 March 25, 2005 |
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Upcoming ACAP Calls
March 28: Finance Committee March 29: Compliance Roundtable April 5: Pharmacy Directors Roundtable April 6: QM Committee April 6: Webcast: Using CAHPS Surveys for Ambulatory Care Improvements April 6: Executive Committee April 19–21: ACAP Board Meeting
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
Senate Rejects Medicaid Cuts; New Challenges Lie Ahead Backed by an extraordinary nationwide grassroots effort, the Senate voted on March 17th to strip language out of the Senate Budget Resolution that would have required the Senate Finance Committee to cut up to $15 billion in the Medicaid program and other mandatory entitlement programs. Senators Gordon Smith (R-OR) and Jeff Bingaman (D-NM) led the opposition to the Medicaid cuts, which passed on a 52-48 vote with the support of seven Republican Senators. The amendment replaced the Medicaid cuts with language calling for a bipartisan commission on Medicaid, similar to a bill introduced by Smith and Bingaman. The impetus for the amendment was to allow the Senate Finance Committee to control the scope of any major changes to the program. Unlike the Senate, the House approved mandatory spending cuts that could result in up to $20 billion in cuts to the Medicaid program. Because the House and Senate passed considerably different budget resolutions, members of a conference committee will be convened after Congress' Easter recess to try to work out the differences; staff on the Budget Committees have already begun preliminary talks. At press time, it was unclear whether and to what extent members on both sides of the aisle would be able to agree on the issue of mandatory Medicaid cuts. However reports from congressional staff and the administration indicate a determination to pass a budget resolution this year. Following the votes in Congress, the Governors announced they had been working with Health and Human Services Secretary Leavitt to identify ways to trim Medicaid spending. According to NGA's Director, Ray Scheppach, there has been agreement on principles but more discussion on the details is needed. (See related article under Policy and Advocacy for more details) The four areas of agreement are:
ACAP Sets Date for Policy Conference
Managed HealthCare Executive Spotlights Koller ACAP will host a Policy and Advocacy Conference on June 22, 2005 in Washington, DC. All ACAP CEOs are encouraged to attend. The conference will also be open to other Medicaid-focused managed care plans. Please contact Andrea at 202.331.4600 for more information. The lead story in the March 2005 edition of the trade publication Managed HealthCare Executive featured former Neighborhood Health Plan of Rhode Island (NHPRI) CEO and founding ACAP member Christopher Koller. This month Koller transitioned into his new position as Rhode Island's first-ever Health Insurance Commissioner (see ACAP newsletter 1/21/05). The feature story focused on Koller's decade long background with NHPRI, which was recently named by the National Committee on Quality Assurance as one of the top ten Medicaid health plans in the country. In his interview with author Michael McCue, Koller noted that the success of NHPRI was due to several factors, including the way that NHPRI was able to employ creative insurance payments and benefit policies to increase behavioral health provider capacity and to pay for quality. Under Koller's leadership NHPRI has become a model for improving access to care through a system that utilizes the insurance card, an educated consumer, and a collaborative provider. According to Koller, his tenure at NHPRI has provided him with the experience necessary to serve as the point person for all healthcare access and affordability initiatives for the state. He shared with Managed Healthcare Executive the three lessons that he would carry to his new position:
One of the priority policy issues for Koller is to secure agreement on adequate reserve levels, which he believes will allow the state to evaluate rate proposals relative to these benchmarks. Also topping his policy priorities are to simplify and improve the health insurance market for small businesses and individuals, develop more cost and quality transparency, support the state's work in healthcare information technology planning and coordinate the state's purchase of health insurance. NHP Takes Leadership Role in Medicaid Matters Campaign A new public education and communications campaign, "Medicaid Matters to Someone You Know," is working to engage constituencies at a state and local level around the Medicaid debate. The campaign is being coordinated by Community Catalyst and the Georgetown Health Policy Institute and has the support of a large contingency of national advocacy organizations. The Neighborhood Health Plan of Massachusetts, a member of ACAP, has taken a leadership role in getting the campaign off the ground by contributing to Medicaid Matters and donating communication staff and resources to assist in getting the web site up and running quickly. The campaign combines the personal testimony of stakeholders with facts about the Medicaid program that show the breadth and importance of Medicaid to many constituencies. It will provide a messaging toolkit for people working across the country on this issue. The Medicaid Matters web site provides various advocacy tools, photos and templates that can be adopted for use by organizations. These resources focus on the constituencies that depend on Medicaid, including children, the elderly, people with disabilities, and those from rural areas, and can be used in targeted states to educate the media, general public and decision makers about the importance of the current structure of Medicaid. The web site will provide links to national level data on these constituencies as well as those serving Medicaid patients, such as drug stores and hospitals. For more information on the campaign contact Rob Restuccia, Executive Director of Community Catalyst, at 617-275-2814 or restuccia@communitycatalyst.org.  |
| PUBLIC POLICY AND ADVOCACY |
ACAP Receives Guidance from NGA Staff on Medicaid Reform At this week's meeting of the Partnership for Medicaid - a nationwide coalition of safety net providers of which ACAP is a member - Matt Salo, Legislative Director of the Health and Human Services Committee for the National Governors' Association, offered insight on the Governors' strategy for Medicaid reform in the coming months. Salo noted that the Governors' proposals are still being developed and he encouraged ACAP and other members of the Partnership to weigh in with NGA with ideas and feedback on reform proposals. In his remarks on the content of Medicaid reform proposals, Salo stated that although the health care system as a whole needs to be modernized, there is widespread agreement among Governors that the current Medicaid financing structure will not be able to support the health care safety program in the future. Among the proposals that the Governors are working on are:
ACAP Urges Support for Removing Cuts Ahead of the Senate vote on the budget resolution, ACAP signed a letter sent on behalf of the Partnership for Medicaid, a coalition of safety-net providers and other key organizations, signaling the group's endorsement of the Smith-Bingaman amendment to the Fiscal Year 2006 Senate Budget Resolution. ACAP and the other members of the Partnership indicated that the budget process should not be used to drive solutions for improving the Medicaid program. Instead our organizations reiterated that reform efforts should preserve the federal guarantee of Medicaid coverage, and not reduce or eliminate its services or consumer protections. The Partnership also conveyed to Senators that reform efforts must appreciate the critical role that safety net providers, including Medicaid-focused managed care plans such as the members of ACAP, play as essential sources of care for millions of Medicaid recipients and uninsured Americans. ACAP also signed similar coalition letters sent by the Medicaid Coalition, which includes a broad spectrum of advocacy and provider organizations, and one sent by a coalition of provider organizations, including the American Hospital Association, the American Academy of Pediatrics and the American Health Care Association. The text of these letters can be found on ACAP's Policy and Legislative Positions page at: http://www.ahcahp.org/pandl/05policy_positions.asp CMS Director Discusses Coverage for Low-Income Children On March 23rd the Alliance for Health Reform cosponsored a briefing with the Robert Wood Johnson Foundation on the topic of outreach and enrollment of children in Medicaid and the State Children's Health Insurance Program (SCHIP). ACAP staff attended the briefing to get the insider's view from Dennis Smith, director of the Center for Medicaid and State Operations within the Center for Medicare and Medicaid Services. Also participating on the panel were Gregg Martin from the National Conference of State Legislators, Sandra Nichols from the AMERIGROUP Corporation, and Donna Cohen Ross of the Center on Budget and Policy Priorities. In his remarks Mr. Smith focused on the Bush administration's progress on its "Cover the Kids" campaign. The campaign was developed to address the problem of millions of children being eligible for Medicaid and SCHIP, but still going without coverage. Mr. Smith stated that the Administration would move forward with the "Cover the Kids" campaign despite concerns that have been raised that funding for outreach and enrollment does not guarantee that there will be funding for covering health care services. However, he provided no further details of the plans included in the Administration's budget proposal or a timeline for when details of the SCHIP and Medicaid proposals will be released. Mr. Smith also stated that he was "surprised" by the comments of the other panel members and audience "because [he] thought that outreach was something they could agree upon." Smith went on to discuss the challenges of the current SCHIP program, many of which were inevitable because of the assumptions that had to be made when the program was created. He also expressed the Administration's interest in working with Congress to identify ways to better distribute money to states. Mr. Martin of NCSL raised several concerns with the Administration's proposals including:
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| EXCELLENCE AND ACCOUNTABILITY |
April 6 Quality Management Committee The next call for members of ACAP's Quality Management Committee is scheduled for April 6th. The call will begin at 2 p.m. ET. The items to be discussed include:
April 5 CHCS Network Exchange Call On April 5th ACAP plans are invited to participate in a Network Exchange Call being hosting by The Center for Health Care Strategies. The topic for the call will be "Current Application of Predictive Modeling in Managed Medicaid Health Care." It will begin at 1:00 pm and run until 2:30 pm ET. Predictive modeling is one tool that can help plans prioritize and anticipate the future medical needs of their members. The analysis produced by the modeling is a statistical representation based on a member's clinical history, as compared to population-based clinical outcomes, defining the probability of future adverse events for the individual. The guest experts on the call include:
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," 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 CareSource Best Practices Call on ER Diversion More than 20 people participated in the March 15th Best Practices conference call to learn more about CareSource’s ER Diversion efforts. Diane Smelter, Vice President for Care Management and Nancy Murphy, Director of Care Management gave an overview of CareSource’s efforts to reduce inappropriate emergency room use. Members with four or more ER visits are given an educational packet that explains the importance of a medical home, reviews CareSource’s transportation benefit, and provides the phone number for their 24-hour Nurse Triage line. Since implementation, over 50 percent of callers to the Nurse Triage line have been successfully diverted from the ER to a more appropriate level of care. CMO/CFO Roundtable on Return on Investment On March 15, the CMOs and CFOs of ACAP plans held a joint roundtable to discuss Return on Investment initiatives. Joe Stankaitis, CMO of Monroe Plan, discussed his health plan’s participation in the CHCS Best Clinical and Administrative Practices (BCAP) initiative on Return on Investment. He reviewed CHCS’s Guidelines for Cost Reporting and discussed how his health plan calculates collects and evaluates the costs associated with the quality improvement initiative they are implementing under this project. Dr. Stankaitis also mentioned a literature search that on return on investment. ACAP is following up with CHCS on this issue and will circulate the literature search to ACAP CMOs and CFOs. Medicare Roundtable On March 16, Medicare contacts from ACAP plans heard from Marty Mattei, Director of Pharmacy Services at Colorado Access, and David Heywood of AlohaCare who both attended CMS’s regional trainings. Dr. Mattei attended the Prescription Drug Plan training in New Orleans and Dave Heywood attended the Medicare Advantage training in San Diego. Links to the CMS training materials are available in the Medicare Roundtable section of ACAP’s website. Meg Murray, Executive Director of ACAP, also discussed the association’s proposal to allow ACAP plans to become Special Needs Plans under a special Medicare Demonstration that would include risk-sharing. CMS has expressed interest in the proposal but has asked ACAP to provide more information on some aspects of the proposal. ACAP will be scheduling a Medicare roundtable early this summer to discuss the development of marketing plans for Medicare enrollees. A date will be posted in upcoming newsletters. CMO/QM Conference Call on Proposed 2006 NCQA HEDIS Measures On March 17, Peggy Oehlmann of ACAP and Lee Partridge of the National Partnership for Women and Families discussed the National Committee on Quality Assurance’s (NCQA) proposed 2006 HEDIS measures with ACAP CMOs and Quality Directors. Among concerns highlighted by plan staff and ACAP staff are:
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| FUNDING OPPORTUNITIES & NEWS |
RWJF Invites Proposals for Changes in Health Care Financing Initiative Changes in Health Care Financing and Organization (HCFO) is an initiative of the Robert Wood Johnson Foundation that supports policy analysis, research, evaluation, and demonstration projects. The HCFO initiative awards grants in two categories: small grants for projects requiring $100,000 or less and projected to take twelve months or less; and large grants for projects requiring more than $100,000 and/or projected to take longer than twelve months. Projects may be initiated from within many disciplines, including health services research, economics, sociology, political science, public policy, public health, public administration, law, and business administration. Funded projects should provide public and private decision makers with usable and timely information on health care policy and financing issues. For more information visit: http:///hcfo.net. |
| NEWSFLASH |
Connecticut Governor Signs Bill To Extend HUSKY Benefits to Adults Through June 30 Last week Connecticut Gov. Jodi Rell (R) signed a bill to extend HUSKY coverage to 13,000 adults whose children are enrolled in the program until June 30, 2005. However, during the bill signing she warned the Connecticut Legislature that long-term continuation of the program might not be viable. The HUSKY program provides health coverage for children enrolled in Medicaid and HUSKY Part B provides services for children in higher income families. The HUSKY plan was originally aimed at children and was later expanded to include adults. When the state's economy slowed lawmakers voted to remove adults from the program as of April 1, 2003. A federal lawsuit was filed to continue coverage, and a judge ruled that adults set to lose coverage would need two years notice, extending their coverage until April 1, 2005. The extension Gov. Rell signed will cost $7.5 million. New York Governor, Bush Administration Pursue Medicaid Deal On March 16th, New York Gov. George Pataki introduced a plan to "right-size" the state's health care system. The proposal includes many of the concepts the Bush administration supports to give states greater control over their Medicaid programs. According to Gov. Pataki, the plan would turn over control of New York's Medicaid program from its cities and counties to the state. Secretary Leavitt indicated the Administration's support of the plan because it would ensure continued medical coverage to millions of New York residents. Other provisions of the plan include:
New Health Affairs Article on Extending Health Coverage This month the journal Health Affairs has published a Web Exclusive article, entitled "Change in Challenging Times: A Plan for Extending and Improving Health Coverage." The article coauthored by Jeanne Lambrew, Ph.D. Associate Professor in the Department of Health Policy at George Washington University and John Podesta and Teresa Shaw both of the Center for American Progress, calls for providing health coverage to all Americans and describes a plan that builds on the current system to insure all, lays the foundation for a more quality-oriented and efficient system, and finances its new investment with a small, dedicated value-added tax. In addition, the article calls for shifting the debate from one about health and economics to one about morality. A copy of the article can be found in the web exclusives section of the Health Affairs website at: http://www.healthaffairs.org Massachusetts Publishes Quality Report Card The Massachusetts Health Quality Partners (MHQP) group recently released the state's first public report on the performance of nine major physician networks. MHQP is a coalition of doctors, hospitals, health plans, consumers, and government agencies. The 2004 Physician Network Quality Report is based on the quality of patient care provided to members of Massachusetts' five largest health plans in 2003. The report compares physician network performance on 16 quality measures developed by the National Committee on Quality Assurance, including use of depression and asthma medications, breast and cervical cancer screening, chlamydia screening in young women, cholesterol testing for those with heart disease, overall diabetes care, and well-child and adolescent care. In 2006, MHQP plans to release the results of a statewide survey of patients' experiences with over 400 primary care medical groups across the state and comparative clinical quality data for more than 150 groups. |
| JOBS |
Medical Director Opening Fitzgerald Associates is conducting a search for a Medical Director for a premier multi-service healthcare center in Boston. The ideal candidate is a physician leader with successful physician practice management and EMR implementation experience. This person will serve as facilitator, collaborator, and mentor to ensure high quality and efficient delivery of medical care to meet the patient and community-focused goals of the organization. Compensation includes a competitive base salary, rich benefits package, and the opportunity to work in a mission-oriented, team environment that is innovative, dynamic and dedicated to serving the needs of the community. A complete job description is available upon request. Inquiries and resumes should be submitted to: Diane Fitzgerald with Fitzgerald Associates at DF@ fitzsearch.com. Vice President, Health Management Services A prominent Disease Management company in New Jersey is seeking a Nurse Executive to be responsible for the overall operations of the organization's Health Management Services division. Key charges include P&L responsibility, hiring and management of staff, and ensuring the clinical integrity and quality of the company's disease management products. Requirements include a nursing credential with an MBA, MHA, or equivalent degree or experience, and business/operations experience in a health plan or disease management company. Medical management and/or disease management background is essential.
ACAP Job Bank
Fitzgerald Associates is conducting the search for this position and can provide a complete job description upon request. Inquiries and resumes should be submitted to: Diane Fitzgerald, Fitzgerald Associates, DF@fitzsearch.com or 781.863.1945. Recent job postings are available at ACAP's job bank at: http://www.ahcahp.org/jobs/jobs.asp. For information on posting a job for your organization please contact Andrea Maresca at amaresca@communityplans.net. Health Plus Seeks CIO, COO Health Plus is seeking to hire a Chief Information Officer and a Chief Operating Officer. Health Plus, a member of ACAP, is a not-for-profit Medicaid focused managed care plan committed to quality healthcare and dedicated to the health and well-being of its culturally diverse communities through partnerships with members, providers, and community-based organizations. Health Plus is one of the fastest growing managed care organizations in New York City. Health Plus currently enrolls Health Care Plus, Child Health Plus and Family Health Plus members in all five boroughs of New York City. For more information contact Tom Early at (718) 852-5090. |
| 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 |
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 4pm ET |
29 Compliance Officers Roundtable 3pm ET |
30 |
31 |
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April Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2/3 |
| 4 |
5 Pharmacy Directors Roundtable 3pm ET CHCS Network Exchange Call |
6 QM Committee Call 2pm ET Executive Committee Call 3:30pm ET Webcast: Improving Patient Care: How Medical Groups Are Using CAHPS Surveys for Ambulatory Care |
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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 |
| 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 |