  However, most observers believe that the Federal government must create an environment that creates certainty, provides standards, and helps health care providers upgrade their systems.  In this session, attendees will hear from a key policymaker in Congress on progress in promoting and improving health information technology in America’s health system.  He will offer his perspective on the major issues in health IT and the role that Congress has in this debate.

Moderator: Dave Ford, CareOregon

State Medicaid Directors' Perspective

Doug Porter, Medicaid Director, Washington State

• Key Strategies to Use Evidence-based Medicine in Medicaid
• How is Washington State likely to implement the changes allowed in the DRA?

Moderator: Darnell Dent, Community Health Plan of Washington