 July 1, 2005 |
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Upcoming ACAP Calls
July 13: Chief Medical Officers & Medical Directors Roundtable July 19: Compliance Officers Roundtable July 26: Pharmacy Directors Roundtable July 27: ACAP Board Quality Management Committee
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
NGA Endorses ACAP Drug Rebate Proposal The National Governors Association released a preliminary report on Medicaid reform which endorsed ACAP's proposal to allow plans to have access to the Medicaid drug rebate. Under the federal drug rebate, States receive between 18 and 20% discount on brand name drug prices and between 10 and 11% for generic drug prices. According to a study by the Lewin Group, Medicaid-focused MCOs typically only receive about a 6% discount on brand name drugs and no discount on generics. Because many MCOs (particularly smaller Medicaid-focused MCOs) do not have the capacity to negotiate deeper discounts with drug companies, Medicaid is overpaying for prescription drugs for enrollees in Medicaid health plans. The Lewin Group estimated that this proposal could save the federal and state governments and plans up to $2 billion over 10 years. This legislation has been endorsed by organizations representing both state government and the managed care industry, including the National Association of State Medicaid Directors, the Association for Community Affiliated Plans, Medicaid Health Plans of America, the National Association of Community Health Centers, and now, the National Governors Association. ACAP and NASHP Release Survey of Medicaid Managed Care On June 23rd at a Capital Hill briefing, ACAP and the National Academy of State Health Policy released a major new report—Medicaid Managed Care: Looking Forward, Looking Back—which tracks changes and trends in Medicaid managed care between 1990 and 2002. The report is based on six NASHP surveys of state Medicaid managed care programs (conducted in 1990, 1994, 1996, 1998, 2000, and 2002). The surveys gathered information on the scope and operation of both risk and primary care case management programs. The report also looks ahead and includes a discussion with state officials of trends that may continue and factors that may impact the future of Medicaid managed care. Among the report's key findings:
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| PUBLIC POLICY AND ADVOCACY |
ACAP Policy and Advocacy Day On June 22 ACAP hosted over 70 senior level representatives of Medicaid-focused health plans for its first Policy and Advocacy Day. The CEOs represented over 50 Medicaid-focused health plans and 5 million beneficiaries. The attendees heard from representatives of the Congress, Administration, State Medicaid agencies, and Governors. Several health plans also discussed how they are working with their states to improve the Medicaid program through state level a Medicaid Commission or encouraging the state to use managed care plans in innovative ways, such as for providing long-term care services or acting as facilitated enrollment brokers. The presentations of the speakers are available on the ACAP website. At the end of the conference, the CEOs discussed the need to come together periodically for discussions on what is happening with Medicaid managed care nationally and how the plans can affect that. ACAP will host periodic conference calls to facilitate these discussions. The CEOs also asked for a clearinghouse of reports on Medicaid managed care. ACAP has such a bibliography on its website. ACAP will also work with the other Medicaid Managed Care associations to draft a report on the savings to be had if the states enrolled the remaining families and children into Medicaid managed care as a way to improve quality and access and control the Medicaid budget. ACAP Presents at State of Industry Press Briefing Meg Murray, Executive Director of ACAP, spoke at June 29th briefing on the state of the Medicaid managed care industry at the National Press Club. She discussed the recent trends in the industry including the growing level of capitated managed care enrollees compared to PCCM enrollees and the high number of states which currently enroll the SSI population into managed care. The briefing was sponsored by the Medicaid Health Plans of America and also included America's Health Insurance Plans. House and Senate Hold Multiple Hearings on Medicaid Recognizing the pending deadline for action to reduce spending in the Medicaid program, the House and Senate have been active the past couple of weeks, holding multiple hearings on the health program for poor and medically needy Americans. The Senate Finance and House Energy and Commerce Committees held back to back hearings on June 15th to examine the National Governors Association's newly released Medicaid reform proposals (which included ACAP's drug rebate proposal). On June 22nd, the Energy and Commerce Committee held a hearing on prescription drug and pharmacy payments in Medicaid. On June 28 and 29th, the Senate Finance Committee held a hearing on "fraud and abuse" in Medicaid, focusing on Intergovernmental Transfers (IGTs), prescription drug payments, and assets transfers. Finally, the Senate Special Committee on Aging (chaired by strong Medicaid supporter Gordon Smith (R-OR)) held a hearing entitled "Mandatory or Optional? The Truth about Medicaid," the first in a year-long series of hearings in the Aging Committee intended to help inform and educate members about the Medicaid program. In an effort to raise Congressional awareness of ACAP and our proposal to provide the Medicaid drug rebate to Medicaid health plans, ACAP has submitted testimony to each of the Committees touting the importance of Medicaid health plans to beneficiaries and their State partners. These statements will become part of the permanent record of the hearings and will be available for review by Congress and the public. You can download copies of ACAP's statements for the record from ACAP's website. |
| EXCELLENCE AND ACCOUNTABILITY |
Recap: CIO Roundtable On June 29, CIOs met to discuss upcoming proposed health information technology legislation. Chris Koppen, ACAP's lobbyist, gave an overview of recent federal proposals related to information technology. Several ACAP CIOs volunteered to work on an ad hoc committee to identify areas of opportunity for IT infrastructure improvement that would improve the interaction of safety net plans and providers. The CIOs also discussed predictive modeling programs. Marilyn Daly @ NHP, Howard Brill @ Monroe, and Gretchen McGinnis @ Colorado Access each discussed their respective predictive modeling programs. Recap: Best Practices Call on Reviewing Data Flow to Improve Quality and Maximize Revenue On June 30, Gary Feldbau, MD, Medical Director, and Marsha Simmons, Clinic Process Consultant/Senior Project Manager, of Community Health Plan of Washington discussed 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. They developed a best practices toolkit that was distributed to clinic staff to improve clinic understanding of CHPW's encounter data submission policies and procedures. Recap: Provider Relations Roundtable On June 30, Provider Relations Directors discussed Provider Evaluation and reviewed a tool developed by Community Health Plan of Washington. The tool is posted in the Provider Relations section of our website (within Members Only, under Staff Roundtables) and measures providers on the following criteria: Access to Care, Quality of Care, Courtesy, and Data Quality. Provider Relations Directors also discussed Provider Satisfaction surveys and compared survey templates from several ACAP plans. Reminder: Chief Medical Officers Roundtable Our next CMO call is scheduled for July 13 at 3 pm Eastern time. On this call we will briefly discuss upcoming federal health information technology legislation and ask CMOs for suggestions on improvements to the medical information exchange between plans and safety net providers. After this brief discussion, the focus of the call will be on behavioral health issues. ACAP medical directors will have an opportunity to compare carve-outs, vendor relationships, and efforts to integrate behavioral health care with physical health comorbidities. Reminder: Compliance Officers Roundtable Our next Compliance Officers Roundtable is July 19 at 3 pm Eastern time. Topics and an agenda will be circulated prior to the call. Please contact Peggy Oehlmann at poehlmann@communityplans.net with questions or agenda items. Reminder: Pharmacy Directors Roundtable Our Next Pharmacy Directors Roundtable is July 26 at 3 pm Eastern time. Topics and an agenda will be circulated prior to the call. Please contact Peggy Oehlmann at poehlmann@communityplans.net with questions or agenda items. |
| NEWSFLASH |
Reminder: Deadline for National CAHPS Benchmarking Database (NCBD) CAHPS Comparison For 2005 the National CAHPS Benchmarking Database (NCBD) will again compile ACAP specific CAHPS data but they need permission from each health plan or sponsoring state agency to do so. Most ACAP plans' 2005 CAHPS data was submitted via their state Medicaid agencies, so it is important to send a request to your state Medicaid agency contact requesting that they approve use of your health plan's CAHPS information in the ACAP report. ACAP plans in New York, Massachusetts, California, and Oregon do not need to do anything, as these state Medicaid agencies are not participating in CAHPS this year. Other ACAP plans need to either request permission from their stated Medicaid agencies that their data be included in the ACAP comparison or submit CAHPS data (if your plan participates directly in CAHPS) to NCBD by July 1. If your plan has not submitted data yet or you are unsure whether your data has been received by NCBD, please contact Peggy Oehlmann at poehlmann@communityplans.net. NCQA Offers ACAP Plans Discount on Medicaid Quality Compass ACAP has been in discussion with NCQA about the purchase of NCQA’s Quality Compass. NCQA has generously offered ACAP plans a discount on a multi-user subscription for the 2005 version of their Plan-Specific Medicaid Data and National Average for HEDIS/CAHPS. For specific details and costs, please contact Peggy Oehlmann at poehlmann@communityplans.net or 610-457-5739. Dyani Jones to Intern at ACAP Dyani Jones started at ACAP as an intern on June 27th. She recently graduated from Stanford University with a major in human biology and will be attending Harvard University's Dental Program in the fall. She can be reached at 202.331.4600 or intern@communityplans.net. |
| JOBS |
Care Source Seeks Director Specialty Products This position will report to the Senior Vice President, Business Development & Regulatory Affairs of Care Source in Dayton, OH. The job components include: developing and implementing the next generation Medicaid managed care products to further the mission and strategic objectives of CareSource Management Group and its affiliated plans. Please contact Nancy Brady, VP of Human Resources, at 937-531-2019 or nancy.brady@care-source.com or see the ACAP Job Bank for a job description. |
| Upcoming Events |
July Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2/3 |
| 4 Independence Day |
5 |
6 |
7 |
8 |
9/10 |
| 11 |
12 |
13 Chief Medical Officers & Medical Directors Roundtable |
14 |
15 |
16/17 |
| 18 |
19 Compliance Officers Roundtable |
20 |
21 |
22 |
23/24 |
| 25 |
26 Pharmacy Directors Roundtable |
27 ACAP Board Quality Management Committee Conference Call 2 pm Eastern |
28 |
29 |
30/31 |
| 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 |