 May 13, 2005 |
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Upcoming ACAP Calls
May 17: Customer Services Roundtable May 18: Safety Net Task Force May 26: Quality/Disease Management Roundtable June 2: Program Committee June 8: CFO Roundtable June 9: Executive Committee June 21: ACAP Safety Net Task Force June 29: CIO Roundtable
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
RI Congressman, EPA Laud NHPRI for Asthma Program This month the Environmental Protection Agency recognized Neighborhood Health Plan of RI as one of four national leaders in addressing environmental trigger management. In its announcement the EPA stated it was "highly impressed" with NHPRI's asthma management program and "plans to highlight Neighborhood's efforts in upcoming asthma education and outreach materials." The award is given to health plans for its demonstrated leadership in addressing environmental management and triggers as part of their comprehensive asthma management programs. NHPRI's asthma management program helps members with persistent asthma to better manage their asthma. Its program has resulted in decreased emergency room use and inpatient hospitalizations for asthma. The key features of the program include:
ACAP Urged Secretary to Create Independent Medicaid Commission In advance of the announcement on the creation of the Medicaid advisory panel (see “HHS Secretary Announces Medicaid Commission Process”), ACAP sent a letter to Health and Human Services Secretary Mike Leavitt thanking him for the Administration’s agreement to create a Medicaid Commission. ACAP went on to share its concerns and thoughts on such a Commission and asked the Secretary to ensure that the Commission is credible, fair, and balanced. ACAP noted its support for conducting such a Commission through the Institutes of Medicine (IOM), which could help to ensure that the Commission is unencumbered in its deliberations and recommendations. The letter also urged the Secretary to consider the important role of Medicaid-focused plans in improving access and raising the standards on quality health care for those that are covered by Medicaid. ACAP’s letter can be viewed at: http://www.ahcahp.org/pandl/05policy_positions.asp Safety Net Task Force Call for ACAP Plans The first call for ACAP's Safety Net Task Force will be held on Wednesday May 18th at 3pm EDT. CEOs wishing to participate in the Task Force are invited to join this call. The Task Force will address ways to better define the reinvestment ACAP plans make in their communities in order to protect the Medicaid program and the MMC business, and specifically the niche that ACAP plans have in this marketplace. Please contact Meg Murray or Andrea Maresca at 202.331.4600 for more information.
Reminder ACAP Policy and Advocacy Conference
June 23: ACAP to Host Congressional Briefing on MMC Trends 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. More information is available at: http://www.communityplans.net On Thursday, June 23rd at 8:30 am, ACAP will host a Congressional briefing for Capitol Hill staff. The purpose of the briefing is to release a new study examining the trends in the scope and operations of state Medicaid managed care programs. ACAP funded the National Academy for State Health Policy (NASHP) to analyze the data NASHP collected in its 2002 survey to produce the sixth edition of the Medicaid Managed Care Guide. This series of surveys forms the most detailed and accurate, historical database available on Medicaid managed care. ACAP believes this will provide critical information for policymakers as they consider how to strengthen this safety net program. The study examines Medicaid managed care program policies, including the following topics:
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| PUBLIC POLICY AND ADVOCACY |
HHS Secretary Announces Medicaid Commission Process On Wednesday, June 11 HHS Secretary Leavitt announced the Administration's plans for creating a Medicaid advisory panel. According to a report in the New York Times, the panel has a September 1st deadline to recommend how to find the $10 billion in "savings" included in the FY2006 Budget Resolution and December 31st target for making "longer-term recommendations on the future of the Medicaid program." ("New Panel Will Study Medicaid with Eyes for Big Change," NYT 5/12/05) Secretary Leavitt rejected bipartisan Congressional requests to have an independent commission conducted by the Institutes of Medicine (IOM); instead the Secretary will appoint the voting members. The commission will have up to 15 voting members and 18 nonvoting members. It will address 10 questions, such as "Should eligibility, benefits and financing structures for three broad categories of beneficiaries - including mothers and children, individuals with disabilities and the elderly - be modified?" The voting members will include
Members of Congress Express Views on Medicaid Commission Prior to Secretary Leavitt's announcement, a bipartisan group of 13 Senators, including 7 Republicans, sent a letter to the Secretary requesting that the Institutes of Medicine (IOM) be charged with the responsibility for conducting the Medicaid Commission. In their letter, the Senators stated, "We believe this [IOM] is the best way to ensure that the Administration and Congress receive credible, long-range recommendations on how to improve coverage and access." Also this week, Senator Max Baucus (D-MT), Ranking Member on the Senate Finance Committee, and Congressman John Dingell (D-MI), Ranking Member on the House Energy and Commerce Committee, contacted Secretary Leavitt expressing opposition to cuts. They opposed a Presidential Commission that would be tasked solely with identifying how to find $10 billion in cuts in the Medicaid program, much like the one that the Secretary ultimately approved. The bicameral letter emphasized that Medicaid is not the source of the problems for the budget or the health care system. Congress Moves Closer to Passing Navigator System for Uninsured Patients Last week the House Energy and Commerce Committee approved the "Patient Navigator" bill (H.R. 1812), moving Congress one step closer to enacting legislation that would help uninsured patients with chronic illnesses make medical decisions. The bill calls for $25 million in grants to establish patient navigator programs in low-income and rural communities nationwide. The navigator system would assist uninsured patients evaluate their treatment options, find referrals, find clinical trials and apply for financial assistance. In April the Senate Health, Education, Labor and Pensions (HELP) Committee passed a similar bill (S 898). ACAP will continue to track this bill makes it way to the President's desk for signature. FMAP Legislation Introduced, Impact for ACAP Member This week a bipartisan group of 7 Senators introduced the "Medicaid Formula Fairness Act of 2005" (S.1007). The legislation seeks to protect 28 states from negative changes to the amount of federal funding they can expect to receive in FY 2006 from the Medicaid program. In calculating the Federal Medical Assistance Percentage (FMAP) for FY 2006, CMS used the Per Capital Income (PCI) data from the years 2001, 2002, and 2003. However, this year the method for calculating the PCI in 2003 was revised and the new method was also used to revise data for previous years. As a result, CMS changed the 2001 and 2002 PCI data for states in the FY2006 FMAP calculation. This in turn resulted in a decline in the FMAP for FY2006 for 29 states and will cost them an estimated $860 million. One ACAP plan is located in an affected state—Neighborhood Health Plan of Rhode Island. The FY2006 reduction means that Rhode Island will experience three consecutive reductions—from the base FMAP in FY 2004 to a second reduction in FY 2005 and a third in FY 2006. ACAP members can find more information on the Medicaid Formula Fairness Act under Members' Only, Action Alerts at: http://www.communityplans.net/members/login.asp |
| EXCELLENCE AND ACCOUNTABILITY |
May 17 Customer Service Roundtable After the first Customer Service call in December, plan staff expressed an interest in regularly scheduled Customer Service calls. The next scheduled Customer Service Roundtable is Tuesday May 17 at 3 pm EDT (2 pm Central, 1 pm Mountain, 12 pm Pacific, 9 am Hawaii). The topic of the call is grievance/complaint/appeals structures. There will be some time at the end of the call for discussion of benchmarks and whether customer service staff would be interested in collecting this data. The following questions will be posed for discussion:
Staff Roundtables
June 29 CIO Roundtable Are you implementing a new system or program? Are you interested in what other plans are doing in this area? If so, please contact Peggy Oehlmann poehlmann@communityplans.net. On June 29, ACAP will host a CIO Roundtable on "Predictive Modeling." Representatives from plans will discuss the predictive modeling programs implemented by their plans including the pros and cons of the programs available. Please contact Peggy Oehlmann at poehlmann@communityplans.net if there are other topics you would like to add to the agenda. The call will begin at 3 pm EST (2 pm CST, 1 pm MST, 12 pm PST, 10 am Hawaii). Recap: Roundtable on Culturally Appropriate Marketing Materials On May 3, 2005, ACAP Marketing Directors met to discuss development and use of culturally appropriate materials. NHPRI shared some of the materials they have developed under their Hablamos Juntos grant from RWJF. One issue that arose was the differences between Spanish dialects and how a plan's population of Spanish speakers and their understanding of translated documents can vary. A document translated mainly for those of Mexican-American descent may not make much sense to someone from the Dominican Republic. It is important that plans work with a translator familiar with their dominant populations. The plans also talked about the importance of having materials written in the original language to begin with and not simply translated from English. The next Marketing Directors call is on September 13, 2005. Recap: CHCS Asthma Benchmarks Project On May 4, 2005, Jane Deane Clark of CHCS discussed an asthma benchmarking opportunity with ACAP Medical Directors and Quality Managers. As part of its collaborative quality improvement projects on asthma, CHCS has begun collecting standardized asthma benchmarks from health plans in New York and California. These benchmarks are based on HEDIS specifications, but modified slightly to reflect the complexity of the Medicaid population. Given ACAP plan interest in benchmarking opportunities, CHCS and ACAP encourage ACAP plans to submit their asthma data to CHCS to be included in the benchmarking analysis. If your health plan was unable to participate in the project, please contact Peggy Oehlmann at poehlmann@communityplans.net for more details on the project. Recap: Best Practices Call on CAHPS Data On May 11, 2005, Lisa Franchetti, Quality Management Project Coordinator, at Neighborhood Health Plan of Rhode Island discussed NHPRI's reasons for conducting an independent CAHPS survey. While many health plans participate in CAHPS via their state survey of Medicaid enrollees, a few ACAP plans conduct independent CAHPS surveys each year. NHPRI is able to add questions relevant to the needs of its members, analyze complete survey results, and implement changes to improve customer satisfaction in a timely manner. As a result of asking customized questions about which provider sites survey respondents went to, NHPRI was able to sort its CAHPS results by provider type and found differences across and within CHCs, hospital-based sites, and private practices. They then used this data in discussions with provider sites to encourage practice site improvement. Recap: HR Roundtable on Rewards Programs On Thursday, May 12, ACAP Human Resources Directors and staff held a roundtable to discuss employee recognition programs. Ann Van Etten of Affinity Health Plan led the discussion and focused on her plan's desire to move to the next level of recognition programs. Specifically, Affinity is currently evaluating web-based recognition tools that the plan could tailor for different behaviors across the various departments. Several other plans discussed their recognition programs but Affinity is the first to consider a completely web based program. A resource for plans' recognition programs can be found on the Members' Only section of the ACAP website under Plan Documents at: http://www.communityplans.net/members/login.asp. For more information or ideas that you would like discussed on future HR calls, please contact Peggy Oehlmann at poehlmann@communityplans.net |
| FUNDING OPPORTUNITIES & NEWS |
RWJ Community Health Leadership Program The Robert Wood Johnson Community Health Leadership Program (CHLP) has issued a request for letters of intent. The program honors outstanding individuals who overcome daunting odds to expand access to health care and social services to underserved and isolated populations in communities across the United States. The program's goal is to elevate the work of its leaders through financial support, opportunities for growth and networking, and assistance raising awareness of their contributions. The award is $120,000, with $105,000 in support of the leader's program and $15,000 as a personal stipend. Ten awards are made each year. The deadline is September 22, 2005. More information is available at: http://www.communityhealthleaders.org/ Colorado Foundation Seeks Applications for Oral Health Improvement Program The Caring for Colorado Foundation began a 5-year, $5 million dollar Oral Health Improvement Program in 2002. The Foundation is currently requesting proposals from community-based nonprofit or governmental agencies for the fourth year of the Oral Health Improvement Project. The purpose of the project is to positively impact oral health in Colorado and to begin to address the oral health needs of the underserved, the foundation began. The deadline for applications is July 1, 2005. More information is available at: http://www.caringforcolorado.org/published.php BCBS of Mass Foundation Announces Grants to Address Racial & Ethnic Healthcare Disparities The Blue Cross Blue Shield of Massachusetts Foundation has announced that it will provide three-year grants to nonprofit organizations to reduce racial and ethnic healthcare disparities in communities in Massachusetts. The grants will be awarded to support initiatives that take a comprehensive and innovative approach to improving access and reducing barriers to quality healthcare and support services for targeted racial and ethnic groups experiencing specific health disparities. The deadline for letters of inquiry is June 3, 2005. For more information go to: http://www.bcbsmafoundation.org/foundationroot/index.jsp |
| NEWSFLASH |
HHS Secretary Calls for Investment in IT This week HHS Secretary Leavitt issued a new report, "Health Information Technology Leadership Panel: Final Report," The report emphasizes investment in information technology (IT) as an essential, high priority for the American health care system and the economy. During the release of the report, Secretary Leavitt stated, "Information technology is a pivotal part of transforming our health care system... Working in close collaboration, the federal government and private sector can drive changes that will lead to fewer medical errors, lower costs, less hassle and better care." The report was released at the Business Roundtable's Chief Executive Officer Health Care Summit. In remarks to attendees, Secretary Leavitt and Treasury Secretary John Snow discussed the burden of rising health care costs on the U.S. economy and global competitiveness and the role of health IT in managing these costs. The panel, convened by The Lewin Group, identified three key imperatives for health IT:
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, and Pat Curran from CareOregon 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 plan staff who are attending on June 14 and would like to have dinner with other ACAP plan staff, please let Meg Murray know at 202.331.4601. 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 Bipartisan IT Health Legislation Introduced This week Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA) introduced the 21st Century Health Information Act (HR 2234). Senator Hillary Clinton (D-NY) is working on introducing a similar bill with Senate Majority Leader Frist (R-TN). The purpose of the bill is to replace the current paperwork system with secure, confidential electronic health information networks. The bill's supporters believe this will ultimately save lives and money by eliminating preventable medical errors, reducing unnecessary duplication of testing, and enhancing patients' health care experience. The bill takes a regional approach by convening providers, patients, health plans, employers, and other health care stakeholders locally to address three issues:
Florida Medicaid Overhaul Legislation Moves Forward Last week the Florida Assembly took one more step towards enacting legislation that would restructure the state's Medicaid system. On Friday, May 6, the Florida House passed a bill under which the state would pay an amount per Medicaid beneficiary based on a person's health needs to an HMO or other health plan, which would have discretion over how to treat the beneficiary. Florida Gov. Jeb Bush and legislative leaders on Friday reached a deal whereby only a few counties would implement the changes initially. In exchange, Gov. Bush secured a commitment from legislators for the second phase: statewide implementation. The bill now moves to Gov. Bush and the federal government also must approve the proposal before it can take effect. Report Finds Medicaid Enrollees Unable to Afford Prescriptions A new study from the Center for Studying Health System Change found that more than one-fifth of all adult Medicaid enrollees (22%) in 2003 reported they could not afford to get at least one prescription filled in the previous year. The study, published in the May/June edition of the journal Health Affairs, found that the prescription drug access problems experienced by Medicaid beneficiaries are comparable to the uninsured-22% vs. 26%. However, only about 9% of adults with employer-sponsored health coverage said they were unable to afford a prescription. The report noted that the proportion of Medicaid enrollees living in states with four or five cost-containment policies increased between 2001 and 2003 from 16% to 62%. Although states have taken more steps to control rising Medicaid drug spending in recent years, the proportion of Medicaid beneficiaries reporting they couldn't afford prescription drugs remained unchanged between 2001 and 2003. The authors of the study suggest that one reason that there was no change in the proportion of enrollees that couldn't afford prescriptions was because health care providers and Medicaid patients became more knowledgeable about how the policies worked and were better able to navigate the system to get needed prescription drugs. They also suggest that states may have gained more experience in using cost-containment policies, which may have reduced access problems. For more information about the study go to: http://www.hschange.org/CONTENT/741/ |
| JOBS |
HealthRight Seeks Health Care Program Analyst
To post a job in ACAP's newsletter and website please contact Andrea at 202.331.4600 or amaresca@communityplans.net
Health Right, Inc. a Medicaid Managed Care Organization based in Washington, DC seeks a Health Care Program Analyst to work closely with Senior Management team to assist with the development of organizational policies and other health related programs. Specifically, the Analyst will assist with the development of targeted health programs as well as the monitoring tools required to evaluate said programs. Applicants should have a graduate degree in public policy, public administration, public health or related field. The position requires a person with strong skills in quantitative methods and data analysis. |
| 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 Customer Services Roundtable |
18 Safety Net Task Force Call |
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 Program Committee Call |
3 |
4/5 |
| 6 |
7 |
8 CFO Roundtable |
9 Executive Committee Call |
10 |
11/12 |
| 13 Medicaid Managed Care Conference |
14 Medicaid Managed Care Conference |
15 Medicaid Managed Care Conference |
16 |
17 |
18/19 |
| 20 |
21 ACAP Safety Net Task Force Call |
22 ACAP Policy and Advocacy Day |
23 ACAP Congressional Briefing |
24 |
25/26 |
| 27 |
28 Provider Relations Roundtable |
29 CIO Roundtable |
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 |