 May 14, 2007 |
|
|
Upcoming ACAP Calls
May 16: Quality Manager/Medicare Director Roundtable May 17: Chief Financial Officer Roundtable May 22: Medicare SNP Roundtable May 24: Chief Medical Officer Roundtable June 7: Pharmacy Director Roundtable June 14: Marketing and Communications Roundtable June 21: Provider Relations Roundtable
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 Denver Health Health Plan of San Mateo 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 NJ Horizon Healthcare Santa Clara Family Health Plan Total Care Virginia Premier |
| HIGHLIGHTS | ||||||||||||||||||||||||||||||||||||||||||||||||
ACAP and NACHC Release a New Study on How Safety Net Health Plans and Other Safety Net Providers Can Reduce Avoidable ER Visits More than 30 percent of all ER or Emergency Department (ED) visits each year are unnecessary and preventable, according to a joint study released by the Association of Community-Affiliated Plans (ACAP) and The National Association of Community Health Centers (NACHC). The report, The Impact of Health Centers and Community-Affiliated Health Plans on Emergency Department Use, documents a growing trend of wasteful Emergency Departments (ED) visits that can be easily remedied with the expansion of more primary care options or “health care homes.” The report also underscores how safety net health plans and Community Health Centers can provide solutions to this crisis through partnerships that could lead to higher quality and more cost-effective health care. According to the study, over $18 billion dollars are wasted annually on ED visits that could have been redirected to a regular medical or health care home. Individuals, especially the uninsured, are crowding U.S. emergency rooms with non-urgent health problems. Redirecting Medicaid patients to appropriate primary care programs, health plans and Community Health Centers can generate substantial cost savings to hospitals and payers. Margaret Murray, Executive Director of ACAP, commented, “Health plans that support and use the safety net are critical in promoting primary care among low-income populations.” A case in point is CareSource Health Plan, a Medicaid managed care plan in Ohio that saved over $992,700 by implementing Emergency Department Diversion (EDD) Program. Care Source’s program concentrated efforts to educate their members on proper usage of the ED and to develop a nurse follow up program to help patients identify with a “medical home.” “We now know there are 56 million Americans today who are struggling without regular, consistent access to the health care they need,” said Dan Hawkins, Vice President for Federal, State and Public Affairs at NACHC. “Providing these medically disenfranchised Americans with primary health care options not only makes fiscal sense, but is vital to our nation’s public health. When people have a place to go for care, a health care home, they use it and stay healthy and out of hospitals.” Key findings of this report include:
For a copy of the report The Impact of Health Centers and Community-Affiliated Health Plans on Emergency Department Use visit www.nachc.com/research. |
||||||||||||||||||||||||||||||||||||||||||||||||
| PUBLIC POLICY AND ADVOCACY | ||||||||||||||||||||||||||||||||||||||||||||||||
CareSource Urges Ohio House to Expand Medicaid Managed Care to Uninsured, Others ACAP member CareSource was invited to testify before the Finance and Appropriations Committee of the Ohio House of Representatives on April 12 and gave the Committee a respectful earful. Janet Grant, Executive Vice President of CareSource, began her presentation by acknowledging the investment in managed care made by the State, and by describing the meteoric rise in Medicaid managed care penetration in the past two years: Ohio will watch its Medicaid managed care enrollment grow from 31 percent of all Medicaid enrollees in June 2005 to an anticipated 70 percent early this summer. Grant also explained that Medicaid expansions using the existing managed care program are a natural tool – a “tunkey solution” for covering currently uninsured individuals as part of a comprehensive coverage strategy. “These plans have a demonstrated ability and commitment to serve low income, higher need populations, expertise as state contractors, existing provider networks including traditional safety net providers and programs in place to improve quality and access while controlling costs,” she said. “ A common delivery system also provides for continuity of care for individuals whose eligibility may float between programs and consistency for family members who may qualify for different programs.” In addition, she encouraged the Legislature to consider reversing the carve out of certain populations – dual eligibles – from Medicaid managed care. Explaining that CMS currently supports the development of Medicare Advantage Special Needs Plans (SNPs) that focus on the unique needs of dual eligibles, Grant suggested that the use of integrated Medicare and Medicaid approved managed care plans streamlines the complexities of navigating Medicare FFS, Medicaid FFS and Part D prescription drug plan coverage for vulnerable consumers. ACAP Relaunches Campaign to Expand Medicaid Drug Rebate to MCOs In early May ACAP plans responded with gusto to an action alert circulated by ACAP to recruit Senate sponsors for a bill expanding the Medicaid drug rebate to managed care organizations. ACAP has long promoted this effort on the Hill, and after substantial success in 2005 (the bill passed the Senate), feels strongly that 2007 may be the year Congress as a whole passes the bill. The bill, which would produce federal savings of approximately $1.8 billion over five years, has been promoted as a possible way to pay, in part, for SCHIP reauthorization. Health plans will also reap the rewards of a drug rebate expansion. While states receive between 18 and 20 percent discounts on brand name drugs, Medicaid MCOs receive only 6 percent on average, and while rebates for generic drugs are in the neighborhood of 10 percent, MCOs typically receive no discount. Plans have been effective at keeping drug costs low by managing utilization and promoting the use of generics over brand name drugs, but adding the drug rebate to the mix would produce even greater savings. ACAP anticipates the bill to be introduced within the next few days. ACAP members were asked to email or fax a letter of endorsement from their health plans asking Senators to become original cosponsors of Senator Bingaman’s “Drug Rebate Equalization Act.” Plans were also asked to follow-up emails and faxes with phone calls to the Senators’ Washington offices (reachable through the Congressional switchboard at (202) 224-3121), and relate any progress to ACAP staff. (Please contact Jenny Babcock at 202-331-4605 or jbabcock@communityplans.net if you would like a copy of the template letter or need further information.) The proposal has been endorsed by MHPOA, NACHC, NGA, NASMD, the Partnership for Medicaid, and the Medicaid Commission.
ACAP Sharing Services
CMS Releases
Value-Drive Health Care Letter to StatesIn 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. The Centers for Medicare and Medicaid Services (CMS) distributed a letter to State Medicaid Directors on April 25 inviting states to participate in its Value-Driven Health Care (VHC) initiative. The letter outlined the four “cornerstones” of the initiative, which include 1) interoperable health information technology, 2) transparency of quality information (promoting the use of standardized quality measures and other concepts), 3) transparency of price information, and 4) incentives for high-value health care (encouraging enrollees to practice sound preventive and wellness behaviors and to use providers with the highest quality and lowest cost, incentivizing providers to provide high-quality care, and offering consumer-directed health plan products). A number of states already have an Executive Order or Statement of Support for the VHC project. These states are California, Georgia, Indiana, Minnesota, Missouri, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia and Washington. Additional information on CMS’s Value-Driven Health Care initiative can be found at http://www.hhs.gov/transparency. |
||||||||||||||||||||||||||||||||||||||||||||||||
| EXCELLENCE AND ACCOUNTABILITY | ||||||||||||||||||||||||||||||||||||||||||||||||
Submit Your Nominees for ACAP’s 2nd Annual Supporting the Safety Net Award Supporting the Safety Net Award will be presented to a community-based organization (CHC, hospital, community provider, etc.) or individual whose work goes clearly beyond the norm and whose services are recognized as best practices that stand as a model for replication and spread in the safety net environment. In 2006, the award was presented to Ms. Mardy Sandler of the Baby Love Program at the University of Rochester Medical Center in New York. The Monroe Plan for Medical Care, an ACAP member plan, contracted with Baby Love, to provide “high touch” social outreach for the plan’s high-risk pregnant members. Nominees can be self-nominated or can be nominated by an ACAP plan. The short application (3-5 pages) and supporting information (outlined in the announcement) are due on Tuesday, May 22, 2007. Eligibility criteria, questions to address in the application, and selection criteria are outlined in the attached document. The award recipient will be invited to attend ACAP’s CEO Summit on July 24-25, 2007 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. Please forward the announcement to your community partners and please think about any potential plan partners that have demonstrated substantial commitment to serving safety net populations. Please contact Pat Barta at patbarta@communityplans.net with any questions you may have about the award or nomination process and to receive a copy of the announcement.
ACAP Job Bank
Reminder: QM Directors
Roundtable ACAP 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. QM Directors Roundtable, May 16 at 3 pm Eastern time. Medicare Directors (and anyone else interested) are also invited to attend this roundtable. The topic of this call will be the health risk assessment form, VES-13, developed by the RAND Corporation and used to assess quality of care for vulnerable older members. Debra Saliba, MD, from RAND will present an overview of the tool, and Craig Newton of MercyCare will describe how his health plan uses the VES-13 on its Medicare members. Reminder: CFO Roundtable CFO Roundtable, May 17 at 3pm Eastern time. CFOs will address the topic of risk management auditing, including strategies and standards of operation. Vilma Thompson and Rachel Brier from NHPRI will present an overview of why this topic is important to their plan and the auditing process they use. Reminder: CMO Roundtable CMO Roundtable, May 24 at 3pm Eastern time. On this call, Peggy Oehlmann, ACAP Assistant Director for Quality, will present an overview of ACAP’s continued voluntary partnership with the Center for Health Care Strategies (CHCS) in the collection of benchmark asthma data. Liz Ward will report on a planned September 2007 meeting in Washington DC for health plan Medicare directors and chief medical officers. The principal topic of this roundtable will be planning and implementing enrollment of the SSI population. Joe Stankaitis, MD (Monroe Plan for Medical Care) and Margie Rowland, MD (CareOregon) will give short presentations on their work in this area. Recap: Chief Operating Officer Roundtable The April 26, 2007 COO Roundtable addressed how health plans use their Web sites for member communication. Particular emphasis was placed on the 2007 changes to the NCQA accreditation requirements that commercial and Medicaid plans offer information to members and prospective members that help them select physicians and hospitals. Although some plans opt not to seek NCQA accreditation, they are nonetheless taking strides to make their Web-based directories more user-friendly, searchable, valid, language-sensitive, and printable. Information on these new NCQA accreditation requirements for the Web is posted on ACAP’s Web site (www.communityplans.net) Select Members Only and enter the password “quality”. Recap: Ad Hoc Roundtable on Dental Care for Children in Medicaid and SCHIP This May 2, 2007 Roundtable provided a description of the major points in the Children’s Dental Health Improvement Act (H.R. 1781 and S. 739). ACAP welcomed suggestions on how it can work on behalf of plans in supporting the proposed legislation. Elaine Batchlor, MD, discussed LA Care’s Oral Health Initiative 2003-2005 and how the findings and conclusions of that initiative led to planning the 2007 Oral Health Initiative, through which LA Care – which does not directly cover dental care – makes grants from its reserves to improve dental care in the community. The group discussion addressed the variety of carved-in, carved-out and contractual arrangements for dental health services in the states and plans represented, as well as common barriers in access to such services (e.g., difficulty getting an appointment, insufficient numbers of dental providers, low payment rates, and other). Plans noted that higher payment rates could lead to better dental access for enrollees, and it was mentioned that one plan found that marketing the availability of dental benefits led to an increase in plan enrollment. Recap: Compliance Officer Roundtable The May 3, 2007 Roundtable focused on health plan auditing practices for compliance. Typically, plans conduct internal auditing, while using the option to bring in outside auditors for selected areas (e.g., contract compliance). Compliance auditing staffs are limited in number, and auditing functions are often performed cooperatively with departments within the health plan. The Annual Audit Plan is an internal formal plan approved by some form of an executive compliance committee. Generally, three to four departments are audited each year based on a system of weighting and ranking by risk. It was noted that CMS is working on guidelines for risk assessments to be performed by any health plan contracting with Medicare. Recap: Chief Information Officer Roundtable On this May 10 call, Jennifer Babcock, ACAP’s Assistant Director for Policy, presented an overview of ACAP’s work to ensure that safety net health plans are a part of Congressional efforts to improve America’s health information technology infrastructure. Participants then discussed the use, management, and data integration of computerized disease registries, which are systems that track and manage disease-specific information for individual patients and populations. Registries play an important role in several ways, including patient case management, provider feedback, the integration of practice guidelines, etc. Recap: Medicare SNP Roundtable The Thursday, April 26th Roundtable focused on Medicare Advantage risk adjustment. On this call, Beth Henchel from Denver Health led a discussion on plans’ current approaches to risk adjustment methodology. The conversation built upon the discussion plans had in Arizona on risk adjustment and covered topics such as plan resources dedicated to risk adjustment and pitfalls plans have experienced with risk adjustment. Kirk Strawn and other staff from PopHealthMan also joined us for the call and shared their insights and technical expertise on risk adjustment with roundtable participants.  |
||||||||||||||||||||||||||||||||||||||||||||||||
| NEWSFLASH | ||||||||||||||||||||||||||||||||||||||||||||||||
Medicare Advantage News Highlights ACAP Safety-Net Plans’ Work on SNPs and Their Effort to Add More in 2008 This month’s Medicare Advantage News features ACAP's work on Medicare Special Needs Plans and highlights several of the ACAP SNP plans’ experience with their program and for some the creation of their new SNPs. Currently there a dozen nonprofit ACAP Medicaid managed care plans that offer a SNP product line. Combined enrollment for these SNPs is expected to reach 55,000 this year. Virginia Premier and CareSource are among other such “safety net” organizations who expect to offer SNPs for 2008. Meg Murray stated to the reporter for MAN, “The health plans’ interest in the SNPs is due to the fact they have been serving the low-income population. They have the skills and care management and knowledge of social service networks that low-income populations need. Once they were able to focus on dual eligibles under the SNP model, it was a good fit with their mission, and they had the business acumen to provide high-quality care to this vulnerable population. The unique thing about our plans is they truly are integrating Medicaid and Medicare.” The article includes experience from CareSource, Community Health Plan of Washington, Neighborhood Health Plan of Rohde Island, and Affinity HealthPlan. Chairman of ACAP and CEO of CHPW Darnell Dent commented on the challenges that Medcaid managed care plans with SNPs face. “We’re at somewhat of a disadvantage because we have no brand awareness with the senior population. It’s an interesting challenge. We’re trying to figure out how to market Medicare….It’s a different population and a different set of needs.” As of April 1, about 35,000 beneficiaries had enrolled in one of the dozen ACAP member plans’ SNPs, according to the latest available CMS enrollment data. Although the 2007 open-enrollment period for most MA plans ended March 31, CMS allows year-round enrollment for SNPs. Colorado Access had enrolled 2,474 members into its SNP since its February 2005 launch, while Mercy Care Plan in Arizona had amassed the largest SNP enrollment of the ACAP group with more than 13,000 SNP members (see the table below).
Click Here To Read Full Article
Sources: ACAP (plan sponsors) and CMS (enrollment data) CareSource Submits Medicare Advantage Application CareSource recently announced its intention to offer a Medicare Advantage Special Needs Plan in Ohio in 2008. The company recently submitted its application to the Centers for Medicare and Medicaid Services. The new plan, CareSource Advantage, will focus on the dual eligible population, which includes consumers who are eligible for both Medicare and Medicaid. “We are excited about building on our Medicaid experience to expand our service offering to reach even more underserved consumers,” said Pamela Morris, President and CEO of CareSource Management Group. As part of the company’s most recent expansion, CareSource has developed an advanced care management and disease management program to support its providers in serving its special needs members. CareSource recently expanded its managed care offering to include similar programs for the Aged Blind or Disabled (ABD) Medicaid population in Ohio. Upon approval from the Centers for Medicare and Medicaid Services, CareSource expects to begin marketing the new plan in October. New York City, State Provide Discounted EHRs for Medicaid Physicians An iHealthBeat report on an American Medical News article stated that New York City and State are providing 1,000 doctors with discounted electronic health record software and technical support to improve health outcomes among the city's low-income residents. Called the Primary Care Information Project , the initiative will be run by the New York Department of Health and Mental Hygiene and is funded with $27 million in city funds and $3 million in state funds. The Primary Care Information Project intends to deliver EHRs to patients who may not otherwise have access to them, and to address major public health issue. Physicians qualifying for the program must have practices located in one of three low-income New York neighborhoods, or at least 30 percent of their patients must be enrolled in state-funded insurance plans, such as Medicaid. Doctors who are selected for the program will receive eClinicalWorks' EHR software and two years of technical assistance, a value of approximately $12,000 per physician. In return, physicians must pay $4,000 to help cover a city-organized office workflow assessment, as well as provide their own hardware and high-speed Internet connection to run the system. Considerations in Designing Personal Health Records for Underserved Populations Hurricanes Katrina and Rita underscored the utility and importance of electronic, easily portable personal health records (PHRs). A new issue brief from Mathematica Policy Research describes the role that PHRs--comprehensive paper- or electronic-based systems recording an individual's health-related information over time--can play in reducing health care disparities. The brief also looks at barriers to PHR adoption for underserved individuals and the implications of widespread use of PHRs. Based on focus groups conducted with individuals from medically underserved, low-income minority groups from New Brunswick, NJ, the brief suggests that a variety of outreach efforts may be needed by developers of PHR systems to overcome consumer mistrust before PHRs are accepted on a wider scale. Click here for the issue brief. CHCS Network Exchange Call -- Medicaid Best Buys: Managed Care Models for Aged, Blind, and Disabled Beneficiaries Tuesday, May 29, 2007, 1:30-3:00 p.m. (ET) Aged, blind, and disabled beneficiaries make up only 27 percent of Medicaid enrollees, but account for close to 70 percent of total Medicaid spending. By managing the care of these beneficiaries more effectively, state Medicaid programs and health plans can improve health outcomes and better manage costs. This 90-minute web conference will discuss innovative state and health plan strategies for improving care management for adults with chronic illnesses and disabilities. The discussion will be moderated by Melanie Bella, Senior Vice President of the Center for Health Care Strategies. Speakers include:
ACAP Health Plans May Be Eligible for Drug Class Action Settlement Two nationwide class action lawsuits against pharmaceutical companies were recently settled. Consumers and third party payors (insurance companies, union health & welfare funds) that paid for part or all of the cost of these drugs may be eligible to get payments from these settlements. Serostim: $29 Million settlement Gov’t Employees Hospital Assoc. v. Serono Int’l, et. al (D. Mass.) Drug for AIDS Wasting Deadline to submit claims: July 19, 2007 More info: www.serostimsettlement.com or 1-800-378-3615 GlaxoSmithKline: $70 Million settlement In re Pharmaceutical Industry Average Wholesale Price Litigation (D. Mass.) Drugs at issue: Alkeran, Imitrex, Kytril (injectable and oral), Lanoxin, Myleran, Navelbine, Retrovir, Ventolin (Albuterol), Zantac, Zofran (injectable and oral), Zovirax (Acyclovir) Deadline to submit claims: May 28, 2007 More info: www.gsksettlement.com or 1-888-568-7645 The Prescription Access Litigation project has asked ACAP to spread the word about these settlements to health plans which might qualify. Please let ACAP know if you are eligible for and pursue these claims. To learn more about PAL, visit prescriptionaccess.org or call 617-275-2931. ACAP CEOs, CFOs, CIOs, CMOs, and COOs, Information on 15th Annual Medicaid Managed Care Congress The Institute for International Research will present the 15th 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 13-15, 2007 at the Baltimore Marriott Waterfront in Baltimore, MD. Participants will hear keynote presentations from Ron Pollack, Executive Director of Families USA, Theresa Pratt, Deputy Director of the Disabled and Elderly Health Programs Group at CMS, Bruce Johnson, Technical Director of the Division of Benefits, Eligibility & Managed Care at CMS, and Robert Mollica, Senior Program Director, National Academy of State Health Policy. Georganne Chapin, President and CEO, and Janet Sullivan, M.D, Chief Medical Officer, both of Hudson Health Plan, will participate in a panel called “How are States and Health Plans Collaborating to Improve the Quality and Enhance Access to Care?”. This session will be moderated by yours truly, Assistant Director for Policy at ACAP. 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 enter priority code P1258ACAP when registering to get the 15% off the current registration price. A detailed agenda is available at: http://www.iirusa.com/MMCC. Please contact Jenny Babcock at jbabcock@communityplans.net if you have questions. ACAP will also coordinate an informal dinner for ACAP plan representatives attending the meeting. As in the past, the dinner will be sponsored by New Kirk. Newkirk produces Identification Cards and Post-enrollment member materials for many Medicaid and Medicare health plans. The dinner will be held on Thursday night, June 14th at Charleston Restaurant, which is a short walk from the hotel (http://www.charlestonrestaurant.com/). Please let Jenny Babcock (jbabcock@communityplans.net) know if you would like to attend by Friday, June 8. September 17-18, 2007: CEOs, CMOs, Medicare, Policy Staff Hold the Date for CMO/Medicare Meeting on September 17 and 18 Policy/Medicare Legislative Fly-In in Washington DC! More Info to Come! Karen Fifer Ferry and Ray Sessler Start Harwich Group Karen and Ray have left Neighborhood Health Plan of Rhode Island to start the Harwich Group. Karen was previously the CFO and Ray the COO of NHPRI. The Harwich Group provides executive level resources to enhance and supplement clients' existing management teams. By providing specialized skills and seasoned perspectives, honed over decades in senior management roles, Harwich professionals partner with client executives to leverage their internal expertise and focus on achieving critical corporate objectives. Karen and Ray can be reached by phone at (401)-369-9549 or by email at kfiferferry@theharwichgroup.com and rsessley@theharwichgroup.com |
||||||||||||||||||||||||||||||||||||||||||||||||
| Upcoming Events | ||||||||||||||||||||||||||||||||||||||||||||||||
May Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
|
|
1 |
2 Ad Hoc Roundtable on Dental Care for Children |
3 Compliance Roundtable |
4 |
5/6 |
|
7 |
8 |
9 |
10 CIO Roundtable |
11 |
12/13 |
|
14 |
15 |
16 Quality Management Directors/Medicare Directors Roundtable |
17 CFO Roundtable |
18 |
19/20 |
|
21 |
22 Medicare SNP Roundtable Supporting the Safety New Award Applications Due |
23 |
24 CMO Roundtable |
25 |
26/27 |
|
28 |
29 |
30 |
31 |
|
|
June Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
|
|
|
|
|
1 |
2/3 |
|
4 |
5 |
6 |
7 Pharmacy Director Roundtable |
8 |
9/10 |
|
11 |
12 |
13 |
14 Marketing and Communications Roundtable ACAP Dinner at Medicaid Managed Care Congress in Baltimore |
15 |
16/17 |
|
18 |
19 |
20 |
21 Provider Relations Roundtable |
22 |
23/24 |
|
25 |
26 |
27 |
28 |
29 |
30/1 |
|
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 |