 April 29, 2005 |
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Upcoming ACAP Calls
May 3: Marketing Roundtable May 4: CMO, Quality Managers Joint Roundtable May 11: Best Practices Call May 12: COO, HR Directors Joint Roundtable
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
California's Alameda Alliance for Health Joins ACAP The Association for Community Affiliated Plans (ACAP) is pleased to welcome the Alameda Alliance for Health as its newest member. The Alliance, a Medicaid-focused not-for-profit health plan established in 1996, is led by Chief Executive Office Ingrid Lamirault. The Alliance currently provides health care services to more than 92,000 people living in California's Alameda County through Medi-Cal, the Healthy Families Program, and Group Care, a program serving In-Home Supportive Services Workers. In December 2004 the Alliance was awarded $950,000 in funding from the California Endowment, the California HealthCare Foundation and Measure A to expand needed health care coverage for low-income Alameda County residents. Among the most recent of the Alliance's initiatives, the plan submitted its application to the state of California for approval to launch its Healthy Kids program. Healthy Kids is part of the Alameda County Children's Health Initiative, which is working toward increasing the number of kids up to 18 years old with health coverage through a variety of strategies. Healthy Kids will offer comprehensive health, vision and dental coverage to low-income children under age 18 who do not qualify for Medi-Cal and the Healthy Families program and have a family income up to 300 percent of the Federal Poverty Level. The Alliance expects to receive a decision by July of this year. In addition to providing access to health care for Alameda county residents, the Alliance's socially driven mission inspires its employees to participate in numerous charitable activities throughout the year. For more information about Alameda Alliance for Health visit their multilingual website at: http://www.alamedaalliance.com/homepage800.html Monroe Plan Featured in "Quality Matters This week's edition of the Commonwealth Fund's "Quality Matters" publication featured the Monroe Plan for Medical Care, Inc., a member of ACAP, in a case study of quality improvement in Medicaid. The Monroe Plan is a non-profit managed care organization based in Rochester, New York with a longstanding commitment to improving the quality of care for its members. The Monroe Plan has developed various performance improvement initiatives since the late 1990s. The goal of the Monroe Plan's quality improvement program is to make organizational changes to ensure adherence to appropriate practice guidelines through care coordination. New York State's Medicaid incentive program has rewarded efforts such as Monroe's and enabled the plan to invest in new and innovative quality initiatives. The most recent issue of "Quality Matters" presents Monroe's prenatal care initiative as a case study on pay for performance successes in Medicaid and discusses two other initiatives on asthma care and cancer screenings that the Monroe Plan has implemented. The feature in "Quality Matters" can be accessed at: http://www.cmwf.org/publications/publications_show.htm?doc_id=274106#casestudy ACAP's Policy and Advocacy Day Set for June ACAP will host a Policy and Advocacy Day for all Medicaid focused health plans on June 22nd in Washington, DC at the Wyndham Washington Hotel. This conference is offered at no charge to Medicaid focused plans. Reservations can be made with the Wyndham Hotel by calling (202) 457-9139. More information and instructions for booking onlline is available at the ACAP website: http://www.communityplans.net/ Participants will have an opportunity to hear from Congressional staff engaged in Medicaid negotiations as well as representatives from the National Governors' Association, the Washington office staff of individual governor who have taken a lead in Medicaid reform, state Medicaid Directors, CMS officials and other Medicaid health policy leaders. On Thursday, June 23rd ACAP will also host a congressional briefing to release a new study detailing recent trends and the outlook for Medicaid managed care. ACAP also urges participants to use this opportunity to meet with members of their congressional delegation. ACAP staff is available to assist you in scheduling these appointments. For more information please contact Andrea Maresca at 202.331.4600 or at amaresca@communityplans.net. Recap ACAP's April Board Meeting From April 19-21, AlohaCare hosted ACAP's CEOs and their board chairs for a board meeting in Honolulu, Hawaii. ACAP plans were exposed to the specific challenges faced by this state's Medicaid beneficiaries and the safety net providers who serve them. During the meeting, participants toured the Waianae Comprehensive Community Health Center which is in the process of modernizing its facility to provide a holistic approach to health care and to focus on disease prevention. ACAP CEOs also benefited from several presentations including an update on how ACAP member CareOregon developed a plan to return to financial sustainability; the process of succession planning for changes in leadership at health plans, experiences with strategic planning processes for health plans; and the challenges and opportunities of states' efforts to expand Medicaid managed care. ACAP members can access the materials and presentations through the Members' Only section of our website at: http://www.ahcahp.org/members/login.asp  |
| PUBLIC POLICY AND ADVOCACY |
Congress, Administration Reach Budget Deal on Medicaid Cuts It was a week of highs and lows as intense negotiations on the future of the Medicaid budget came to a close. Ultimately the pressure on Congress to pass a Budget Resolution this year combined with a political climate favoring tax cuts resulted in a deal that calls for drastic cuts to the Medicaid program. Despite negotiations between concerned Republicans advocating to strike Medicaid cuts, including Senator Gordon Smith (R-OR) and Congresswoman Heather Wilson (R-NM), and HHS Secretary Leavitt the budget resolution requires Congress to find a minimum of $10 billion in cuts to Medicaid over five years. This agreement is counter to the original Senate passed bill which stripped all Medicaid cuts as well as a motion that was overwhelmingly approved this week in the House that called for protecting the Medicaid program. In the final budget resolution approved by the House and Senate, the Senate Finance Committee was instructed to find $10 billion in cuts to entitlement programs. The Finance Committee's cuts to Medicaid are capped at $10 billion. The House Energy and Commerce Committee was instructed to find $14.7 billion in cuts to mandatory spending programs, most of which is expected to come from the Medicaid program. However, the Energy and Commerce Committee still has the authority to identify cuts above the $14.7 figure. Any differences in what House and Senate committees recommend will have to be worked out in a conference committee later this year, again creating the opportunity to make deeper cuts to the Medicaid program. Despite conflicting reports, as of press time for this publication no formal agreement had been reached on the creation of a commission to study Medicaid. According to some reports from Congressional staff, Secretary Leavitt agreed to a Medicaid commission during negotiations and has proposed that he have the authority to appoint the members of such a commission which would report out recommendations by September. Concerns have been raised about this approach, including that such a commission would lack true credibility and would favor reform proposals put forward by the Bush Administration. Other ideas for a commission include requesting that the Institutes for Medicine (IOM) take charge of the study . It is unclear if any agreement will be reached on this issue.
ACAP's policy and advocacy related materials can be found on our website at: http://www.ahcahp.org/pandl/default.asp
Governors Circulate Medicaid Proposal This week leaders of the NGA requested feedback on a draft proposal on Medicaid that was distributed to all the governors. The working document, titled "Medicaid Reform -- A Comprehensive Approach," outlines a set of concepts that were being discussed by the governors' Working Group on Medicaid. The draft document includes possible changes that could serve as a foundation for developing the governors' unifying position on Medicaid. Such a proposal by the governors' is expected to receive serious consideration by the Bush Administration and lawmakers in Congress. One change included in the working document is a proposal to establish or increase deductibles and co-payments for beneficiaries. According to reports this week, governors hope such a proposal would force beneficiaries to contribute to the cost of the program and discourage abuse. Also being considered is a proposal to make it more difficult for seniors to transfer their assets to family members or others to qualify for nursing home care under Medicaid. Governors have also indicated support for creating costs savings by making the program more efficient through electronic medical records and state purchasing pools. According to a statement from the NGA the document is not official NGA policy. To date the official policy remains that NGA opposes efforts that would shift costs to the states and that Medicaid reform should be driven by good policy and not the federal budget process. |
| EXCELLENCE AND ACCOUNTABILITY |
May 3 Marketing Roundtable On Tuesday, May 3rd, ACAP will host a Marketing Directors Roundtable to discuss cultural competency in marketing. The questions that will be addressed include:
Please contact Peggy with other questions that you would like addressed during the call or with items you would like on the agenda for future calls.
A schedule of all Staff Roundtables can be found on the Members' Only section of ACAP's website. For more information contact Peggy Oehlmann at poehlmann@communityplans.net.
May 4 CMO, QM Managers Roundtable on Asthma Benchmarking Project On May 4th at 3 pm EDT (2 pm Central, 1 pm Mountain, 12 pm Pacific, 10 am Hawaii), 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 plans’ 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. More information and background materials can be found on the Members' Only section of the ACAP website under "CMO Roundtable." Please contact Peggy Oehlmann at poehlmann@communityplans.net with any questions. May 11 Best Practices 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 Joint Operations, HR Directors Roundtable On May 12th, ACAP will host a joint roundtable for Operations and Human Resource staff starting 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 a discussion on recognition programs. She will talk about Affinity's corporate recognition programs and has requested feedback from other ACAP plans on unique ways to recognize valuable employee contributions. The questions for discussion include:
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| FUNDING OPPORTUNITIES & NEWS |
Funding Opportunity for Care for Medicaid Patients In early May 2005, the Center for Health Care Strategies will solicit applications from quality improvement teams as part of the Medicaid Disease Management Initiative. Successful applications will become part of a national collaborative to design, test, and share the best practices developed for care delivery for Medicaid recipients with multiple chronic conditions. Sites will be selected for their readiness to undertake a major project that will include both a model development component and a quality improvement collaborative. Once the teams are selected, expert faculty will provide training to help the teams overcome barriers and close the gaps in co-morbid chronic disease management. The initiative will be independently evaluated. The Medicaid Disease Management Initiative was developed to bring together state Medicaid agencies, health plans, and providers to develop, measure, and disseminate successful models of care delivery for Medicaid recipients with multiple chronic conditions. This initiative is funded by a two-year grant from Kaiser Permanente, with additional support from The Robert Wood Johnson Foundation. More information about the Disease Management Initiative can be found at: http://www.chcs.org/info-url_nocat3961/info-url_nocat_show.htm?doc_id=272035 Center Hosts Funding for Health Month The Foundation Center is sponsoring Funding for Health Month in May. Throughout the month the Center will be holding health related events, educational programs and releasing new web resources at its five library/learning center locations in New York, Atlanta, Cleveland, San Francisco, and Washington, DC. The Center will also be releasing a new study, "Foundation Funding for Children's Health," which is an in-depth look at the topic of health care funding. More information is available at: http://fdncenter.org/focus/health/ |
| NEWSFLASH |
Georgia's Medicaid Managed Care RFP Big Draw for Companies According to Medicare Advantage News (Financial Analysts Cite Sizable Opportunity As MCOs Bid on GA Medicaid Pacts for '06, 4/14/05), there were about twelve major companies that submitted bids in response to Georgia's plan to shift 1 million Medicaid beneficiaries from fee-for-service (FFS) into mandatory managed care statewide throughout 2006. Among those submitting bids were AMERIGROUP Corp., UnitedHealthcare, WellCare Health Plans and Blue Cross and Blue Shield of Georgia. BCBS of Georgia, the state's largest health insurer, bid on all six regions in Georgia. The MAN article quotes financial analysts that predicted intense competition among MCOs because of the significant financial opportunity at stake. They went on to say that the potential earnings impact from the Georgia's shift to Medicaid managed care will be more significant for Medicaid-focused companies compared to larger commercial plans. Georgia's Medicaid program currently covers 1.5 million Medicaid and PeachCare enrollees with an annual budget of $6.8 million. Cover the Uninsured Week May 1st to the 8th is "Cover the Uninsured Week," a project of the Robert Wood Johnson Foundation. This annual week is dedicated to engaging individuals and organizations from every sector of society in campaigning for healthcare coverage for the 45 million uninsured or underinsured Americans. Some of the events include health and enrollment fairs, campus activities, business seminars, and faith-based meetings. For more information go to: http://covertheuninsuredweek.org/ Rise in Medicaid Pay for Performance Initiatives Featured The April 28th edition of the Commonwealth Foundation's (CMF) publication "Quality Matters" spotlighted the issue of Pay-for-Performance in Medicaid. As part of this feature topic, the Monroe Plan, a member of ACAP, was highlighted for its work on prenatal care, asthma care and cancer screenings (see Highlights) According to the CMF, state Medicaid agencies have begun to consider pay-for-performance and other financial and non-financial incentives when negotiating their contracts with managed care plans. In turn, some Medicaid managed care plans are offering quality incentives to their providers. The complete article can be found at: http://www.cmwf.org/publications/publications_show.htm?doc_id=274106#casestudy Conflicting Reports on Uninsured Numbers This week new analyses were released estimating the number of U.S. residents without health insurance. Notably both cited that the number of uninsured may be overstated. One analyses by the Actuarial Research Corporation estimated that nine million of the 45 million uninsured actually had health insurance coverage in 2003. The other study conducted by the Urban Institute and based on 2001 data, estimates that four million of the 45 million uninsured may have had coverage. Both studies also found that the uninsured population is growing as more residents lose private coverage. The two analyses were commissioned by HHS Assistant Secretary for Planning and Evaluation Michael O'Grady after four government surveys found the number of uninsured in 2003 ranged from 19 million in the Survey of Income and Program Participation to 45 million in the Current Population Survey. Although both surveys are conducted by the Census Bureau, the CPS is traditionally the most widely relied upon survey. It was not clear what produced the discrepancy in the numbers but some of the hypotheses offered included that residents might answer "no" to health insurance questions to avoid follow-up questions on the "lengthy" survey or that residents do not want to say they receive public assistance. CMS to Hold Low-Income Access Open Door Forum On May 4th at 2 p.m. EDT CMS will host a low-income access Open Door Forum. The agenda items to be discussed include:
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| JOBS |
Croke Leaves NHPRI to Become Health Program Specialist ACAP wishes to congratulate Alison Croke as she leave Neighborhood Health Plan of RI to move into her new role as the Senior Health Program Development Specialist for ACS in Rhode Island. ACS (formerly Birch and Davis) has a contract with the RI Dept. of Human Services to administer the RIte Care program. As Senior Health Program Development Specialist, Ms. Croke will be working with DHS to design and implement new health care programs for Medicaid recipients and uninsured Rhode Islanders. Ms. Croke worked at NHPRI for two and a half years and prior to that was with the Center for Health Care Strategies (CHCS) for four and a half years. |
| Upcoming Events |
May Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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30/1 |
| 2 |
3 Marketing Roundtable |
4 CMO, Quality Managers Joint Roundtable |
5 |
6 |
7/8 |
| 9 |
10 |
11 Best Practices Call |
12 COO, HR Directors Joint Roundtable |
13 |
14/15 |
| 16 |
17 |
18 |
19 |
20 |
21/22 |
| 23 |
24 |
25 |
26 Quality/Disease Management Roundtable |
27 |
28/29 |
| 30 Memorial Day |
31 |
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June Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2 |
3 |
4/5 |
| 6 |
7 |
8 CFO Roundtable |
9 |
10 |
11/12 |
| 13 Medicaid Managed Care Conference |
14 Medicaid Managed Care Conference |
15 Medicaid Managed Care Conference |
16 |
17 |
18/19 |
| 20 |
21 |
22 CIO Roundtable ACAP Policy and Advocacy Day |
23 ACAP Congressional Briefing |
24 |
25/26 |
| 27 |
28 Provider Relations Roundtable |
29 |
30 |
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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 |