 May 27, 2005 |
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Upcoming ACAP Calls
June 2: Program Committee June 8: CFO Roundtable June 9: Executive Committee June 21: ACAP Safety Net Task Force June 29: CIO Roundtable June 30: Best Practices
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
AlohaCare's McComas Featured in Managed Healthcare Executive The May 1st cover story in Managed Healthcare Executive featured the CEOs of Hawaii's health plans, including AlohaCare's CEO John McComas. In "Island Investment," author Michael McCue reported on the particular challenges faced by a health plan in an island community, such as the lack of infrastructure to manage rare diseases and injury trauma, as well as the benefits, like the stable nature of the health plan's membership. One common point that McComas and the other CEOs featured in the cover story shared was the need for flexible, efficient technologies. In addition to being expensive to get a patient from one island to another to see a specialist, they noted that it is also very time-consuming for both the plan and the member. The piece specifically focused on McComas' leadership in building AlohaCare's specialty network and the plans' commitment to building a community for the island population that meets their specific cultural desires and physical needs. In 2003 AlohaCare-which was founded by ten community health centers and currently has 50,000 members-launched a new effort to recruit and retain specialty physicians that could address the island community's unique challenges, particularly for a Medicaid-exclusive health plan like AlohaCare. Managed Healthcare Executive quote McComas saying, ""Most physicians participated with AlohaCare out of a sense of community service and not as a business decision. We needed to recognize and acknowledge them for that. It ignited a paradigm shift for us." The result was "Thanks, Doc!"-AlohaCare's campaign that included a new TV commercial and a series of physician-appreciation events. McComas went on to tell the magazine, "As soon as the TV spot aired, we were overwhelmed by the volume of positive feedback. 'Thanks, Doc!' was a message that resonated intimately with our physicians." The complete article can be viewed at: http://www.managedhealthcareexecutive.com/mhe/article/articleDetail.jsp?id=159384&&pageID=3 Chapin Editorial on Expanding Medicaid Managed Care The Middletown Times Herald Record recently published an editorial penned by Georganne Chapin, President and CEO of Hudson Health Plan, an ACAP member plan. In "Expanded Managed Care Makes Medicaid Better," (May 16, 2005) Chapin makes the case that more Medicaid managed care (MMC) can help address the burgeoning costs and challenges associated with access and quality in the safety net program. Although Chapin notes that MMC is not the cure for all the program's challenges, she states that MMC "is an important first step toward a health care system that promotes preventive care, eliminates waste, and ensures the financial viability of the state's hospitals, community health centers, mental health services and many private doctors." In the editorial, Chapin questions the proposal by New York Governor Pataki that would cut $1.5 billion from Medicaid and the Family Health Plus programs. She goes on to describe the negative impact such a dramatic cut would have and the wisdom of pursuing this instead of first attempting to expand managed care that has proven so successful in New York state. The complete article can be found at: http://www.recordonline.com/archive/2005/05/16/16myview.htm CareSource Wins Two Ohio Health Care Awards This month CareSource, Ohio's largest Medicaid managed health care plan and a member of ACAP, won two Meritorious Awards for 2005 from the Ohio Association of Health Plans. In a statement following the announcement, CareSource President and CEO Pamela B. Morris said, "We are thrilled to receive these two Meritorious Awards… The programs that were recognized are just two examples of how CareSource exemplifies best practices among managed care plans in the state." In the category of Community Outreach and Partnership, CareSource won for its Consumer Council program. CareSource has five Consumer Councils made up of health plan members, community agencies that serve the Medicaid population, and CareSource staff. The object is to better understand the issues CareSource members face and to generate ideas for how to serve members better. Feedback from the Consumer Councils has led to changes in several CareSource policies and procedures. CareSource also won in the category of Business and Operational Performance for its Medical Management department's use of the electronic fax. E-fax has streamlined the work of the department by allowing it to direct faxes to the appropriate staff member through e-mail. All faxes are confirmed, and lost faxes can be traced. E-fax also allows staff members to copy and paste information into the company database. This technology has reduced the amount of time the Medical Management department spends on each case by an average of 10 percent. Network Health Takes Home 7 Health Care Awards Network Health recently won seven awards from two nationally recognized health care marketing publications, Healthcare Marketing Report and Marketing Healthcare Today. The awards recognized Network Health's marketing materials, including the "Grow Healthy Together" calendar for mothers-to-be; the plan's member handbook; its Web site (www.networkhealth.org); and the "Everyone Deserves Care this Good" video. Marketing Healthcare Today's Gold Aster Award, given for excellence in medical marketing, was awarded for Network Health's 2004 Year in Review.  |
| PUBLIC POLICY AND ADVOCACY |
HHS Secretary Releases Details for Medicaid Commission On Friday, May 20, HHS Secretary Leavitt officially published details and the process for creating a Medicaid Commission. The commission is required to submit two reports to the Secretary. The first will provide recommendations for $10 billion in "savings" to the Medicaid program and is due by September 1st. The second report is due December 2006 and will include recommendations for the long-term sustainability of Medicaid. The Secretary will be appointing up to 15 voting members, including:
ACAP to Host Congressional Briefing
ACAP Endorses Legislation to "Cover More Kids"On June 23rd, ACAP will release a new report produced by the National Academy for State Health Policy titled, "Medicaid Managed Care: Looking Forward, Looking Back," at a briefing for staff on Capitol Hill. The briefing follows ACAP's Policy and Advocacy Conference on June 22nd. Senate Majority Leader Bill Frist (R-Tenn.) and Sen. Jeff Bingaman (D-N.M.) recently introduced a bill (S. 1049) that would allow the U.S. Department of Health and Human Services to provide $100 million in grants over two years to states, local communities, schools, faith-based organizations and others to help enroll eligible children in Medicaid or SCHIP. The grants would be awarded to organizations with "innovative" outreach and enrollment programs for uninsured children. In addition, the bill would allow states to use information from other public assistance programs to determine whether applicants qualify for Medicaid or SCHIP. ACAP has endorsed the "Covering the Kids" legislation and is encouraging plans to contact their Senators to urge them to cosponsor the legislation. There is broad support among members of Congress for expanding outreach efforts and President Bush also has spoken of the need to ensure that all eligible children are enrolled in Medicaid or SCHIP. Still, the task of members of Congress to find $10 billion in "savings" in the Medicaid program will likely crowd out efforts to devote additional funding to expand enrollment and outreach, at least in the foreseeable future. ACAP's letter of support can be found at: http://www.ahcahp.org/pandl/05policy_positions.asp ACAP Endorses FMAP Legislation Senator Jeff Bingaman (D-NM) recently introduced legislation, "The Medicaid Fairness Act of 2005" that would minimize the impact of the fluctuations in the Federal Medical Assistance Program (FMAP) funding formula. ACAP has endorsed the bill which was developed in response to changes made in the way the FMAP calculation is made and how the Centers for Medicare and Medicaid Services has applied this new formula. The change is anticipated to adversely affect 29 states which are on scheduled to receive a decrease in their FMAP for fiscal year 2006 by total estimated at $860 billion. According to Sen. Bingaman's office, this legislation would restore $442 million of the lost Medicaid dollars to 18 states, including one ACAP plan state -- Rhode Island. In its letter of endorsement, ACAP stated that diminished state funding could undermine access to high quality care and force Medicaid focused health plans, such as those that belong to ACAP, to restrain investments in care, technology, and new programs that they otherwise would make. Medicaid-focused managed care plans need the guarantee that their state will have adequate funding available so that plans can continue to provide access to high quality care for Medicaid beneficiaries. ACAP's letter of support can be found at: http://www.ahcahp.org/pandl/05policy_positions.asp |
| EXCELLENCE AND ACCOUNTABILITY |
June 29 CIO Roundtable 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).
Reminder
June 30th Best Practices Call "Improving Encounter Data Collection"CIO Roundtable changed from June 22 to June 29. The call is at 3 pm Eastern time and the topic of the call is "predictive modeling." ACAP will host a Best Practices call on June 30th at 2 pm Eastern time (Note the time is different from the usual schedule—1 pm Central, 12 pm Mountain, 11 am Pacific, 8 am Hawaii). Gary Feldbau, MD, Medical Director, and Marsha Simmons, Clinic Process Consultant/Senior Project Manager, of Community Health Plan of Washington will discuss CHPW's ongoing initiatives to improve encounter data collection across its provider network. After working with consultants to identify key issues arising from clinic audits and physician interviews, CHPW developed a multi-faceted program to identify and resolve encounter data reporting problems. Plan staff work clinic by clinic to address specific challenges and to improve accuracy and timeliness of encounter data submission. For more information visit the ACAP website at http://www.ahcahp.org/bppo/confcalls.asp or contact Peggy Oehlmann at poehlmann@communityplans.net Customer Service Roundtable On May17, 2005, ACAP Customer Service Directors discussed grievance/complaint/appeals structures across ACAP Plans. The plans compared definitions of complaints/grievances/appeals as well as statistics on the number of grievances reported and the number of staff designated to grievances/appeals departments. While much of the discussion focused on member grievance issues, AlohaCare discussed its successful initiative to educate provider practices on proper coding as a strategy to reduce billing grievances. Quality Management/Disease Management Directors Roundtable On May 26, 2005, ACAP Quality Management/Disease Management Directors discussed disease management initiatives and best practices for serving members with asthma. ACAP plans on the call discussed their various case management programs. All the plans on the call do telephonic case management intervention for members with severe and persistent asthma. Some ACAP plans either contract with vendors to do home assessments or have plan staff conduct home assessments. One plan trains provider practices to do asthma education. The plans also work with community entities or federal initiatives such as Healthy Homes to do environmental assessments of asthma triggers. |
| FUNDING OPPORTUNITIES & NEWS |
Call for Proposals: Medicaid Value Program The Center for Health Care Strategies (CHCS) has issued a call for proposals for its Medicaid Value Program: Health Supports for Consumers with Chronic Conditions. Successful applicants will participate in an 18-month initiative to improve the quality of care for adult Medicaid consumers with multiple chronic conditions. The application deadline is June 17, 2005. For more information visit: http://www.chcs.org/info-url3964/info-url_list.htm?cat_id=628 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/ |
| NEWSFLASH |
Coverage Expansion Bill Awaits CO Governor's Signature Several bills that would expand health coverage have passed the State Legislature and are now awaiting action by Colorado Gov. Bill Owens (R). Gov. Owens is expected to sign into law a bill (HB 1262) that would use revenue from an increase in cigarette taxes to raise income-eligibility levels to provide public health insurance to an additional 90,000 low-income families. The tax is expected to generate $172 million annually. A portion of the money would be used to fund clinics that provide health care to the uninsured. The tobacco tax revenue also would be used to provide home care and therapy for about 600 children with disabilities or chronic illnesses who currently are on a waiting list. And the bill would make available funds to provide Medicaid coverage to undocumented immigrants. IL Receives Recommendation on MMC The Illinois Commission on Government Forecasting and Accountability recently released a report on the State's options to expand Medicaid managed care. The report, produced by The Lewin Group, notes that Illinois is far behind other states in implementing MMC and goes on to evaluate a variety of models of MMC by eligibility group and geographic area. Lewin also provides recommendations as to the approaches the authors believe should be taken based on their analytical findings. The state could save nearly $200 million in the first year of full implementation of the recommendations. The recommendations to elected officials included the immediate development of a mandatory enrollment capitated program in an area that would collectively encompass 19 counties where all non-Medicare and non-spend-down Medicaid recipients would be enrolled. The full report can be accessed on The Lewin Group's Web site. National Coalition on Health Care This week the National Coalition on Health Care called on Congress and the President to prioritize health care reform. The group, comprised of a group of 150 business, labor, health care, pension and religious organizations representing 150 million U.S. residents, said what is needed is the establishment of a universal health care system over the next five years. Coalition President Henry Simmons told Members of Congress that according to their economic projections, universal health care could save the federal government about $125 billion annually by 2015. More information about the Coalition's studies and initiatives can be found at: http://www.nchc.org/ "Princeton Conference" Brings Health Policy Experts Together on the Uninsured This month, a proposal released during the 12th annual "Princeton Conference" served as the discussion piece for how to address the issue of the uninsured. The proposal, developed by Stuart Butler of the Heritage Foundation and Henry Aaron of the Brookings Institution, was designed to offer states a range of options that would let them test out proposals such as "single payer" or tax credits. The proposal calls for rewards for states that demonstrate improved coverage numbers. Although the proposals' authors embraced the concept of leaving the decision to states on whether they wish to test out new programs, others such as Alan Weil, executive director of the National Academy for State Health Policy, disagreed. Weil told the group of health policymakers, congressional staff, and researchers that it would not be good health policy to leave such critical decision entirely up to states. He noted that covering the uninsured mostly involves redistribution of income-a responsibility that the federal government should undertake. |
| JOBS |
San Francisco Health Plan Seeks CFO SFHP is seeking a Chief Financial Officer. The Chief Financial Officer provides leadership and oversight for the financial and accounting policies and practices of the Plan, and actively participates in the strategic and tactical planning process by providing analysis and business acumen. The CFO studies and interprets trends, projects financial needs, and recommends courses of action. The ideal candidate will have a CPA or Masters Degree in Finance, Business or related field required; knowledge of accounting principles, including GAAP and government accounting standards; knowledge of health care financing required, with preference for knowledge of Medi-Cal Managed Care and SCHIP programs. For more information go to http://www.communityplans.net/jobs/jobs.asp Maryland Seeks Deputy Director - Medicaid Eligibility Policy The Maryland Department of Health & Mental Hygiene is accepting applications for the position of Deputy Director - Medicaid Eligibility Policy. The position is responsible for the review, interpretation, and implementation of Medicaid Federal and State laws, policies, regulations, and procedures. This supervisory position is responsible for assisting in the management of four important Medicaid eligibility divisions -- Eligibility Services, Eligibility Training & Local Operations, Maryland Children’s Health Program, and the Systems Interface Unit. For more information go to http://www.communityplans.net/jobs/jobs.asp Maryland Department of Health & Mental Hygiene Seeks Policy Analysts The Maryland Department of Health & Mental Hygiene, Office of Planning and Finance, is accepting applications for three (3) full-time permanent Health Policy Analyst Advanced positions. These positions perform advanced/expert professional level work in the Planning Administration. Primary responsibilities include program planning & evaluation related to developing & implementing long term & acute care initiatives; analyzing State and Federal legislative initiatives; and communicating with stakeholders. Applicants should have a bachelor’s degree & three years experience evaluating, analyzing, researching & developing health care services polices & programs. A master’s degree (preferred) in health sciences, health care administration, public health, public policy or closely related field will substitute for one year of experience, a doctorate for two. For more information go to http://www.communityplans.net/jobs/jobs.asp |
| Upcoming Events |
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 Meeting |
22 ACAP Policy and Advocacy Day |
23 ACAP Congressional Briefing |
24 |
25/26 |
| 27 |
28 Provider Relations Roundtable |
29 CIO Roundtable |
30 Best Practices Call |
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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 |