 February 25, 2005 |
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Upcoming ACAP Calls
March 2: CIO Roundtable March 7: Program Committee Call March 9: Provider Relations Roundtable March 10: HR and Claims Directors Roundtable March 15: CMO/CFO Roundtable March 15: Emergency Department Diversion Best Practices Call
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
ACAP Contracts For Study of Medicaid Managed Care in the States For over a decade the National Academy for State Health Policy (NASHP) has tracked the scope and operations of state Medicaid managed care programs through a series of comprehensive surveys conducted in 1990, 1994, 1996, 1998, 2000, and 2002. This series of surveys forms the most detailed and accurate, historical database available on Medicaid managed care. All 50 states and DC responded to all six surveys. ACAP will fund NASHP to analyze the data collected in the 2002 survey to produce the sixth edition of the Guide, which will examine Medicaid managed care program policies. The report is expected in the Spring of 2005. |
ACAP Endorses Bipartisan Bill Creating Medicaid Commission Senators Gordon Smith (R-OR) and Jeff Bingaman (D-NM) and Representative Heather Wilson (R-NM) and Delegate Donna Christensen (D -Virgin Island) recently introduced legislation that would establish a bipartisan commission to undertake a comprehensive study of the Medicaid program. This legislation comes as the Bush Administration, Congress and state and local leaders face pressure to hold down the cost of the Medicaid program. During the press conference about the introduction of the bill, the sponsors stated that they believed this legislation is the best alternative to the $60 billion in cuts that the President has proposed to the Medicaid program. They also urged the Bush Administration and others to support a forthright and comprehensive approach when making any changes to the Medicaid program. The Commission would be comprised of a bipartisan group of all stakeholders -- federal, state and local government, providers, consumers and Medicaid experts. The proposal for a Commission could help stakeholders identify how to bridge a broad range of proposals and ultimately reach consensus on how to hold down the costs of entitlements, but strengthen and preserve the safety net for vulnerable populations. ACAP has endorsed the Bipartisan Commission on Medicaid (S. 338/H.R. 985) and will be encouraging elected officials from ACAP plan states to support the legislation. ACAP's press statement on the bill can be found at: http://www.communityplans.net/publications/press%20releases.asp and our letter to the bills' authors at: http://www.ahcahp.org/pandl/05policy_positions.asp |
Medicaid 101 at HRSA
CEO-CFO Meeting Evaluation Forms
Meg Murray and Lee Partridge from the National Partnership for Women and Families were asked by the Health Resources and Services Administration (HRSA) to provide an overview of Medicaid to over 200 HRSA staff that interact with the program. They described the state and federal policy development process, summarized the eligibility and spending categories and discussed upcoming trends and issues in Medicaid, including the impact of technological changes on Medicaid, the increasing costs of long term care, the dysfunction of the current funding system and movement towards more managed care. ACAP CEOs and CFOs are asked to submit evaluation forms for the February meeting if you haven't done so already. The forms can be found on the Members' Only section under conferences. |
ACAP Board Meeting On February 14 and 15, ACAP CEOs and CFOs gathered for a board meeting in Washington, DC. The focus of the first meeting day was the changing political and regulatory environment and its impact on ACAP plans. The CEOs and CFOs met together on the second day on topics related to managing the financial implications of upcoming challenges and opportunities for ACAP plans. The following are highlights from the meeting. Rick Fenton, Deputy Director of the Families and Children's Group at the Centers for Medicare and Medicaid Services discussed the President's budget proposal for fiscal year 2006 and specifically the Medicaid proposals. In addition, he spoke about the current process for applying for and content of Medicaid waivers, including the status of Florida's proposal. He also noted that the Administration would support an early reauthorization of the SCHIP program. When asked about HEDIS Comparisons of Medicaid managed care plans, Mr. Fenton stated that CMS is attempting to identify resources to continue the comparisons which they have funded in previous years. Participants also received a "View from the Medicaid Directors" on ongoing issues and initiatives at the state level. Tracy Williams of the Ohio Medicaid Program discussed the findings and recommendations of the Ohio Commission on Medicaid, including its endorsement of expansions of managed care. Tricia Roddy of the Maryland Medicaid program spoke about her state's plan to move long-term care into managed care. ACAP also invited Congressional staff from two Senate offices. Alice Weiss, health counsel for the Democratic staff of the Senate Finance Committee, offered one perspective on the outlook for Medicaid reform, federal budget proposals, and ways that ACAP plans can continue to build their relationships with their elected officials. Plans also heard from Catherine Finley, staff director of the Aging Committee for Senator Gordon Smith (R-OR). Ms. Finely spoke in detail about new legislation introduced by her boss to create a bipartisan commission to study the Medicaid program. In a CFO-only meeting, CFOs from 9 ACAP plans discussed three key issues: the role of the CFO within each plan's senior leadership team, reserve allocations and use of risk-based capital calculations, and investment policies used by ACAP plans. Based on their discussions, CFOs concluded that CFOs find value in weekly senior leadership meetings with structured agendas. CFOs also learned that 4 of the 9 plans they represented were subject to Risk-Based Capital calculations and that RBC can be an effective financial planning tool in several areas. Finally, the investment policy discussion revealed that the investment policies of the plans vary significantly in terms of: size and complexity of portfolio, risk tolerance, internal investment management sophistication, and regulatory oversight. Plans can download materials and presentations from the February meeting through the Members' Only section of our website under conferences.  |
| PUBLIC POLICY AND ADVOCACY |
ACAP Submits Statement for Senate Budget Committee Hearing On February 16, the Senate Budget Committee held a hearing on the topic, "Medicare and Medicaid: Rising Health Care Costs and the Impact on Future Generations." The hearing was scheduled in response to the rapidly rising costs of health care, which Budget Committee Chairman Gregg (R-NH) said would overwhelm the federal budget in the future if changes were not made. During the hearing, Senator Gregg noted that the President's budget proposes to reduce the growth of Medicaid by $500 million in fiscal year 2006. ACAP submitted a statement to the Budget Committee which acknowledged the rising costs of health care, including Medicaid. ACAP went on to urge the committee, the Congress and the Administration to more fully explore the complexities of the Medicaid program and to consider the critically important role that Medicaid managed care plans have in improving quality of care, controlling Medicaid costs, and managing the care received by plan enrollees. The complete statement can be found on ACAP's Policy and Legislative Positions page at: http://www.ahcahp.org/pandl/default.asp ACAP Plans Head to Capitol Hill Several ACAP plans extended their trip to Washington, DC for ACAP's annual board meeting in order to meet with their elected officials in Congress. The plans had heard several assessments of Medicaid policy proposals and the political climate that is taking shape. ACAP plans from Massachusetts, Oregon, Connecticut, New York and Ohio met with Senators, Representatives, and their respective staff for a total of 10 meetings. ACAP staff and plans educated these offices about Medicaid managed care and the value-added that they bring to the Medicaid program in terms of costs, quality and satisfaction. ACAP members also requested that their respective elected officials cosponsor the Bipartisan Commission on Medicaid, which would establish a commission to study the program before implementing reforms. One member, Congressman Richard Neal (D-MA), has already cosponsored the bill as a result of this visit. ACAP Signs Medicaid Coalition Letter to Budget Committees This week ACAP joined other members of the Partnership for Medicaid in sending a letter to all members of the House and Senate Budget committees urging them to oppose cuts in or a cap on the federal budget allotment for Medicaid. The letter to members acknowledged the need for reforms in Medicaid and went on to say that the Partnership wants to be a constructive force in efforts to improve the program. In addition, the Partnership emphasized that it would be willing to discuss ways to improve the Medicaid program without dramatic cuts. The text of the letter is available at: http://www.ahcahp.org/pandl/default.asp Medicaid Policy Materials Available The President's fiscal year 2006 budget proposal was released in early February. Congress is now preparing to release and debate its own budget proposals which are expected to include substantial provisions impacting Medicaid and other health care safety net programs. A summary of the President's budget proposal and ACAP Talking Points on Medicaid Reform are available on the Member's Only section of our website under Action Alert. New ACAP Fact Sheet Responds to Florida Medicaid Proposal ACAP has released a new paper in response to Florida Governor Jeb Bush's far-reaching waiver proposal. In its current form, the proposal would result in tremendous changes to this state's program and its 2.1 million Medicaid beneficiaries. ACAP's Fact Sheet highlights how the proposal would undermine certain key aspects of the Medicaid program, including:
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| EXCELLENCE AND ACCOUNTABILITY |
Community Health Network of CT Launches New Partnership with State The Community Health Network of Connecticut (CHCNT) and the Connecticut Department of Health recently announced the formation of a new partnership - DPH-CHNCT Choices - A Nutrition Initiative - to improve the health of families by improving nutrition and increasing physical exercise. The partnership combines the strengths of CHNCT and the state as they work to create sustainable health promotion initiatives in underserved communities in Connecticut. They will focus on working with school districts and federally qualified health centers (FQHC's). This new partnership will also help educate Connecticut families about strategies to maintain good health and services available to them. According to Sylvia Kelly, President and CEO of CHNCT, "This partnership between Community Health Network of Connecticut and the Department of Public Health will enable both organizations to jointly focus on the needs of Connecticut's underserved population. Through our nutrition and health education efforts, in collaboration with local schools and health centers, significant numbers of individuals will be able to adopt positive and sustaining nutrition and health habits." In his press statement, Connecticut's DPH Commissioner Glavin noted that this new alliance will allow families to make relatively small lifestyle changes that will have a notable impact on their overall health. CMO/CFO Roundtable March 15: "ROI Calculations"
Monday 2/28 Deadline for IT Offer
ACAP has scheduled a joint roundtable call with CMOs and CFOs. The topic for this call is in response to the interest among ACAP medical directors to discuss ROI in more detail. One initiative that several ACAP plans participate in is the Center for Health Care Systems' (CHCS) Business Case for Quality Initiative. On the March 15 call, Joe Stankaitis, the CMO at Monroe Plan, will walk through the guidelines outlined by CHCS's consultants. ACAP Plans are reminded that the Gartner IT offer is only valid until February 28th, 2005. Please contact Peggy Oehlmann with any questions at poehlmann@communityplans.net or (610) 457-5739. ACAP plans that use a different model to calculate ROI are encouraged to contact Peggy Oehlmann if you would like to discuss your plan's approach. Also, if you have specific questions/issues regarding ROI that should be added to the agenda, please contact Peggy at poehlmann@communityplans.net. CIO Roundtable March 2: "Implementing Disease Registries and Related IT Issues" ACAP has scheduled a call for CIOs to learn more about the IT issues involved in setting up disease registries. Terry D'Attore, CIO at Hudson Health Plan, will discuss his plan's efforts to develop and implement disease registries. Presentation materials will be posted under the CIO Roundtable section on the Member's Only page of our website. The call will begin at 3 pm EST (2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii). Please contact Peggy Oehlmann at poehlmann@communityplans.net if there are other topics you would like to add to the agenda. HR and Claims Directors Roundtable March 10 on "Work at Home Policies" This call will be a joint call with Human Resource Directors and Claims Directors. Jim Karl and Leann Olson will discuss Community Health Network of Connecticut's Work at Home policy that was recently developed for claims staff. The call will begin at 3 pm EST (2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii). Please contact Peggy Oehlmann at poehlmann@communityplans.net with any questions. Best Practices Call: "Emergency Department Diversion" 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:
New Healthcare Disparities ToolKit The Health Research and Educational Trust (HRET) has just released a new Web-based toolkit for the collection of race, ethnicity, and primary language information by hospitals and other health care providers. This toolkit comes in the wake of the Department of Health and Human Services' announcement that the federal government will implement a national electronic medical record system in 10 years. In addition, twenty-two states currently mandate the collection of race and ethnicity data. These practices and the impending changes have created a need for standardization. The HRET toolkit, produced with support from The Commonwealth Fund, was developed to help health plans, community health centers, hospitals, health systems, and other health organizations collect accurate information from patients to meet regulatory and local community demands , specifically for collecting race, ethnicity, and primary language information. The data can be used for monitoring health care delivery and quality of care by linking to clinical measures and targeting appropriate interventions to specific groups. The toolkit can be accessed at www.hretdisparities.org |
| FUNDING OPPORTUNITIES & NEWS |
National Center on Minority Health and Health Disparities RFA The NIH National Center on Minority Health and Health Disparities has released a request for applications for Community Participation in Health Disparities Intervention Research. The goal of the RFA is to support community-based participatory research in planning, implementing, evaluating, and disseminating effective interventions for a disease or condition to reduce and eventually eliminate health disparities through partnerships between minority health populations, subpopulations, and other heath disparity populations and researchers. Eligible organizations include not-for-profit and for-profit public or private organizations, units of state and local governments, eligible agencies of the federal government, domestic institutions/organizations, faith-based or community-based organizations, and Native American tribal organizations. For complete program guidelines and application materials go to: http://grants.nih.gov/grants/guide/rfa-files/RFA-MD-04-004.html |
| NEWSFLASH |
A new study published in the February issue of Health Services Research examines whether Medicaid managed care is associated with lower hospitalization rates for ambulatory care sensitive conditions compared to Medicaid fee-for-service. The study also looked at whether there was a differential effect of Medicaid managed care by patient's race or ethnicity on the hospitalization rates for ambulatory care sensitive conditions. The study found a 33 percent lower rate of hospitalizations for ambulatory care sensitive conditions in mandatory managed care compared with fee-for-service, but the study's authors also note that there is some selection bias because of voluntary Medicaid managed care programs. The authors conclude that Medicaid managed care is associated with a large reduction in hospital utilization, which likely reflects health benefits. According to the report, the greater effect of Medicaid managed care for minority compared with white beneficiaries is consistent with other findings that suggest that managed care is associated with improvements in access to ambulatory care for those patients who have traditionally faced the greatest barriers to health care. Outlook for National Health Care Spending This week new health care spending projections were released by the Centers for Medicare and Medicaid Services in an article titled, "Trends: U.S. Health Spending Projections For 2004-2014." CMS projected that the new Medicare drug law, set to go into effect in January 2006, will produce a dramatic shift from private to public spending on prescription drugs. Medicaid will pay a smaller proportion of the nation's prescription drug bill, dropping from 18 percent of the total spending in 2005 to 9 percent in 2006. This is largely due to the fact that Medicare will assume purchasing of drugs for dual-eligible seniors. Other findings of the CMS analysis include:
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| JOBS |
MR-The Meyers Group Seeks VP Health Services Research The Meyer's Group, based in Columbia, MD is accepting applications for the position of Vice President of Health Services Research. This person will direct the development and implementation of the company's applied behavioral health research agenda including: prioritization of research initiatives, coordination of collaborative research with universities and other research entities, development of research grants, obtainment of research funding, preparation of papers and publications, distribution of better practices resulting from findings and direction of Research Advisory Panel. Candidates should have a Ph.D. in a field related to health services research and at least eight years experience conducting research, including publications in peer reviewed literature. The ideal candidate will also possess knowledge of health services research related to quality of care and managed care delivery. For more information please contact Kara Gulati at (301) 625-5600. |
| Upcoming Events |
March Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2 CIO Roundtable 3pm ET |
3 |
4 |
5/6 |
| 7 Program Committee Call 3pm ET |
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9 Provider Relations Roundtable 3pm ET |
10 |
11 HR and Claims Director Roundtable 3pm ET |
12/13 |
| 14 |
15 CMO - CFO Roundtable 3pm ET Emergency Department Diversion Best Practices Call 4pm ET |
16 Medicare Roundtable 3pm ET |
17 Policy Roundtable 3pm ET |
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19/20 |
| 21 |
22 |
23 |
24 |
25 |
26/27 |
| 28 |
29 Compliance Officers Roundtable 3pm ET |
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31 |
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April Events |
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1 |
2/3 |
| 4 |
5 Pharmacy Directors Roundtable 3pm ET |
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8 |
9/10 |
| 11 |
12 |
13 |
14 |
15 |
16/17 |
| 18 |
19 ACAP Board Conference |
20 ACAP Board Conference |
21 ACAP Board Conference |
22 |
23/24 |
| 25 |
26 |
27 |
28 |
29 |
30/1 |
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ACAP Mission: To improve the health of vulnerable populations through the support of Medicaid-focused community affiliated health plans committed to these populations and the providers who serve them. James Hooley, Chairman Margaret A. Murray, Executive Director |
Association for Community Affiliated Plans 2001 L Street, NW, 2nd Floor Washington, DC 20036 Contact Us |