 March 14, 2005 |
|
|
Upcoming ACAP Calls
March 15: CMO/CFO Roundtable March 15: Emergency Department Diversion Best Practices March 16: Medicare Roundtable March 17: New--CMOs, Quality/DM Directors, CIOs Roundtable March 17: Policy Roundtable March 28: Finance Committee March 29: Compliance Roundtable
Upcoming Events Calendar
 
ACAP Links
 
 |
| HIGHLIGHTS |
Medicare Advantage News Highlights ACAP Medicare Demo Proposal The March 3rd edition of Medicare Advantage News (MAN) ran a front page story on ACAP's proposal to allow small Medicaid-focused managed care organizations to use their strong ties to community health centers to improve case management for beneficiaries who qualify for both Medicare and Medicaid. ACAP is working with the Centers for Medicare and Medicaid Services to develop a demonstration proposal that would allow Medicaid focused plans and CMS to share financial risk in order to encourage such MCOs to offer Medicare Advantage (MA) special needs plans (SNPs). In an interview with MAN, Meg Murray, ACAP's Executive Director, explained the need for a waiver of the payment rules for Medicaid-focused plans, "The basic issue is that for a lot of smaller plans focusing solely on Medicaid, to enter the Medicare market is very risky for them. But they think they've done such a good job of care management that they have the core competencies to handle vulnerable populations." Currently Medicare enrollees comprise 7% of the client base of community health centers that are affiliated with ACAP plans. However, this figure is likely to grow over time with the population's aging and with the Bush administration's goal of doubling the number of such centers. ACAP is engaged in discussions with CMS to determine how best to use the plans' substantial experience with serving high-need patients. ACAP Discount for 13th Annual Medicaid Managed Care Congress The Institute for International Research will present the 13th Annual Medicaid Managed Care Congress, bringing states and plans together to measure outcomes and maximize return on investment for Medicaid Managed Care. The event is scheduled for June 13-15, 2005 at the Hyatt Regency in Baltimore, MD. Meg Murray, Executive Director of ACAP, will present on the challenges for Medicaid managed care plans in identifying providers willing to participate in provider networks. Several staff from ACAP plans will serve on or lead panel discussions including:
ACAP members receive a 15% discount. Please contact Andrea at amaresca@communityplans.net for information on the ACAP discount. A detailed agenda is available at: http://www.iirusa.com/MMCC05/index.cfm/x=/Link=1 House, Senate Release Budget Plans on Medicaid Last week the Senate and House Budget Committees released their respective budget plans for federal fiscal year 2006. The President, Senate and House all have different proposals. House and Senate leaders are expected to bring the resolutions to the floor for a vote on March 16 or 17. The proposed Senate budget resolution offered by Budget Chairman Gregg (R-NH) gives the Finance Committee a deadline of June 15 to find savings of $1.784 billion in 2006 and $14 billion over 5 years (2006-2010). Upon releasing the budget plan Sen. Gregg stated that there is tremendous potential for savings in the Medicaid program because of waste and abuse in the system. He has stated that at least 34 states are estimated to be receiving up to $6 billion a year in federal Medicaid dollars inappropriately. The Finance Committee has sole jurisdiction over Medicare and Medicaid. Finance Committee Chairman Grassley (R-IA) has said he does not anticipate touching Medicare and that the committee is focusing on Medicaid to achieve the savings. Sen. Grassley went on to add that it was going to be challenging to identify savings of that magnitude. An equally ominous situation exists for the Medicaid program in the House where the Budget Committee has proposed that the Energy and Commerce Committee hit a $20 billion savings target over 5 years by June 15, although it does not specify which programs should be cut. The Energy and Commerce Committee has three program areas where it could make cuts, but it is expected to focus on Medicaid to achieve required savings. The reductions could lead to cuts in federal expenditures for Medicaid and SCHIP totaling $15.1 billion or more over the next 5 years (2006-2010) and possibly up to the entire $20 billion. April Board Meeting Deadline ACAP CEOs are reminded that the hotel deadline for the April Board Meeting is March 17th. Please visit the "Board Meetings" section on the website or contact Andrea at amaresca@communitplans.net for more information. Senate Budget Committee Issues First Strike Against Medicaid Cuts Despite the grim outlook for Medicaid in the Senate budget proposal, Senate Budget Committee members passed a non-binding "Sense of the Senate" resolution on Medicaid. The resolution, offered by Senators Wyden (D-OR), Corzine (D-NJ), and Murray (D-WA), expresses Senators' support for the Medicaid program, the importance of the federal guarantee to Medicaid, and stated that the budget should not "cap federal Medicaid spending, or otherwise shift Medicaid cost burdens to state or local governments." Although nonbinding, the Medicaid resolution is an important step in building awareness and support for efforts to strip the budget plan of language that would result in drastic cuts to the Medicaid program.  |
| PUBLIC POLICY AND ADVOCACY |
Bush Administration, Governors Talk Medicaid at Annual Meeting Medicaid topped the agenda for most of the nation's governors at a meeting this month in Washington, DC. During the meeting the governors released a paper prepared by Health Management Associates, "Medicaid in 2005: Principles & Proposals For Reform" which offers a comprehensive view of the issues, problems and challenges confronting Medicaid in 2005 and beyond. The paper also offers principles and options for reform. The Governors are using this report as a blueprint in their ongoing discussions with President Bush, Secretary Leavitt and Members of Congress. In his speech to the Governors, President Bush pledged to seek changes to Medicaid and it was clear that all ideas were on the table. Republican and Democratic Governors alike used this high profile meeting to reiterate their opposition to proposals to cut Medicaid or shift more costs to states, specifically the $60 billion in cuts in the President's FY06 budget proposal. One major sticking point revolves around the Administration's claim that states are using "accounting gimmicks" to extract more Medicaid money from the federal government to reduce their financial burden. Still, governors from both parties agreed that cuts are inevitable. ACAP Survey Reminder ACAP CEOs and Policy staff are reminded to send in their Policy Surveys by Monday March 14th. Please email them to Chris Koppen at ckoppen@avancerhp.com.
ACAP has scheduled a Policy Roundtable call for Thursday, March 17. The call will focus on recent Congressional action on the federal budget and its impacts on the Medicaid program, recent developments in ACAP's policy initiatives, and a discussion of plans' perspective on cost-sharing proposals. The agenda will include the following topics:
ACAP Sends Letter to Budget Committee Leaders Prior to the release of the House and Senate Budget Committee proposals, ACAP sent letters to the Chairs and Ranking Members of the committees. In its letter, ACAP urged the Budget Committee leaders not to include any proposals that would adversely impact the ability of health care providers to meet the health care needs of millions of Americans who rely on Medicaid. The letter also urged Congress 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 text of the letter can be found on the Policy section of ACAP's website at: http://www.ahcahp.org/pandl/05policy_positions.asp |
| EXCELLENCE AND ACCOUNTABILITY |
March 15 Roundtable for CMOs and CFOs The next CMO Roundtable will be held on Tuesday March 15th. ACAP CFOs are also invited to participate in this call. The call has been scheduled in response to interest among ACAP medical directors in discussing ROI in more detail. Currently several ACAP plans participate in the CHCS Business Case for Quality initiative. Joe Stankaitis, the CMO at Monroe Plan, will walk through the guidelines outlined by CHCS's consultants. ACAP plans using a different model to calculate ROI are encouraged to contact Peggy Oehlmann at poehlmann@communityplans.net if you would be willing to discuss them. Also, if you have specific questions regarding ROI please let Peggy know. The call will begin at 3 pm EST (2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii). Materials for the call are now available on the Members Only section under the CMO Roundtable & CFO Roundtable sections of our website. ACAP Plan Staff Are you interested in receiving updates on upcoming roundtables? Please send an email to Andrea at amaresca@communtiyplans.net with your contact information and you will be included in future notices. On March 15, Diane Smeltzer, Vice President of Care Management, and Nancy Murphy, Director of Care Management, both of CareSource, will lead a discussion on their company's Emergency Department Diversion Program. In this presentation, they will outline:
Materials for the presentation can be found on the ACAP website under Best Practices at: http://www.ahcahp.org/bppo/confcalls.asp March 16 Medicare Roundtable The next Medicare Roundtable is scheduled for Thursday March 16. Marty Mattei from Colorado Access will briefly review the highlights of the prescription training in New Orleans and Dave Heywood from AlohaCare will do the same for the Medicare Advantage training in San Diego. The agendas for the Medicare Advantage training and the Prescription Drug Plan training can be found on the CMS website at: http://www.cms.hhs.gov/healthplans/training/ Please contact Peggy at poehlmann@communityplans.net if there are specific questions you would like either of the presenters to address. CMS also has a Medicare Advantage listserv on that periodically sends out updates. ACAP will send out relevant emails to its Medicare group. Plan staff can also sign up by going to: http://www.cms.hhs.gov/mailinglists/default.asp?audience=15 Also on this call, Meg Murray will discuss the Medicare demonstration concept that ACAP is developing. The concept paper can be found on the Members' Only section of ACAP's website under Medicare Roundtable. The ACAP demonstration concept was recently featured in an article in the March 3rd edition of Medicare Advantage News (MAN). The call will begin at 3 pm EST, 2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii. Please visit the Medicare Roundtable page under the Members Only section for more information and to access the presentation materials: http://www.ahcahp.org/members/login.asp NEW March 17 Roundtable for CMOs, Quality/DM Directors, CIOs On Thursday March 17 at 2pm ET ACAP will convene a special conference call with Lee Partridge of the National Partnership for Women and Families to discuss NCQA's proposed new HEDIS measures. Lee is seeking informal feedback from ACAP plan staff on the proposed measures. If there is interest by plans' staff, ACAP will develop and submit more formal comments which are due to NCQA by C.O.B on March 22. More information and an overview of the proposed HEDIS measures can be found at: http://www.ncqa.org/Programs/HEDIS/Public%20Comment/PublicComment.htm#NEW%20MEASURES The call will begin at 2 pm EST (1 pm CST, 12 pm MST, 11 am PST, 9 am Hawaii). Please note this is an hour earlier than our usual call time. Please contact Peggy at poehlmann@communityplans.net with any questions or if you are unable to participate but would like to provide feedback. April 6th Webcast: "Improving Patient Care: How Medical Groups Are Using New CAHPS Surveys for Ambulatory Care" On Wednesday, April 6 from 1:30-3 pm ET ACAP plans have an opportunity to participate in a free webcast on how medical groups are using CAHPS surveys for ambulatory care. The webcast will feature representatives of medical groups in Boston and Minnesota who will share their experiences in fielding early versions of the new CAHPS Clinician and Group Surveys and in using the data for quality improvement. CAHPS, formerly known as the "Consumer Assessment of Health Plans Study," now refers to a family of surveys that examine health care quality from the patient's perspective. To learn more about CAHPS Ambulatory Care Surveys, visit: http://www.cahps-sun.org/Products/ACAHPS/ACAHPSIntro.asp For more information and to register for the webcast, visit: http://www.cahps-sun.org Recap: NICU Best Practices Call On February 8, Jim Glauber, MD of Neighborhood Health Plan of Massachusetts and Peggy Waters, RN of Network Health discussed their respective NICU management programs. NHP has contracted with Paradigm Health to do an on-site review, evaluation, and case management of NHP members in the NICU. Network Health has a multi-departmental approach to NICU management, involving the social case management program, medical management, maternal & child health case managers, and the behavioral health department. Recap: CFO Roundtable On the February 24 CFO roundtable, Janet Grant, Senior Vice President of Business Development and Regulatory Affairs at CareSource, gave an overview of HRSA's loan guarantee program, the benefits of the loan guarantee and the details of the application process. CFOs also discussed the February 2005 CEO/CFO meeting and prioritized follow up items from the meeting. In preparation for the June 8 CFO roundtable, ACAP will develop and circulate a brief survey of ACAP plan investment policy indices. The CFOs will briefly review the survey but will focus on a discussion of how ACAP plans use their Board's Finance Committees. Recap: CIO Roundtable On March 1, ACAP CIOs discussed the IT issues involved in developing and implementing disease registries. Terry D'Attore and others from Hudson Health Plan discussed the software selection, resource requirements, and practice recruitment issues involved in development of Care Focus, Hudson's disease registry program. For the June 22 roundtable, CIOs will discuss predictive modeling. Recap: Provider Relations Roundtable On March 9, ACAP Provider Relations representatives gave an overview of how their provider relations departments were structured. Plan representatives reviewed the responsibilities of provider relations, discussed reporting relationships, and outlined how the department coordinates with medical management, credentialing, and claims. Of the nine health plans on the call, six have credentialing separate from provider relations while three built credentialing into provider relations. For future roundtables, the provider relations directors plan to discuss ways to measure provider performance, pay for performance initiatives, and best practices for improving physician satisfaction. Recap: Human Resources/Claims Directors Roundtable On March 10, ACAP Human Resources Directors and Claims Directors held a joint roundtable to discuss work-at-home policies. Jim Karl and Leanne Olson of Community Health Network of Connecticut discussed the work at home policy for claims staff at CHNCT. Most of the claims examiners at CHNCT work at home at least several times a week. Quality is monitored through daily review of claims production and through periodic home audits. |
| FUNDING OPPORTUNITIES & NEWS |
Health Delivery Organizations Invited to Apply for Community Service Award The Foster G. McGaw Prize honors health delivery organizations (hospitals, health systems, integrated networks, or self-defined community partnerships) that have demonstrated exceptional commitment to community service. The awards program is sponsored by Baxter International Foundation, the Cardinal Health Foundation, and the American Hospital Association. More complete program information and application materials can be found at: http://www.aha.org/aha/awards-events/foster/application/application.html Proposals Sought for Innovative Health Programs The VHA Health Foundation has issued a request for proposals through its "Creating Better Health Through Innovation" program. Nonprofit health care providers, including hospitals, healthcare systems, clinics, and medical practices, are encouraged to submit proposals for innovative programs. The foundation will award grants ranging from $100,000 to $250,000 to support promising initiatives at the local level that represent a novel or significantly better approach to solving a problem or need related to health or healthcare. Programs selected for funding represent innovations that are beyond the concept stage, ready to implement, expand, or further refine, and are candidates for replication in other markets. The deadline for submitting letters of intent is April 18, 2005. More information is available at: http://www.vhahf.org/vhahf/ Children's Dental Health Grant Program The Samuel Harris Fund For Children's Dental Health has announced it will award grants to applicants whose oral health promotion programs are designed to improve and maintain children's oral health through community education programs. The grant program's main objective is to help children whose socio-economic status impacts on their access to professional oral care and adversely affects their oral health habits at home. Grants of up to $5,000 will be awarded to community-based, not-for-profit, oral health promotion programs. The deadline for applications is July 8, 2005. Examples of qualified programs and detailed information can be found at: http://www.ada.org/ada/prod/adaf/prog_access_harris.asp |
| NEWSFLASH |
GAO Announces Members of the Health Care Working Group The Government Accountability Office (GAO) recently named the members of the new Health Care Working Group that was created by the Medicare Modernization Act of 2003. Sen. Wyden (D-OR) was responsible for including this language in the bill. The group has been tasked with holding a national dialogue on issues related to health care services, delivery and cost. Medicaid is one of many issues to be discussed. The work group has been given 2 years to hold hearings and issue recommendations. More information about the work group and the members can be found at: http://www.gao.gov/special.pubs/citizenshealthpr0228.pdf Report on Medicaid Drug Rebate Program Last week investigators at the Government Accountability Office (GAO) announced that CMS fails to consistently verify the accuracy of price data reported by drug manufacturers and used to compute the discounts required by law. This means that the Medicaid program often overpays for prescription drugs. According to a March 8th article in the New York Times ("Report Says Medicaid Overpays for Drugs," 3/8), even when CMS officials find errors and problems in the data, they do not require drug companies to make corrections. In response to the report CMS officials indicated that it would be helpful for them to provide clear guidance on how to calculate the "best price." Health Center Trends Show Increased Reliance on Medicaid Managed Care Plans An article in the March/April 2005 issue of the journal Health Affairs examines whether the Federal Health Center Growth Initiative can be expected to eliminate primary care-sensitive health disparities. The study first looked at how primary care delivery changed and sustained its growth during 1994-2001. Researchers then looked to these trends to identify lessons for implementing the federal initiative that was launched in 2002. Among the key findings of the study were:
AHRQ Releases National Healthcare Disparities Report The Agency for Healthcare Research and Quality (AHRQ) recently released the second National Healthcare Disparities Report. This year's report builds on the benchmark data released in last year's inaugural report. The report examines quality of care for racial and ethnic minority groups, low-income Americans, and other vulnerable populations. The report highlights nine efforts that, over the past year, have moved the nation closer to this goal, including a focus on federally funded health centers. It can be accessed at: http://www.qualitytools.ahrq.gov/disparitiesreport. Information specifically on FQHCs is available at: http://www.qualitytools.ahrq.gov/disparitiesreport/browse/browse.aspx?id=4981&q=%22health+centers%22. New Data Collection Toolkit from HRET The Health Research and Educational Trust (HRET) has released a new Web-based toolkit for collection of race, ethnicity and primary language information by hospitals and other health care providers. The toolkit is based on a 2004 report funded by the Health Research and Educational Trust and the Commonwealth Fund, "Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection in Hospitals." The online toolkit is available at: www.hretdisparities.org/ |
| JOBS |
Whistler Joins CareSource as VP of Government Affairs In February, Chrisopher Whistler joined CareSource Management Group (CSMG), an ACAP member based in Ohio, as the vice president of government affairs. Whistler has been tasked with positioning CSMG as a leader in health care policy solutions for the state and federal levels of governments through creating new advocacy initiatives and by maintaining relationships with key government entities. CSMG created this position to further its vision, mission and strategic objectives and its Medicaid managed care plans in Ohio, Michigan and Indiana. Whistler previously worked on budget policy in both the legislative and executive branches of state and local government. Most recently, he was director of the Office of Management and Budget for the Franklin County, Ohio, Board of Commissioners, and before that, director of finance for the majority caucus in the Ohio House of Representatives. Whistler has also performed research and analysis of the Ohio Medicaid program, including forecasting expenditures and developing cost-containment proposals. |
| Upcoming Events |
March Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
| |
1 |
2 CIO Roundtable 3pm ET |
3 |
4 |
5/6 |
| 7 Program Committee Call 3pm ET |
8 |
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 NEW: CMOs, Quality/DM Directors, CIOs Roundtable 2pm ET |
18 |
19/20 |
| 21 |
22 |
23 |
24 |
25 |
26/27 |
| 28 Finance Committee Call |
29 Compliance Officers Roundtable 3pm ET |
30 |
31 |
|
|
April Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
| |
|
|
|
1 |
2/3 |
| 4 |
5 Pharmacy Directors Roundtable 3pm ET |
6 Webcast: Improving Patient Care: How Medical Groups Are Using CAHPS Surveys for Ambulatory Care |
7 |
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 |
| 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, mmurray@communityplans.net, 202.331.4601 |
Association for Community Affiliated Plans 2001 L Street, NW, 2nd Floor Washington, DC 20036 http://www.communityplans.net Contact Us |