 June 18, 2007 |
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Upcoming ACAP Calls
June 21: Provider Relations Roundtable June 26: Medicare SNP Roundtable July 9: Program Committee July 12: Quality Managers/Disease Management Roundtable July 17: Medicare SNP Roundtable July 18: Policy Roundtable
Upcoming Events Calendar
 
ACAP Links
 
ACAP Members
Affinity Health Plan Alameda Alliance for Health AlohaCare Boston Medical Center HealthNet Plan CareOregon CareSource Children's Mercy Family Health Partners 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 Prestige Health Choices Santa Clara Family Health Plan Total Care Virginia Premier |
| HIGHLIGHTS |
ACAP Drug Rebate Bill Introduced ACAP IS ON A ROLL, legislatively speaking! The last two weeks have brought ACAP unparalleled success in moving our legislative agenda to elevate “safety net health plans” (SNPs) on Capitol Hill forward. (Please also see stories on disparities and health information technology under Public Policy and Advocacy.) This is the result of months of work by ACAP and ACAP’s members to effectively target messages to their elected Representatives and Senators to ensure that SNHPs are part of the solution on a wide variety of issues being debated in Congress. On June 11, 2007 ACAP saw the introduction in the Senate of our top legislative agenda item – extending the Medicaid drug rebate to managed care organizations. After months of drafting and the solicitation of input from various groups across the spectrum, Senator Jeff Bingaman (along with Senators Akaka (HI), Kerry (MA), Mikulski (MD), Salazar (CO), and Whitehouse (RI)) introduced S. 1589, the Drug Rebate Equalization Act of 2007. This legislation differs dramatically from S. 1585 introduced in the 109th Congress by responding to a variety of concerns from different organizations. Unlike last year, the legislation would (1) explicitly extend the drug rebate to health plans, (2) ensure that health plans, while complying with basic rules governing the Medicaid drug rebate, can maintain their own drug care coordination and management systems (including the use of positive formularies), and (3) protect against so called “double dipping” between both the Medicaid drug rebate and the 340B discount drug pricing programs. All of these changes were the result of outreach by ACAP and Senator Bingaman to other organizations, including the National Governors Association, the Public Hospital Pharmacy Coalition, the Center for Budget and Policy Priorities and FamiliesUSA. Likewise, we appreciate the health plans that took their time to submit comments on last year’s legislation and how it could be improved. In introducing the legislation, Senator Bingaman said, “This bill will not only allow Medicaid beneficiaries’ rebates on prescription medications, but it will also save tax payer dollars.” ACAP has been working with the Senate Finance Committee to promote this legislation as a way to offset the costs of reauthorizing the SCHIP program. If your Senator is not a cosponsor of this legislation, there is still time. Feel free to contact your Senator and ask them to cosponsor S.1589, the Drug Rebate Equalization Act of 2007. ACAP has been working to identify some potential members, any advice from ACAP’s member plans about Republicans they know that would help in this effort would be greatly appreciated. Please contact Chris Koppen, ACAP’s Washington Lobbyist, at ckoppen@avancerhp.com with any such information. Prestige Health Choices in Florida Joins ACAP A new safety net health plan is being established in Florida and will become a member of ACAP. The health plan is being established by Health Choice Network (HCN) which is a not-for-profit nationwide network of CHCs created to delegate essential business services that can be more efficiently or effectively operated jointly. The community health centers, which govern HCN, are community-based, consumer-governed corporations that operate in areas of high medical need. HCN help its member centers function effectively within a large-scale integrated delivery system without losing their independence or community-based focus. Business and clinical systems include information technology, financial leadership and systems, centralized patient billing, managed care risk contract management, electronic health and oral health records, certain clinical services, disease management programs and Healthy Body, Healthy Soul, a faith-based disease prevention initiative. The Network also plays an important role in formulating health care policy, conducting advocacy and educational efforts and providing technical assistance on behalf of the Centers. HCN is led by President and CEO Kevin Kearns, COO Terisa James and Senior Vice President Margaria Ollet. Health Choice Network has grown to include 17 member organizations in Florida, which operate nearly 100 primary care and behavioral health sites throughout the state. Outside Florida, membership includes the New Mexico Health Network and the Utah Health Network. Together, Network members provided care for more than 450,000 patients in 2005, most being minorities from disadvantaged communities. While the Network is a separate corporation, maintains its own staff and operates functions that are delegated by the community health centers, its governing board of directors is comprised of the chief executive officers or executive directors of its member Community Health Centers. In addition to membership fees and services paid by member Centers for integrated services, the Network is supported through grants from federal, state and local government, corporate foundations, donations and sponsorships and other funding sources. HCN is in the process of creating a for-profit Provider Services Network (PSN) called Prestige Health Choices which will take capitation from the state for Medicaid. It will be headed by Paul Rothman. They are setting up initially as a PSN because it allows them to roll over all the Medicaid beneficiaries that currently use the network into a PCCM program on day one. This will allow them to begin operations with 28,000 beneficiaries. They will then covert them to full risk members for most acute care services. They are not in the counties that Florida is doing its Medicaid waiver demonstration (which ACAP has expressed concerns about.) They will be using a Third Party Administrator to do backroom services, such as claims payment. They are currently evaluation RFP responses to choose this vendor. They anticipate being operationally by October and will convert to an HMO within the first year of operation. The leadership of
the plan will be employees of the Health Choices. They hope to
someday start a Medicare SNP plan as well. Community Health Plan of
Washington has been providing them with some technical assistance
and encouraged them to consider ACAP as a resource and for
membership. |
| PUBLIC POLICY AND ADVOCACY |
Safety Net Health Plan Definition Included in Health Disparities Legislation In addition to our success with S.1589, the Drug Rebate Equalization Act of 2007 (see Highlights), ACAP has made legislative strides in other areas as well. After months of negotiations with Senate Health Education Labor and Pensions (HELP) Committee over health disparities legislation, ACAP was able to accomplish two major goals when HELP Chairman Ted Kennedy (MA) introduced S. 1576, the Minority Health Improvement and Health Disparities Elimination Act of 2007. For the first time in legislative history, S. 1576 would define “safety net health plans” in Federal statute as not-for-profit health plans that serve 75% or more of their enrollees in Federal, state or local health programs. This is important for any number of reasons, not the least of which is that it brings recognition and credibility to these non-profit health plans and gives ACAP an opportunity to point to existing law when other opportunities arise for funding or participation in government programs. In addition to establishing the definition in statute, the legislation would also provide opportunities for safety net health plans to participate in Federal efforts to reduce health disparities among its enrollees. In fact, in addition to allowing SNHPs to participate in these efforts, it would give priority in funding to those safety net health plans that act in coordination with local community health centers to do so. Finally, the legislation would include safety net health plans in a list of other safety net providers that would collectively be designated as “Federal Health Safety Net Organizations,” along with DSH hospitals, community health centers, or Indian health providers. ACAP would like to particularly thank Network Access’ Pano Yeracaris, along with all of the health plans that participated in ACAP’s targeted grassroots effort to express support for inclusion of SNHPs in the health disparities legislation. The inclusion of safety net health plans in this legislation is a great victory on many levels and will continue to lay the groundwork for legislative success in the future. ACAP is encouraging all its members to contact their Senators and ask them to cosponsor S. 1576, the Minority Health Improvement and Health Disparities Elimination Act of 2007. Please contact ACAP if you have any questions. MedMetrics Joins List of Drug Rebate Expansion Endorsements MedMetrics Health Partners, Inc., a not-for-profit Pharmacy Benefits Manager (PBM) founded by and directly affiliated with the University of Massachusetts Medical School, shared its support for the Drug Rebate Equalization Act of 2007 introduced by Senator Bingaman on June 8 (please see lead story under Highlights) to provide Medicaid managed care organizations’ (MMCOs) enrollees with access to the Medicaid drug rebate. MedMetrics is one of the few PBMs that has a truly transparent purchasing strategy for health plans and does not earn revenues from the drug rebate, and is the PBM for Neighborhood Health Plan of Massachusetts, a safety net health plan serving primarily Medicaid patients. Other endorsements include the Medicaid Commission, the National Governors Association, the National Association of State Medicaid Directors, as well as organizations representing both providers and the managed care industry, including the National Association of Community Health Centers, the Medicaid Health Plans of America, and the Partnership for Medicaid. In addition, the Center on Budget and Policy Priorities included the proposal in a March 2007 paper called Options Exist for Offsetting the Cost of Extending Health Coverage to More Low-Income Children.
ACAP Working on Health Information Technology Legislation
ACAP Sharing Services
ACAP Discusses Special
Needs Plans with Senate Finance Committee StaffIn 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. In our effort to expand its influence in the area of the Medicare Advantage program, ACAP has been seeking to provide input and guidance to Congressional staff about the important role that safety net health plans play in the Medicare Advantage Special Needs Plan program. You may recall the Senate Finance Committee held a staff briefing several months ago to help personal members’ staff get a better understanding of the program. Although ACAP plans were initially invited, due to the traveling issues, no ACAP plans were present at this staff briefing – leaving a glaring hole with few plans in attendance rarely discussing the importance of a SNP meeting the diverse needs of the special populations they serve. Last week, ACAP got its opportunity to host a conference call with Finance Chairman Baucus’ and Ranking Member Grassley’s staff to bring the safety net health plan perspective to the SNP program. For nearly an hour of presentation and questions, CareOregon’s Medicare Director Pat Curran and other CareOregon staff discussed CareOregon’s Medicare Advantage dual eligible SNP product and the programs they use to ensure that the needs of their enrollees are being met and the challenges they face in effectively meeting those needs. Chris Koppen and Liz Ward were also participating on the call and, in discussions after the call, felt that real inroads were made, not only in helping the Committee staff better understand our unique perspective on these issues but also to make ACAP a credible voice that they can turn to for input and advice. During this discussion, staff raised the possibility that SNP reauthorization legislation could be included in a larger SCHIP/MA/Medicare bill – although it was unclear how much of a possibility this was. ACAP staff are working to clarify the issues and timetable and will continue to report this information as we learn it. ACAP Supports Equitable Treatment of States Under the State Children’s Health Insurance Program ACAP recently sent a letter to Senate Finance Committee Chairman Max Baucus (D-MT) and ranking member Charles Grassley (R-IA) urging a correction to an inequity in the SCHIP law that impacts a number of states that provided higher levels of coverage for children before the State Children’s Health Insurance Program (SCHIP) was enacted in 1997. The letter explained that when SCHIP was created, a number of states had already made a commitment to cover low-income children at 185 percent of poverty – or even higher – in their Medicaid programs. The original SCHIP statute prohibited these states from using federal SCHIP dollars for these targeted low-income kids, but a temporary “qualifying states” provision enacted by Congress has allowed these states access to limited amounts (up to 20 percent) of SCHIP allotments for children covered in Medicaid expansions. While this provision has proved helpful, the letter continued, allowing states access to their entire SCHIP allotments to support coverage of low-income kids will ensure that these states are treated equitably. President Signs Supplemental War Bill, Halts CMS Medicaid Cuts President Bush in late May signed into law the Iraq supplemental spending bill (H.R. 2206), which included a two provisions which impact the Medicaid program. First, the supplemental bill included $650 million to fill the SCHIP shortfalls several states will face this year without additional federal funds. Second, the bill also temporarily stopped CMS from implementing two sets of proposed Medicaid regulations that would have cut Medicaid by $5.6 billion over the next five years. The first regulation would have limited public providers to cost and curbed Inter Governmental Transfers (IGTs) and Certified Public Expenditures, cutting $3.8 billion from Medicaid over five years. The second regulation would have ended federal Medicaid outlays for graduate medical education, costing hospitals $1.8 billion.  |
| EXCELLENCE AND ACCOUNTABILITY |
ACAP Benchmarking Opportunities ACAP has been in discussion with NCQA about a discount for the purchase of NCQA’s 2007 Quality Compass. ACAP will cover the cost of the Quality Compass, then recover that cost on a per user basis from each of the participating plans, which are allowed up to three users each. ACAP is once again partnering with the Center for Health Care Strategies (CHCS) to collect asthma benchmarks. CHCS ran asthma collaborative in three states and defined a uniform set of measures making it possible to do comparisons among the states. ACAP plans that voluntarily participate in this project will be aggregated as though they were all located in the same state, which will facilitate comparing the data to the three states. Any ACAP member plan wishing to participate should notify Pat Barta (patbarta@communityplans.net) and Jane Deane Clark (jdclark@chcs.org) by June 19. ACAP member health plans who independently submit CAHPS data to the National CAHPS Benchmarking Database (NCBD) or reside in states that are not submitting CAHPS data this year, and are interested in participating but have not yet registered with the Data Submission System must send NCBD a completed registration form as soon as possible. The registration deadline is June 29, 2007. To register, go to https://ncbd.cahps.org/plancahps/default.asp. If you have any further questions regarding benchmarking please contact Pat Barta patbarta@communityplans.net.
ACAP Job Bank
ACAP Members
Participate in Medicaid Managed Care CongressACAP 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. Hudson Health Plan President and Chief Executive Officer Georganne Chapin and Chief Medical Officer Dr. Janet Sullivan participated in a panel discussion at last week’s Medicaid Managed Care Congress titled “How Are States and Health Plans Collaborating to Improve Quality and Enhance Access to Care?” The session, moderated by ACAP Assistant Director for Policy Jenny Babcock, focused on the processes used by Hudson Health Plan to ensure that providers are encouraged to provide high quality care, and also underlined the partnership between Hudson and the State of New York to promote quality of care in Medicaid. Dr. Foster Gesten, Director of the Office of Health Insurance Programs within the New York State Department of Health, described the progress made by the State with the Quality Assurance Reporting Requirements (QARR), which tracks numerous quality measures over time. ACAP members attending the Medicaid Managed Care Congress also joined ACAP staff at a dinner. Reminder: Provider Relations Roundtable Call, June 21, 3:00pm EDT This roundtable discussion will revolve around how health plans are contracting for outpatient surgery. Ken Vinhateiro, manager of the specialist network at NHPRI, will present a short summary of how this issue has arisen in his plan in the area of outpatient neurosurgery and will open an opportunity for plans to share information. Reminder: Medicare SNP Roundtable Call on June 26, 3:00pm EDT The topic will be "Strategies for managing the impending risk adjustment deadlines and assessing the impact of the 2007 Interim True-Up". Actions that you take in the next two months will determine your January 2008 payment. Plans active in 2006 have two submission deadlines in the next 7 months, while plans that started in 2007 can for the first time, affect their own risk adjusted payments. Kirk Strawn M.D. and Royce Brownfield M.B.A. from PopHealthMan will provide helpful advice in preparing for these critical deadlines. They will provide you with examples of working strategies as well as ways to prevent common pitfalls. Additionally, they will be available to answer questions related to the July 2007 Interim True-Up/Retro Adjustment. PopHealthMan is the ACAP Preferred Risk Adjustment Vendor. Reminder: Quality Manager/Disease Management Roundtable Call on July 12, 3:00pm EDT To address the ever-increasing problem of obesity prevention and weight management, this roundtable will focus on the variety of interventions and benefits health plans are offering/thinking about offering to their members. Carla Parker, Director of Care Management at Community Choice Michigan, will open the discussion with a presentation on how her plan offers support and education to members who would like to control their weight through Weight Watchers. Recap: Marketing and Communication Director Roundtable Call This call on June 14 focused on ideas of how health plans use media and other communications strategies to support state health reform. Elisabeth Handler, Public Information Officer for the Santa Clara Family Health Plan, provided an overview of multiple health reform efforts in California and the history of SCFHP’s involvement in the process. Discussion centered on what puts health plans in a unique position to advocate for reform, examples of strategies in other states (e.g., Massachusetts) undergoing reform, and a number of specific things plans can be doing, such as proactive pitches to the media on reform issues, media events, reaching out to legislative committees to offer testimony and others. Considerations in Designing Personal Health Records for Underserved Populations Hurricanes Katrina and Rita brought the utility and importance of electronic, easily portable personal health records (PHRs) starkly to light in fall 2005. A new issue brief from Mathematica 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 report. |
| NEWSFLASH |
L.A. Care Announces $3 Million Grant to L.A. County for Nursing School L.A. Care Health Plan recently announced a $3 million grant to Los Angeles County for a new nursing school run by Los Angeles County’s Olive View Nursing Program. The grant, which is part of L.A. Care’s $6 million effort to strengthen the health care safety net, is intended to address the dire need for additional nurses in Los Angeles. The grant is funded by L.A. Care’s Community Health Investment Fund, which was established by L.A. Care’s Board of Governors to support projects and initiatives that strengthen community health. According to a study by the University of San Francisco, there is a shortage of nurses nationwide, with Los Angeles County ranking among the worst. Based on its current population, Los Angeles County is short 10,000 nurses, and this figure is expected to double by 2030. The current shortage of nurses puts a strain on a health care system that is already overburdened. With one of the largest and most diverse patient populations in America, Los Angeles County’s shortage of nurses can make it difficult for patients to access health care that is timely and necessary. L.A. Care’s $3 million grant to start the nursing school will support hiring of additional teaching staff, which will enable a higher percentage of qualified students to be admitted. According to the California Board of Registered Nursing, only 39% of qualified applicants at present are admitted to nursing programs. A lack of qualified nursing instructors is a one of the main reasons for the low admission rate of new students. “Even if everyone had health care coverage, it wouldn’t mean much if there are not enough nurses and other health care professionals to serve patients,” said Dr. Elaine Batchlor, Chief Medical Officer at L.A. Care Health Plan. “By providing funding to start a new nursing education program, L.A. Care is not only addressing the immediate of nursing shortfall, we are also building the foundation for a sustained solution.” Another project that will be funded by L.A. Care’s $6 million health care safety net effort is the redesign of Harbor UCLA Ambulatory Care Clinic. The clinic is currently experiencing an appointment backlog for specialty care and a correspondingly high patient volume in its emergency room. The redesign will improve patient flow, shorten wait times, and increase overall clinic efficiency. Other projects that will be funded by L.A. Care’s $6 million program includes an interpretive call center at Rancho Los Amigos National Rehabilitation Center, an endoscopy program at LAC + USC Medical Center, and a program to improve patient access to optometric services at LAC + USC. A list of all funded projects is attached. CareSource Breaks Ground for New $55 Million Corporate Headquarters in Downtown Dayton “We are writing a new page in Dayton’s history books,” said Pamela B. Morris, president and CEO of CareSource. “We are honored to build on this site that is so rich in our community’s heritage.” CareSource has been part of the downtown Dayton business community since its inception in 1989. Today, with more than 538,000 members, the Ohio plan is the largest Medicaid HMO in the state. “We are building for CareSource's future,” Morris said. "A building, though, is just steel and structure. Our employees are the heartbeat of our company." The City of Dayton and the Downtown Dayton Partnership, in conjunction with the Dayton-Montgomery County Port Authority, have been working with CareSource for nearly two years to resolve the company’s long-term space needs. After reviewing all available options, both existing space and new construction, the company committed to the new construction as the best option to accommodate its future business needs. The company has seen significant growth over the past two years, increasing its employee base by 19 percent in the past year alone. Today, CareSource employs more than 700 people with more than 600 of those employees located in downtown Dayton. The new building will support the company’s anticipated growth to as many as 1,200 employees over the next few years. The Dayton-Montgomery County Port Authority will build the new CareSource corporate headquarters at Main Street and Monument Avenue in downtown Dayton. The company will lease the building from the Port Authority. The new headquarters and the City’s commitment for a new public parking garage bring a total of nearly $75 million of new investment into downtown Dayton. “We are very excited about breaking ground for this new gateway to downtown Dayton," said City of Dayton Mayor Rhine McLin. "CareSource’s continued growth is very important to our city." The new building will provide the company with more than 300,000 square feet of space. Designed to reflect the company’s culture and support the needs of the company’s employees, occupancy is planned for Fall 2008. The new building was designed by BHDP Architecture, Cincinnati, and is being constructed by Messer Construction Company. Medicaid Wait Rising for Virginia Children, Study Says The Washington Post recently featured an article on the impact of the Medicaid citizenship documentation requirement on individuals in Virginia. The article reveals that according to a state survey of 800 low-income families citizenship documentation can be blamed for eligible children, whose parents applied for Medicaid in Virginia, going without health care for a period of time. The full article can be found here. New York Times Reports that Insurers Benefit Most from HIT iHealthbeat, an e-newsletter devoted to HIT news, reported last week that insurers, rather than physicians, benefit the most from health information technologies that enhance efficiency. The newsletter reported that doctors receive approximately 11 percent of savings from electronic health records (EHRs), and the remainder of savings accrues mostly to private and public health insurers who benefit from fewer unnecessary tests and electronic record keeping, according to research conducted by the Center for Technology Leadership. David Brailer, former national coordinator for health IT, agreed that "The doctors bear all the costs, and others reap most of the benefit." He added, "The incentives are totally awry. On the other hand, Richard Baron a physician in Philadelphia who started using computers and EHRs in 2004 said this transition has helped him become a better physician, and allowed his physician office to cut three office positions. However, the savings in salaries is less than the cost of the technology. |
| Upcoming Events |
June Events |
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6 |
7 Pharmacy Directors Roundtable Cancelled |
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9/10 |
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14 Marketing and Communications Directors Roundtable ACAP Dinner at Medicaid Managed Care Congress in Baltimore |
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16/17 |
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21 Provider Relations Directors Roundtable |
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23/24 |
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26 CMO/QM Directors call with CHCS and ACAP to discuss asthma specifications Medicare SNP Roundtable Call |
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28 |
29 |
30/1 |
July Events |
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30/1 |
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4 Independence Day |
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7/8 |
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9 Program Committee Call |
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12 Quality Management/Disease Management Directors Roundtable Finance Committee Call |
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14/15 |
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16 Executive Committee Call |
17 Medicare SNP Roundtable Call |
18 Policy Roundtable Call |
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21/22 |
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23 ACAP Board Meeting |
24 ACAP CEO Summit |
25 ACAP CEO Summit |
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28/29 |
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31 |
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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 |
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Association for Community Affiliated Plans 1400 Eye Street, NW, Suite 330 Washington, DC 20005 http://www.communityplans.net Contact Us |