ACAP Newsletter

April 21, 2006
 ACAP Newsletter

HIGHLIGHTS

ACAP Announces Its first Annual Supporting the Safety Net Award
This award will honor a plan partner (provider, community based non-profit, legislator, state regulator, etc.) who has worked tirelessly to improve the health of low-income and other vulnerable populations.
Click to read this article.
ACAP Releases Report on Savings from State Managed Care Expansions
ACAP, along with the Medicaid Health Plans of America, released a study by The Lewin Group that asserts that there is tremendous room for expansion of capitation contracting in the Medicaid program, and that optimal use of this model would yield savings of $83 billion across ten years. Margaret Murray, Executive Director of ACAP, said “We were interested in quantifying the degree to which capitation is currently in use as well as the large-scale savings opportunity that still remains.”
Click to read this article.
PUBLIC POLICY AND ADVOCACY

ACAP Spearheads Sign-on Letter on Actuarial Soundness
Click to read this article.
ACAP Establishes Aggressive Legislative Agenda for 2006–2007
Click to read this article.
FY 2007 Budget Update
Click to read this article.
Reminder: May Medicare SNP Call
Click to read this article.
Recap: April Medicare SNP Call
Click to read this article.
EXCELLENCE AND ACCOUNTABILITY

Reminder: CIO Roundtable
Click to read this article.
New! Ombudsman Roundtable
Click to read this article.
Reminder: CFO Roundtable
Click to read this article.
Recap: COO Roundtable
Click to read this article.
NEWSFLASH

Don Blanchon To Head AIDS Clinic
Click to read this article.
Janet Sullivan, MD, CMO of Hudson Health Plan, Receives Distinguished Public Health Service Award From Westchester County Board of Health
Click to read this article.
Colorado Access Names New Executive Director of Access Behavioral Health
Click to read this article.
Jim Hooley Joins NHPRI’s Board
Click to read this article.
ACAP Discount for 14th Annual Medicaid Managed Care Congress
Click to read this article.
    
Upcoming ACAP Calls
 4/27: CIO Roundtable
5/2: New! Ombudsman/Member Advocate Roundtable
5/4: CFO Roundtable
5/11: Provider Relations Roundtable
5/18: Quality Management Directors Roundtable
525: Compliance Officers Roundtable


Upcoming Events Calendar
Click to view calendar.
HIGHLIGHTS

ACAP Announces Its first Annual Supporting the Safety Net Award

This award will honor a plan partner (provider, community based non-profit, legislator, state regulator, etc.) who has worked tirelessly to improve the health of low-income and other vulnerable populations.

Nominees can be self-nominated or can be nominated by an ACAP plan. The short application (3-5 pages) and supporting documents are due on Friday May 12, 2006.

The award recipient will be invited to attend ACAP’s CEO Summit on July 25-26, 2006 in Washington DC for an award ceremony. (The recipient’s travel and hotel expenses will be paid by ACAP and the CEO Summit registration fee will be waived). ACAP will also work with the award recipient and their plan partner to promote the award and develop a press release.

The award announcement is posted in Members Only/ACAP Announcements. Please contact Peggy Oehlmann (poehlmann@communityplans.net or 610-457-5739) with any questions.

ACAP Releases Report on Savings from State Managed Care Expansions

ACAP, along with the Medicaid Health Plans of America, released a study by The Lewin Group that asserts that there is tremendous room for expansion of capitation contracting in the Medicaid program, and that optimal use of this model would yield savings of $83 billion across ten years. Margaret Murray, Executive Director of ACAP, said “We were interested in quantifying the degree to which capitation is currently in use as well as the large-scale savings opportunity that still remains.”

Some of the study’s specific findings regarding the existing use of capitation are summarized below:
  • In the most recent year in which full national data are currently available, FY2003, only 16% of national Medicaid expenditures were paid in the form of capitation.
  • Only one state, Arizona at 85%, “capitates” more than 50% of Medicaid spending. Only five other states capitate more than 30% of Medicaid spending – Pennsylvania (46%), Michigan (45%), New Mexico (44%), Oregon (39%), and Hawaii (36%).
  • Seven of the nation’s ten largest Medicaid programs (FL, IL, MA, NC, NY, OH and TX) rank 25th or lower in the degree of their Medicaid spending that is capitated.
  • Within the blind and disabled Medicaid population, only 14% of Medicaid spending was paid via capitation in FY2003 (even after removing all spending on dual eligibles and long term care).
 Nationally, Lewin estimates that $67 billion of Medicaid fee-for-service spending as of FY2003 (29% of total expenditures) can be favorably impacted by expansion of the capitated model. Regarding the specific savings estimates, Lewin’s key findings are that:
  • At a national level, maximum savings of $83 billion would occur across ten years if the capitation model were immediately applied to all the Medicaid funds that this model seems well-suited to impact. (These savings are entirely attributable to expansion of the capitated model and do not include the savings already occurring through existing Medicaid capitation programs.)
  • Most of these savings ($55 billion or 67% of the national total) would occur through transitioning the non-Medicare blind/disabled population into the capitated setting.
  • 87% of the total savings would result from expanded use of the capitation model in urban areas; 13% of the total savings would be attributable to use of this model in rural areas.
  • The state and federal share of savings is determined by the match rate in each state; maximum nationwide savings would be split 56% Federal and 44% state.
 “We see a tremendous opportunity for increased savings, better access and improved quality -- and an equally large need to attain them given the fiscal constraints confronting both the Federal and State governments related to the entitlement programs,” Murray noted.

The report can be found on the ACAP website at http://www.communityplans.net/publications/working%20papers.asp


PUBLIC POLICY AND ADVOCACY

ACAP Spearheads Sign-on Letter on Actuarial Soundness

ACAP led a coalition of health plans in the creation of letter to the Congress requesting Congressional leaders to ask HHS to evaluate how actuarial soundness is working in the states. While Medicaid health plans are very supportive of CMS’s Checklist for Actuarially Sound rates as a critical step towards federal oversight, guidance and standardization of the states’ Medicaid managed care capitation rate development process, the plans remain concerned that CMS approval of the methodology for setting the capitation rates does not assure that the rates are, in fact, actuarially sound enough to cover the costs of providing care to the Medicaid beneficiaries.

We asked Senators Grassley and Baucus and Congressmen Barton and Dingell in their oversight capacity, to ask the Secretary of the Department of Health and Human Services to evaluate how actuarial soundness is working in the states and its impact on Medicaid beneficiaries and the plans that serve them.

The letter was signed by:

Association for Community Affiliated Plans
Medicaid Health Plans of America
Centene Corporation
National PACE Association
AMERIGROUP, Inc.
New York State Coalition of Prepaid Health Services Plans
Molina HealthCare Inc.
Schaller Anderson, Inc.
SNP Alliance
American Managed Behavioral Healthcare Association
Local Health Plans of California

The letter can be found at http://www.ahcahp.org/pandl/06policy_positions.asp

ACAP Establishes Aggressive Legislative Agenda for 2006-2007

ACAP has established an exciting and aggressive legislative agenda for 2006 and 2007. At the center is the Lewin Group study outlined above that highlights the enormous potential for savings to the Medicaid program by expanding the use of capitation. ACAP will also continue to support S.1585, the Medicaid Health Plan Rebate Act, which Congressional Budget Office has scored as saving at least $1.7 billion over five years by equalizing the treatment of prescription drug discounts between Medicaid managed care and Medicaid fee-for-service. This proposal enjoyed wide support in the last legislative session and was included in the Senate-passed version of the Deficit Reduction Act (although it was not included in the final version).

ACAP plans to leverage the large savings produced by these two proposals to provide funding for three policies to reduce churning in Medicaid and stabilize enrollment. These policies include:

  • Extending Guaranteed Eligibility Period. This proposal would build on the BBA provision that allowed states to guarantee eligibility regardless of changes in income for up to six months to enrollees of any managed care plan. This proposal would amend the provision to allow for 12 months guaranteed eligibility in managed care at the state’s option.
  • Extending Continuous Eligibility to Adults. This proposal would build on the BBA provision that allowed for continuous eligibility for children in the Medicaid and SCHIP programs for up to 12 months by allowing continuous eligibility for adults for up to twelve months as well, at the state’s option.
  • Facilitated Enrollment. Facilitated Enrollment (FE) is a process currently used in New York State to assist eligible uninsured families in obtaining public health insurance eligibility. The FE process uses community based organizations and health plans to find and enroll beneficiaries. Facilitated enrollers collect the required documentation from applicants (pay stubs, proof of residency, asset information, immigration status, etc.), conduct the legally mandated face-to-face interview, and calculate income eligibility for public health insurance. FE is also used to renew beneficiaries’ coverage, and has been central to retention efforts in New York’s public insurance programs. This proposal would extend the FE program to all states, so that all states could enlist community based organizations and health plans in their enrollment and renewal efforts.
 FY 2007 Budget Update

Although Congress is out on its spring recess, the FY2007 Budget Resolution continues to hang as a significant piece of unfinished business. With members scattered to the winds, it is difficult to assess whether the Republican leadership has been able to make any headway on getting enough Republican votes to pass the budget. With the united opposition of Moderate Republicans and Appropriators, House Majority Leader John Boehner will have to make significant concessions without upsetting conservatives in the caucus. Yet, until the budget is officially dead, ACAP and ACAP’s member plans should remain vigilant and ensure that Congress doesn’t approve further cuts in entitlement programs.

Reminder: May Medicare SNP Call

Due to a conflict with other ACAP business, we will need to reschedule the May Medicare SNP conference call. We will notify all Medicare SNP conference call participants of the new date shortly.

Recap: April Medicare SNP Call

On the last Medicare SNP call, John Warren and Jerry Ware from Colorado Access discussed their challenges with provider contracting for Medicare SNPs and also shared their key recommendations for building a Medicare SNP provider network. Plans also discussed their observations and recommendations for creating a more coordinated regulatory environment between Medicare and Medicaid at CMS. ACAP will incorporate plans’ comments into a letter for CMS Administrator Mark McClellan’s senior staff who requested we solicit feedback from our members on this subject and share it with them. Anyone who did not have an opportunity to comment and would like to should contact Liz Ward at eward@communitplans.net.


EXCELLENCE AND ACCOUNTABILITY

Reminder: CIO Roundtable

The next CIO Roundtable is Thursday, April 27 at 3 pm eastern time. A reminder email and agenda items will be circulated prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.

New! Ombudsman Roundtable

Several ACAP plans have requested a roundtable conference call for Ombudsman/Member Advocates. This call is scheduled for Tuesday May 2 at 3 pm eastern time. Plans will discuss the various roles assumed by ombudsman/member advocate within respective ACAP plans. A reminder email and discussion questions will be circulated prior to the call.

Access ACAP Roundtable and Best Practices Conference Calls

The call-in number is 1-719-457-0336. Passcode: 109833
All calls at 3 pm Eastern time, 2 pm Central, 1 pm Mountain, 12 pm Pacific, and 10 am Hawaii, unless otherwise noted.
Reminder: CFO Roundtable

The next CFO Roundtable is Thursday, May 4 at 3 pm eastern time. A reminder email and agenda items will be circulated prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.

Recap: COO Roundtable

On their April 20 roundtable, COOs reviewed the highlights from the recent ACAP COO meeting and prioritized follow up discussion items. COOs discussed and compared Senior Management reporting tools on this roundtable (some plans refer to them as “Monday Morning” reports reviewed each week by the Senior Management team).


NEWSFLASH

Don Blanchon To Head AIDS Clinic

The board of directors of Whitman-Walker Clinic announced that it has selected Donald Blanchon as the Clinic’s next executive director and chief executive officer. Blanchon, 41, has spent the last nine years with the medical management firm of Schaller Anderson, most recently serving as vice president for Medicaid and Medicare programs. From 2002-2004, he was CEO of Maryland Physicians Care, a $325 million managed care health plan owned by four community-based health systems and operated by Schaller Anderson’s Maryland affiliate. Under Blanchon’s stewardship, this operation grew from 20,000 clients to more than 90,000—most of whom were covered by Medicaid and some by private insurance.

Blanchon was selected after a lengthy search conducted with the assistance of Korn/Ferry International.

Earlier in his career, Blanchon was vice president for strategic planning for Health Services for Children with Special Needs. He also spent five years as a budget examiner in the federal Office of Management and Budget.

Established in 1973, Whitman-Walker Clinic is a non-profit, community-based provider of health care and social services in the Washington, D.C. metropolitan area. Through three sites, in the District of Columbia and Northern Virginia, the Clinic offers primary medical and dental care; mental health and addictions counseling and treatment; HIV education, prevention, and testing; legal services; case management; and a food bank. Whitman-Walker Clinic is committed to meeting the life needs of the gay, lesbian, bisexual, and transgender community and people living with HIV/AIDS.

Janet Sullivan, MD, CMO of Hudson Health Plan, Receives Distinguished Public Health Service Award From Westchester County Board of Health

In a letter informing Dr. Sullivan of the award, Dr. Douglas Aspros, President of the Westchester County Board of Health wrote, “Your innovative programs directly help thousands of residents, their families, and the community’s health care system…Your creativity in promoting preventive health care through physicians has assuredly reduced the number of individuals suffering from preventable illnesses and diseases.”

Georganne Chapin, President and CEO of the not-for-profit Hudson Health Plan adds: “Since Dr. Sullivan joined Hudson Health Plan in 1997, she has used our organization as a platform to introduce several public health quality improvement ‘firsts’ that benefit not only the 37,000 Hudson Health Plan members in this county, but the community-at-large as well.”

“This is a wonderful honor,” said Dr. Sullivan of the award. “We applaud Westchester County’s own commitment to public health, and look forward to continuing to work together with the county.”

ACAP Job Bank
 ACAP maintains a job listing site on its website for jobs related to Medicaid managed care and health policy, both in Washington and regionally. If you would like to post a job announcement, please send it to Meg Murray at mmurray@communityplans.net. The job announcements are at http://www.communityplans.net/jobs/jobs.asp.
Colorado Access Names New Executive Director of Access Behavioral Health

Longtime Colorado Access employee and behavioral health professional LeNore Ralston is now the Executive Director of Access Behavioral Care. Colorado Access offers the state’s largest health plans for Medicaid and Child Health Plan Plus. The company also operates Denver’s Behavioral Health Organization, Access Behavioral Care, which manages the behavioral health benefit for all Medicaid recipients who live in Denver. “We are delighted to promote LeNore Ralston to this position. Since joining Colorado Access nearly five years ago, she has worked tirelessly to serve our members in a multitude of capacities. Our behavioral health line of business will benefit greatly by her extensive background and expertise in this area,” said Don Hall, president and CEO of Colorado Access.

Jim Hooley Joins NHPRI’s Board

Jim Hooley, formerly CEO of Neighborhood Health Plan in Boston, has joined the board at Neighborhood Health Plan of Rhode Island.

ACAP Discount for 14th Annual Medicaid Managed Care Congress

The Institute for International Research will present the 14th Annual Medicaid Managed Care Congress, the best practices event for States and Plans looking to improve healthcare quality and control costs. The event is scheduled for June 19-21, 2006 at the Hyatt Regency in Baltimore, MD. Participants will hear keynote presentations from Frederick P. Cerise, Secretary, Louisiana Dept. of Health & Hospitals, Patrick J. Kennedy, Congressman, Rhode Island, and G. Kirk Olsen, CEO, Molina Healthcare of Utah.

IIR's Medicaid Managed Care Congress includes 3-days of workshops, case studies and interactive panel discussions with the nation’s leading Medicaid experts. With representatives from over 20 states, the event provides strategies to improve fiscal operations with sessions on Managed Care expansion into SSI and Long Term Care, implementing Consumer Directed Care accounts for Medicaid populations and effective strategies for using encounter data for rate setting and quality improvement.

ACAP members receive a 15% discount. Please contact Peggy Oehlmann at poehlmann@communityplans.net for information on the ACAP discount. A more detailed agenda is available at: http://www.iirusa.com/MMCC06.

ACAP will also coordinate a dinner for ACAP plan representatives attending the meeting. Please contact Peggy Oehlmann if you are interested in attending the ACAP dinner.


Upcoming Events

April Events

Mon Tues Wed Thurs Fri Sat/Sun
 
  
  
  
  
 1/2 
3 
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 5 
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 8/9 
10 
 11 
Medicare SNP Roundtable		 12 
 13 
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 15/16 
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COO Roundtable		 21 
 22/23 
24 
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 27 
CIO Roundtable		 28 
 29/30 

May Events

Mon Tues Wed Thurs Fri Sat/Sun
1 
 2 
New! Ombudsman/Member Advocate Roundtable		 3 
 4 
CFO Roundtable		 5 
 6/7 
8 
 9 
 10 
 11 
Provider Relations Roundtable

Vendor Relations Committee Call
11 a.m.		 12 
 13/14 
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Quality Management/Disease Management Directors Roundtable		 19 
 20/21 
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Compliance Roundtable		 26 
 27/28 
29 
Memorial Day		 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.

Darnell Dent, Chairman Margaret A. Murray, Executive Director,
mmurray@communityplans.net, 202.331.4601

Association for Community Affiliated Plans
1400 Eye Street, NW, Suite 330
  Washington, DC 20005
http://www.communityplans.net
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