1400 Eye Street, NW Suite 330 Washington, DC  20005 phone 202.331.4601 | fax 202.331.4604 Darnell Dent, Chairman Margaret A. Murray, Executive Director

Massachusetts Health Care Reform Bill: Medicaid Health Plans' Role in Covering the Uninsured

Deborah Enos, Neighborhood Health Plan of Massachusetts

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.

P4P Do Providers 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.

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.

ACAP's Legislative Agenda

Chris Koppen, ACAP lobbyist  and 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

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.

Consumer- Directed Purchasing in Medicaid (as Explained by Yogi Berra)

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

CEO Summit 2006 What's Next?

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

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?

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.