 April 8, 2005 |
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Upcoming ACAP Calls
April 19–21: ACAP Board Meeting May 3: Marketing Roundtable May 4: CMO-Quality Managers Call May 10: Operations Roundtable May 12: HR Directors Roundtable
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
ACAP Provides Feedback to NCQA on HEDIS Measures ACAP recently submitted comments to the National Committee for Quality Assurance (NCQA) on proposed changes to the 2006 HEDIS measures. ACAP made several comments based on the feedback provided by plan staff including:
ACAP Policy & Advocacy Day
ACAP Announces Policy & Advocacy Day Conference ACAP will hold a Policy and Advocacy Day Conference on June 22nd in Washington, DC. Medicaid focused managed care plans are invited to attend. For more information call 202.331.4600. On June 22nd, ACAP will host a Policy and Advocacy Day for ACAP plans and other Medicaid-focused managed care health plans. The meeting is devoted to building a coalition of Medicaid focused health plans to protect the Medicaid program and its beneficiaries. The conference sessions will focus on the implications of the federal budget on Medicaid-focused health plans and their beneficiaries and how such health plans can affect the decision-making process. Plans will have an opportunity to hear from congressional staff from the Republican and Democratic leadership, officials from federal and state Medicaid agencies, and CEOs of Medicaid plans that have worked closely with their states to reform the Medicaid program. ACAP is also urging plans to use this time in Washington to meet with their Members of Congress to discuss Medicaid and the benefits that managed care plans bring to the safety net program. This one-day, no cost conference will be held in Washington, DC at the Wyndham Washington Hotel and ACAP has reserved a block of rooms at a special rate. Please contact Andrea at amaresca@communityplans.net or 202.331.4600 for more information.  |
| PUBLIC POLICY AND ADVOCACY |
Senators Hold Strong on Medicaid Position This week a contingency of the Republican Senators that voted for the Smith-Bingaman amendment to remove Medicaid cuts from the Senate budget resolution met personally with the Senate leadership. In their meeting with Majority Leader Frist (R-TN), Senators Smith (R-OR), Coleman (R-MN), Chafee (R-RI) and Snowe (R-ME) emphasized their concern and opposition to cuts to the Medicaid program driven by the budget process. According to one Senate staffer, this was the first step in efforts to come in the next few weeks as Members try to finalize a budget resolution. Also this week the Senate named members to the Budget Conference Committee. The Senators will begin formal meetings with their House counterparts (as yet unnamed) later this month as they try to reach agreement on a budget resolution. The Senate conferees are Sens. Gregg (R-NH), Domenici (R-NM), Grassley (R-IA), Allard (R-CO), Conrad (D-ND), Sarbanes (D-MD), and Murray (D-WA). Negotiations have already begun at the staff level and, as of ACAP's publication deadline, there was speculation that during informal meetings staff had been considering specific numbers on Medicaid cuts to the tune of $10 billion.
Medicaid Matters
In March, the House and Senate passed dramatically different budget resolutions. In the Senate resolution, Senators Smith (R-OR) and Bingaman (D-NM) led the way in striking cuts to the Medicaid program and instead inserting language to set aside funding for a commission to study and make recommendations for reforming the Medicaid program. Meanwhile the House included language that calls for up to nearly $20 billion in reductions from the Medicaid program. The "Medicaid Matters to Someone You Know" campaign has launched additional new materials. Visit the campaign website at: www.medicaidmatters2005.org/ ACAP Sends Action Alert on Medicaid Commission Bill As the House prepares to name its conferees Congresswoman Heather Wilson (R-NM) has taken the lead in asking her Republican colleagues to join her in sending a letter to House Budget Committee Chairman Nussle (R-IA). The letter urges Chairman Nussle - almost certain to be named a conferee on the budget resolution - to remove the cuts and replace them with a reserve fund to create a commission to study and make recommendations for reforming the Medicaid program. This week ACAP sent a targeted Action Alert to its member plans based in states with key Republican members. These members of the House of Representatives were urged to sign Cong. Wilson's letter. More information about this requested action and additional steps that plans can take as the Budget Conference Committee begins discussions can be found on the Members Only section of ACAP's website under "Action Alerts." Please visit the Action Alert page on ACAP's Members Only section or contact Andrea at amaresca@communityplans.net for more information. |
| EXCELLENCE AND ACCOUNTABILITY |
May 4 Joint ACAP-CHCS Call for CMOs & Quality Managers On May 4th at 3 pm Eastern, ACAP invites its Medical Directors and Quality Managers to participate in a call with the Center for Health Care Strategies to discuss a proposed asthma Benchmarking project. In the past, ACAP plans have expressed significant interest in developing benchmarks on a variety of measures. CHCS, in an effort to track the success of their multiple asthma initiatives, has developed a benchmarking database of measures that are roughly based on HEDIS. The purpose of this call is to review the measures and gauge ACAP plan interest in submitting this data. CHCS is excited about the possibility of having ACAP members use these definitions to collect administrative data to be shared among themselves and with other health plans from California, New York, and probably Indiana. Since all of the health plans work with Medicaid and SCHIP populations, the additional data from the ACAP members will be comparable and add strength to the data set.
Please contact Peggy Oehlmann at poehlmann@communityplans.net if you staff from your plan intends to participate on this call. May 11 Quality Management Roundtable Call On May 11 at 3 pm EST (2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii), Lisa Franchetti, Quality Management Project Coordinator at Neighborhood Health Plan of Rhode Island will discuss her health plan's participation in the CAHPS survey. While many ACAP plans participate in CAHPS via their state survey of Medicaid enrollees, NHPRI conducts its own CAHPS survey each year. By participating in the survey independently, NHPRI is able to ask questions relevant to the needs of its members, analyze complete survey results, and implement changes to improve customer satisfaction in a timely manner. Lisa will discuss the value of independent participation and talk about how NHPRI uses its CAHPS data to improve customer service. May 12 HR Directors Roundtable The HR Directors Roundtable has been changed from Thursday May 5 at 3 pm EDT to Thursday May 12 at 3 pm EDT (2 pm CDT, 1 pm MDT, 12 pm PDT, 9 am Hawaii). On this call, Ann VanEtten, Vice President of Human Resources at Affinity Health Plan will lead the discussion of recognition programs. She will discuss Affinity's corporate recognition programs and would like feedback from other ACAP plans on unique ways to recognize valuable employee contributions. Questions for discussion include:
RECAP: Pharmacy, Policy Staff Discuss ACAP Rebate Proposal The pharmacy roundtable meet to discuss ACAP's proposal to extend the Medicaid drug rebate to the Medicaid plans. Neighborhood Health Plan discussed how their PBM contract was affected when they removed the rebate negotiation from the contract. In 2001 NHP began to obtain its rebates through Harvard Pilgrim Health Plan, while retaining a PBM for processing claims, prior authorization, step therapy, clinical support, administering their e-prescribing program and contracting with pharmacies. To obtain the rebates, the plan receives utilization data from the PBM and then sends that data to Harvard Pilgrim. Harvard Pilgrim then sends the utilization data to the manufacturers with whom it has rebate agreements. The manufacturers then send the rebated amounts to NHP via Harvard Pilgrim. When the change occurred in 2001, NHP also contracted with a new PBM, resulting in essentially no change in their PBM costs. Their rebates, however, increased almost tenfold. RECAP: Compliance Officers Roundtable On March 29, the Compliance Officers discussed a variety of issues, including: document retention policies, credentialing of mid-level practitioners, and tools available to help plans monitor compliance with state contracts. Document retention policies tend to vary based on state regulations, but some plans have found useful resources on both the Health Care Compliance Association's website as well as the National Association of Insurance Commissioners website. Additionally, HCA Management Services has useful resources on their website at: www.hcahealthcare.com. In the discussion of credentialing, the plans were split on whether they credentialed all mid-level practitioners or only Physician's Assistants. Finally, on the discussion about compliance monitoring, most plans had created internal management tools using Excel spreadsheets or databases. Several ACAP compliance officers will be attending the HCCA conference in New Orleans on April 18-20. Pam Siren of NHP (pam_siren@nhp.org) will post a message at the conference for any ACAP plan staff interested in getting together during the meeting. |
| FUNDING OPPORTUNITIES & NEWS |
Funding for Community-Based Health Projects Local Initiative Funding Partners, a partnership program between the Robert Wood Johnson Foundation and local grantmakers, announced the availability of grants to support innovative, community-based projects designed to improve the health and healthcare for society's most vulnerable people. The projects must offer collaborative, community-based services that are new and innovative. The LIFP may also consider significant program expansions - such as a major expansion into new regions or to new populations. Applicants may be either public entities or nonprofit organizations. The projects must be nominated by a local grantmaker interested in participating as one of the funding partners. For more information, go to http://www.lifp.org |
| NEWSFLASH |
CHNCT Announces New Partnership The Community Health Network of Connecticut recently announced that it has formed a partnership with the Physicians' Health Alliance of Meriden. This new partnership means that CHNCT's HUSKY members will now have access to over 30 additional primary care physicians and 65 specialty physicians and institutional providers in the Meriden - Wallingford service area. According to Sylvia Kelly, the health plan's president and chief executive officer, "The comprehensive provider network administered by the Physicians' Health Alliance will significantly increase access to quality healthcare for our members in the region by giving them a larger network of doctors from which to choose. Along with new doctors, the partnership will also bring a wealth of medical and disease management expertise to Community Health Network of Connecticut through the ongoing programs administered by the Physician's Health Alliance. Alexander J. Shak, president and chief executive officer of Physicians' Health Alliance highlighted the benefits of working with CHNCT in his announcement saying, "We are confident that our new HUSKY partnership with Community Health Network will help us maintain and enhance our patients' access to high-quality and cost-effective health care services." HHS Approves First Phase of TN's Cuts In late March, HHS approved the first phase of Tennessee Governor Phil Bredesen's proposed cuts to TennCare. The first phase of the Governor's proposed overhaul would eliminate coverage for approximately 323,000 adults - most of whom have annual incomes that are too high to qualify for traditional Medicaid. However, no cuts can take effect until a U.S. District Court hearing reviews the planned reforms. As of press time, the District Court was scheduled to reconvene on April 7th. The second phase of Gov. Bredesen's proposal calls for restrictions on coverage for about 396,000 adult beneficiaries who would remain in the program. The second phase has not yet been approved by HHS. Ohio Plans Aggressive MMC Expansion Leaders in Ohio's House of Representatives recently issued a proposal to expand Medicaid managed care. The plan calls for moving approximately 125,000 aged, blind and disabled Medicaid consumers into managed care over the biennial budget. The House's proposal is more aggressive than the Governor's 2006 budget recommendation in that it adopts more of the recommendations issued in a report by the Ohio Commission to Reform Medicaid. The Commission's report can be found at: http://www.ohiomedicaidreform.com/ In announcing the proposal, Ohio House Speaker Jon Husted stated that managed care will benefit patients by emphasizing prevention, and will bring some predictability to the Medicaid program, which currently provides health care to 1.7 million low- income, elderly and disabled Ohioans. AHRQ Releases State Resources for Health Quality Measures This week the Agency for Healthcare Research and Quality (AHRQ) released "State Resources for Health Quality Measures." This resource publication provides three different formats to show where states and the District of Columbia rank in 14 categories of health measures. The formats are:
The State Resources tool can be found at: http://www.qualitytools.ahrq.gov/qualityreport/state/srt.aspx?state=AL To view the full 2004 National Healthcare Quality Report, go to: www.qualitytools.ahrq.gov/qualityreport |
| Upcoming Events |
April Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2/3 |
| 4 |
5 Pharmacy Directors Roundtable CHCS Network Exchange Call |
6 QM Committee Call Executive Committee Call 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 Meeting |
20 ACAP Board Meeting |
21 ACAP Board Meeting |
22 |
23/24 |
| 25 |
26 |
27 |
28 |
29 |
30/1 |
May Events |
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30/1 |
| 2 |
3 Marketing Roundtable |
4 CMO-Quality Managers Call |
5 |
6 |
7/8 |
| 9 |
10 Operations Roundtable |
11 |
12 HR Directors Roundtable |
13 |
14/15 |
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17 |
18 |
19 |
20 |
21/22 |
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24 |
25 |
26 Quality/Disease Management Call |
27 |
28/29 |
| 30 Memorial Day |
31 |
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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, 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 |