 September 18, 2006 |
|
|
Upcoming ACAP Calls
10/19: Medicare Roundtable for Operational Plans 9/21: CFO Roundtable 9/27-9/28: Compliance Officers Meeting in New York City
Upcoming Events Calendar
 
ACAP Links
 
ACAP Members
Affinity Health Plan Alameda Alliance for Health AlohaCare Boston Medical Center HealthNet Plan CareOregon CareSource Colorado Access Commonwealth Care Alliance Community Choice Health Plan Community Health Network of Connecticut Community Health Plan of Washington Contra Costa Health Plan Health Plus Health Right, Inc. Hudson Health Plan L.A. Care Health Plan MDWise Mercy Care Plan Monroe Plan for Medical Care, Inc. Neighborhood Health Plan Neighborhood Health Plan of Rhode Island Network Health Santa Clara Family Health Plan Total Care Virginia Premier |
| HIGHLIGHTS |
ACAP Board Meeting and Strategic Planning Conference in Richmond, VA, November 2 & 3, 2006 ACAP Members don't forget to sign up for the conference. The cut off date for the hotel is October 2, 2006. The conference will be held at The Jefferson Hotel. Rooms have been put aside for ACAP at a rate of $195 per night plus tax. To make reservations for the hotel please call them at 1-(800) 424-8014 and tell them you're with the conference. Also, don't forget to register for the conference on ACAP's Website, click here to register and to view the agenda. Senator Smith Hosts Roundtable on Medicaid Managed Care: CareOregon Presents Senator Smith (R-OR) recently hosted the first of many roundtable discussions on Medicaid Reform for the Senate Special Committee on Aging. The first Roundtable was on Medicaid Managed Care and included Dave Ford, CEO Of CareOregon, as well as the Medicaid Director from Arizona and the head of Families USA. Anthony Rodgers, Director of Arizona Health Care Cost Containment System, led off the Roundtable with a discussion on Actuarial Soundness and its place in managed care. Rodgers finds that manipulating capitation to meet a fixed budget objective, without reducing the MCO's medical cost, will eventually destroy a Medicaid managed care program. "MCO capitation rates must be actuarially sound. States that do not adhere to sound rate setting principles eventually destabilize their MCO contractor's financial position. In order to set capitation rates correctly you must take into account both utilization trends and medical cost inflation factors." Rodgers emphasized that in order for the rates to be actuarially sound it is better to reduce benefits, increase co-payments or place caps on membership growth than to set rates that will eventually lead to a financial collapse for MCO contractors. Ron Pollack, Executive Director of Families USA testified before the committee supporting Medicaid managed care with certain caveats. His testimony focused on "the potential of managed care to produce better health outcomes for Medicaid recipients and better coordination between Medicaid and Medicare. Managed care is not a magic bullet for Medicaid: nor is it a panacea for health care in general. However, when implemented carefully and effectively, managed care may provide better care and may be one possible tool for achieving better coordination of care." Pollack finds that during the process "a positive fiscal impact" maybe a byproduct of managed care. He called for an ombudsman program in each MCO and a limited number of patients per care manager. Greg Nycz, Director at Family Health Center of Marshfield, WI, discussed the ACAP-promoted proposal to give the MCOs access to the Medicaid drug rebate. "If Medicaid drug rebates could be extended to Medicaid managed care arrangements, an estimated $2 billion over 5 years could be saved." Alternatively, he said, pharmaceuticals could be carved out of managed care arrangements and paid directly by the states. ACAP member Dave Ford, the CEO of Care Oregon, talked about Medicaid Managed Care's ability to improve care management to the chronically ill. Before moving to CareOregon Ford was the CEO for two for-profit Health Plans in Washington State and in the Maryland/DC areas, which both served Medicaid members. "One of my first observations, when I arrived 3 years ago in Oregon is how medically efficient Oregon is relative to Maryland for the same matched population." He noted that for "SSI recipients, the hospital days/1000 members in Maryland dropped from 2100 to 1900/1000 after 2 years of managed care. In Oregon, it dropped from 1300 to 1000/1000 days after 2 years of care management." Indicating that with similar populations and over the same time period, Oregon had almost half the number of hospital days than Maryland did. From an analysis of their plan and managed care, CareOregon learned several things from their experience. Ford stated that "It is not the care people receive that drives the cost, it's the care they don't get that drives cost." High costs are influenced by too few preventive visits and monitoring visits as well as unheeded follow up calls which cause expensive emergency room visits. Next CareOregon found that a good amount of care comes from a member's social surroundings, such as family, church, and friends; not necessarily from medical systems. CareOregon is currently working on how they can electronically connect the social and the medical communities to communicate on a single patient in order to improve care and prevent acute crisis intervention events. Intel has been the prime contact for CareOrgeon in possibly implementing this electronic initiative In order to improve the area of Medicaid Managed Care, Ford offered the following suggestions to the committee for what more can be done: expand Medicaid to include SSI; integrate mental and behavioral health care with physical medicine; recognize social care and physical care create synergies through collaborative technology; change payment processes and acknowledge what needs to be paid for such as: case management, phone calls, email, and out-of-office care management; and to recognize that Actuarial Soundness is a serious issue. In conclusion, Ford closed with "Our capacity to innovate rapidly and effectively has advanced profoundly in the last decade. Managed Care, which was once a barrier to care is now an enabler and facilitator of care. It is the right care, delivered at the right time, which drives down wasteful, unnecessary care and unsafe practices in our current system. Within our public expenditures of Medicare and Medicaid is where some of the most innovative, best advances in safe, efficient care are emerging. We would encourage your leadership to facilitate better care on a national scale by including more citizens in publicly sponsored managed care."  |
| PUBLIC POLICY AND ADVOCACY |
Congressional Update As Congress prepares to adjourn for the fall elections (scheduled adjournment date is 9/29), the House and Senate are rushing to get their work completed. Although health policy will not take center stage over the next few weeks, there are some things that Congress must do in that area, either now or in a lame duck session after they return from the November elections, notably a correction in payment rates for physicians under Medicare. There is also a press to complete a reauthorization of the Health Center program and health information technology legislation before Congress goes back to campaigning. ACAP has activated our grassroots to make the final push to ensure that safety net health plans are part of Congress' plan to improve the health information technology infrastructure in this country. At this point, both the House and the Senate have opportunities for health plans to participate, but not safety net health plans. Both Senate Majority Leader Bill Frist and House Health Subcommittee Chair Nathan Deal have said that there is enough time to complete the legislation. It is vital that ACAP plans contact their Representatives and Senators and ask them to be sure that safety net health plans are part of the health IT bill. ACAP has also obtained a copy of draft legislative language that a bipartisan coalition of Senators, including Senators Frist, Kennedy, Clinton and Enzi, has produced to address problems related to health disparities. ACAP has discussed the important role that safety net health plans can play in reducing health disparities (particularly among people enrolled in public health care programs) and proposed a demonstration project that would use SNHPs for that purpose. Unfortunately, that demonstration project was not included due to concerns about a potential referral to another committee of jurisdiction -- ACAP continues to push for the inclusion of this demonstration in the legislation. However, there are other opportunities for "health plans" (a term which is undefined in the legislation) to address health disparities. ACAP will continue to stress the importance of ensuring that Congress is aware of the important role that safety net health plans can play in reducing health disparities among enrollees of public health programs. ACAP and Partnership Present Ideas to Medicaid Commission ACAP's membership in the Partnership for Medicaid is bearing fruit for safety net health plans. The Partnership is a coalition of safety net health care providers, advocates, and others dedicated to seeking a third way when discussing federal changes to Medicaid. When the Partnership submitted its recommendations to the National Medicaid Commission this week, the recommendations touted several of ACAP's legislative and administrative priorities. This represents continued progress on promoting ACAP's policy agenda to the highest levels of the Federal government. Specifically, the Partnership for Medicaid promoted (1) the extension of the Medicaid drug rebate to managed care organizations, (2) the collection of health plan quality data at the Federal level, and (3) the results of the Lewin study showing that the expansion of managed care in Medicaid could save tens of billions of taxpayer dollars. The Commission is required to submit its report by the end of the year.
ACAP Sharing Services
South Carolina Releases Concept Paper on Medicaid HSAsIn the members only section of our website, there are several areas that we want to remind you to look at periodically, including a large section of shared documents, which includes disaster recovery plans, compliance documents, job descriptions. We also have several surveys we have done of our plans. South Carolina has sent a concept paper to CMS which outlines its proposal to establish a Medicaid Health Savings Account-type program. As part of this proposal, it would give beneficiaries a Private Health Account to choose a managed care organization (MCO). The beneficiary would direct the Medicaid program to pay the insurance company the premium on their behalf. The Department would provide the MCOs the premium structure for coverage to use as a benchmark to develop their pricing. The plans would compete for the beneficiary's premium dollars through their service package and pricing. To the extent that the final MCO pricing is less than the target rates published by the Department, the MCO would then be required to provide to the beneficiary a stored value card for the value of the difference, rounded down to the nearest $10. The beneficiary would be free to use this residual of their PHA to directly purchase products and services that support health as limited by the MCO. According to the state, the intent is that plans compete for the beneficiary's business by creating an array of attractive coverage packages or pricing while bringing their expertise in disease management to the market to influence quality, health status and cost. Plan benefit design must comply with Deficit Reduction Act benchmark coverage requirements. Plans may design a package of services that is more limited in scope for one or more individual services. They may also offer optional services that are not covered by the current Medicaid program. This might include vision or dental services for adults. They may also choose not to cover some optional services that SC Medicaid covers. Plans may limit the amount of any service they cover as long as they meet the amount, duration and scope test for that service and requirements for EPSDT coverage for children under age nineteen. Advocates are concerned that the use of the benchmark benefits package, as allowed under the DRA, will result in less care for people with disabilities. |
| EXCELLENCE AND ACCOUNTABILITY |
Recap: Medicare SNP Roundtable for Operational Plans On September 12th Medicare Directors from ACAP plans with operational SNPs participated in a roundtable call to discuss medical management. Dr. Margaret Rowland, M.D., the CMO of CareOregon, led off the discussion by describing CareOregon's medical management for their Medicare SNP population.
ACAP Job Bank
ACAP Presents on Safety Net Health Plans to NACHC ConferenceACAP plans can post job announcements in our job bank. Please see our website for more details. You can email job announcements to Christina Boye at cboye@communityplans.net. Meg Murray and Darnell Dent gave a presentation at the NACHC Community Health Initiative conference in Chicago on the role and importance of safety net health plans. Meg Murray discussed how safety net health plans (SNHPs) are not-for-profit health plans that serve Medicaid, SCHIP and other vulnerable populations. These plans are an integral part of the health care safety net, providing health care for low income populations and financial, operational, and leadership support to their communities. Some of the characteristics of safety net plans include:
HRSA Releases New Chartbook on Overweight Children and Physical Activity Among Children A new HRSA publication, "Overweight and Physical Activity Among Children: A Portrait of States and the Nation, 2005," reports on the prevalence of overweight children and their levels of physical activity among children and their families at the national and state levels using data from the 2005 National Survey of Children's Health. The report includes information for each state, easy-to-follow bar graphs as well as breakdown analyses by ethnic and racial group. To view or download the report, click here to visit the Data Resource Center for the National Survey of Children's Health home page and click on the chartbook icon. ACAP Compliance Officers to Meet On September 27 and 28, ACAP Compliance Officers will meet in New York City. Discussion topics include:
CHCS to Host Quality Summit in December CHCS announces that registration for its Quality Summit on Improving Health Care for Racially and Ethnically Diverse Populations is now open. The summit is for Medicaid and commercial health plans, state Medicaid agencies, providers, and other organizations committed to reducing health care disparities and improving care for racially and ethnically diverse populations. Sponsored by the Center for Health Care Strategies and made possible through the Robert Wood Johnson Foundation and The Commonwealth Fund, the Quality Summit will offer a national showcase of best practices in reducing disparities and improving health care quality for all. To register, go to: http://www.chcs.org/usr_doc/QS2006_Registration.pdf CFO Roundtable The next ACAP CFO Roundtable is Thursday, September 21 at 3 pm eastern time. An agenda and materials will be posted prior to the call at: http://www.communityplans.net/members/cfo%20roundtable.asp |
| NEWSFLASH |
Kansas Awards New Managed Care Contracts: Centene/First Guard Loses Contract On August 25, Kansas announced that it had awarded its Medicaid managed care contracts to two new plans -- UniCare Health Plan of Kansas and Children's Mercy Family Health Partners. These two plans will cover 160,000 Kansas residents enrolled in Medicaid and SCHIP. Centene/First Guard was the previous vendor and was not selected in the new contract. Dr. Reuben Cowart Presents at Congressional Black Caucus Legislative Weekend on Health Information Technology In early September, Dr. Ruben Cowart, President and CEO of Syracuse Community Health Center and the Total Care Health Plan, spoke at the Annual Legislative Conference for the Congressional Black Caucus in Washington, DC. He was asked by Representative Ed Towns (D-NY) to present on Community Health Centers and HIT. Dr. Cowart sat on the panel to discuss "Health Technology and African-American Communities." Specifically Dr. Cowart addressed the issue of "How HIT will Benefit Health Service Delivery in Medically Underserved Communities." In Dr. Cowart's, presentation entitled "HIT and Community Health Centers," he addressed the state and the future of HIT, how Community Health Centers impact healthcare, why HIT is important to Community Health Centers, and the challenges they will face in integrating HIT. He communicated how important health centers are in the involvement of implementing HIT in the area of healthcare. "Ninety-three percent of all Community Health Centers already submit their medical claims electronically; eighty-seven percent use electronic patient registries to record and track progress of the patients; sixty percent of Community Health Centers report plans to install a new Electronic Medical Record system within the next 3 years." Additionally, Dr. Cowart's slide presentation emphasized how HIT is vital to Community Health Centers. "HIT helps enhance the overall quality of care provided, helps minimize the implications of the transient nature of patients, helps to more effectively manage chronic conditions, helps eliminate disparities by ensuring compliance with standards of care, and assists Community Health Centers in remaining viable organizations in the healthcare market place." He closed with the following recommendations for increasing the utilization of HIT in Community Health Centers. First, Congress should provide funding for HIT in Community Health Centers that is consistent and that is devoted to this exclusive topic area. Next, funding for HIT should be established based on the purchase price of hardware and software, plus ongoing operation costs. Finally, as Medicaid cost-containment strategies are considered, the possible effects of HIT implementation should also be recognized. Don Hall Comments on Provider-Owned, Medicaid Managed Care Plans and His Experience with Recent Changes at Colorado Access In the September 11th issue of Modern Healthcare, Don Hall provides some insight and some lessons learned from his resignation from Colorado Access and Colorado Access' recent departure from the world of Medicaid managed care. "I do believe that Colorado's experience will be repeated in other states, a significant story to watch given how many states see managed care as a solution to Medicaid's ills. I also believe it behooves every Medicaid managed care plan to maintain other viable lines of business to fall back on as the stresses on the program continue to grow." "Since a Medicaid plan has to serve anyone who meets the program's eligibility requirements, federal and state budgets can't keep up with the growing enrollment resulting in many problems and hardships for Medicaid managed care plans." Hall finds that a major problem stems from the high use of emergency facilities because Medicaid beneficiaries pay low or no co-payments. "The increased use of ERs puts an additional cost burden on state budgets, which causes a vicious cycle of reductions in provider reimbursement rates, fewer providers are willing to accept Medicaid patients, still greater use of the ER and so on." Hall further finds that this difficulty results in an unstable establishment of actuarially sound rates because Medicaid managed care plans offer higher quality of care through higher provider payments. "Hospital emergency rooms usually cost an average of six to 10 times more than the costs for a primary-care provider." Colorado Access's departure from the Medicaid managed care program was a result of significant financial losses and limited growth for the state budget. Colorado Access was informed that its Medicaid rates would be reduced by 15% for the next fiscal year; the plan would have lost around $15 to $20 million. Hall further indicates, "If we accepted the proposed "actuarially sound" rate, we would have to book a premium deficiency reserve of several million dollars because the rate wouldn't be sufficient to cover the expected costs of care for the enrolled populations." The best advice Hall has for provider-sponsored Medicaid managed care plans "is that the only power a plan has, pure and simple, is to sign or not sign a contract. The ultimate negotiating stance is the ability to walk away from the table. Because of the diversified product base at Colorado Access, we were able to not renew the Medicaid contract and still remain in business. While the decision to leave the Medicaid managed-care program was gut-wrenching from a mission and employee perspective, from a business perspective it was a no-brainer." In conclusion, Hall states "Medicaid managed care is changing dramatically and Colorado may be at the front of the new wave of incentive-focused capitation/reimbursement. Provider-sponsored Medicaid managed care plans have a future if they can build enough product diversification to survive without Medicaid. The power to gain a seat at the table in planning the next stage of Medicaid managed care may come from being able to temporarily walk away from that table." Don Hall recently resigned as president and CEO of Colorado Access, Denver, and is now a principal in DeltaSigma, a healthcare consulting firm. ACAP Members Receive Discounts to 4th Annual World Health Care Congress, April 22-24, 2007 in Washington, DC The 4th Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is a meeting of chief and senior executives from all sectors of health care. The conference will convene over 1550 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies. For more information, please visit www.whcc2007.com. ACAP members receive a discount of $300 when you mention the code ACAP. Emerging Issues Include:
|
| Upcoming Events |
September Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
| |
|
|
|
1 |
2/3 |
| 4 |
5 Medicare call to finalize agenda for October meeting in Phoenix, AZ |
6 |
7 |
8 |
9/10 |
| 11 |
12 Medicare Roundtable for operational plans |
13 |
14 |
15 |
16/17 |
| 18 |
19 |
20 |
21 CFO Roundtable |
22 |
23/24 |
| 25 |
26 |
27 Compliance Officers Meeting in NYC |
28 Compliance Officers Meeting in NYC |
29 |
30/1 |
October Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
| 2 |
3 |
4 Medicare Meeting in Phoenix, AZ for Operational SNPs |
5 Medicare Meeting in Phoenix, AZ for Operational SNPs COO Roundtable |
6 |
7/8 |
| 9 |
10 |
11 |
12 CIO Roundtable (note different call-in number) Policy Roundtable |
13 |
14/15 |
| 16 Finance Committee |
17 |
18 |
19 Ombudsman Roundtable Medicare Roundtable for Operational Plans |
20 |
21/22 |
| 23 Program Committee |
24 Executive Committee |
25 |
26 Compliance Roundtable |
27 |
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. |
| 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 Contact Us |