ACAP Newsletter

July 2, 2007
 
ACAP Newsletter


 
HIGHLIGHTS

Legislative Update: Drug Rebate Proposal Maintains Momentum and Safety Net Health Plan Definition to Be Included in HIT Due to ACAP Grassroots MoJo
ACAP's safety net health plan members had a good week on Capitol Hill this week as two major elements of their legislative agenda moved forward as Congress limped into their 4th of July recess.
Click to read this article.
 
PUBLIC POLICY AND ADVOCACY

ACAP Signs on to Children's Health Group Letter in Support of SCHIP Reauthorization
Click to read this article.

ACAP Plans Work to Preserve and Expand SCHIP Qualifying States Provision
Click to read this article.

 
EXCELLENCE AND ACCOUNTABILITY

Recap: Provider Relations Roundtable
Click to read this article.

Recap: Medicare Roundtable
Click to read this article.

Reminder: Medicare Committee Call on July 12 at 3PM EDT
Click to read this article.

Reminder: Finance Committee Call on July 12 at 4 pm EDT:Click to read this article.

Reminder: Executive Committee Call on July 16 at 2 pm EDT: Click to read this article.

Reminder:  Program Committee  Call on July 9 at 3PM EDT Click to read this article.


NEWSFLASH

Assistant Director for Quality Management Sought for ACAP
Click to read this article.

ACAP Plans' Drug Utilization Programs Comport with Federal Drug Rebate Law
Click to read this article.

Hudson Health Plan Receives Award from Case Management Society of America
Click to read this article.

Alameda Alliance Introduces "Mr. Tooth" to Promote Early Dental Care for Kids
Click to read this article.

MDwise Chosen to Negotiate Contract for SSI Program
Click to read this article.

Pay-For-Performance in Medicaid Managed Care: Money Talks, But Only If There's Enough of It, and Only If Plans Talk to Providers as Well
Click to read this article.

Christianson: Mathematica Study Offers Chance to Compare Different P4P Programs Using the Same Measure
Click to read this article.

Peggy Oehlmann Says Goodbye to ACAP
Click to read this article.

New York Board MeetingClick to read this article.
ACAP VENDOR ALLIANCES

ACAP Announces PopHealthMan as First ACAP Preferred Risk Adjustment Vendor and Preferred Medicare Advantage Consultant
Click to read this article.

 
   
Upcoming ACAP Calls
July 9: Program Committee
July 12: Quality Managers/Disease Management Roundtable
July 17: Medicare SNP Roundtable
July 18: Policy Roundtable


 
Upcoming Events Calendar

Click to view calendar.


 

 

HIGHLIGHTS

Legislative Update: Drug Rebate Proposal Maintains Momentum and Safety Net Health Plan Definition to Be Included in HIT Due to ACAP Grassroots MoJo

ACAP's safety net health plan members had a good week on Capitol Hill last week as two major elements of their legislative agenda moved forward as Congress limped into their 4th of July recess.

At the beginning of 2007, ACAP secured a commitment from the Senate HELP Committee that safety net health plans would be part of the bipartisan Senate Health IT legislation when it moved this summer. In fact, initial drafts of the legislation expressly defined and identified "safety net health plans" as able to participate in the same opportunities under the health IT legislation as other statutorily defined health plans. However, in response to concerns raised by "outside groups" (which ACAP is in the process of identifying), the specific SNHP definition was dropped in favor of a broader definition. After ACAP polled our health plan members, it was clear that not all health plans would certainly be included under this new definition and ACAP activated our grassroots to contact the HELP Committee. Thanks to the quick work of Cory Ludington at Community Health Network of Connecticut, Ellen Daley and the staff of the Boston Medical Center Health Plan, Cookie Henahan from Monroe Plan, and the other health plans that got to their HELP Committee Senators, Chairman Kennedy agreed to include SNHPs in the bill. The HELP Committee marked up the legislation on Wednesday of last week with the assurance from Chairman Kennedy's staff that safety net health plans are a part of the bill. What a great example of the success that the coordinated work of ACAP's Washington staff and the grassroots to secure this big win for safety net health plans all across America!! Nice work, all!

ACAP is also preparing for good news in the House of Representatives, as Representative Bart Stupak is set to introduce on Friday the House companion bill to the Bingaman legislation to extend the Medicaid drug rebate to health plans. Representative Stupak is looking for a Republican cosponsor to join him in this effort and ACAP has activated our grassroots to get as many cosponsors on this legislation as possible. Please be sure to contact your Congressional Representatives and ask them to cosponsor this common-sense legislation – particularly before the House goes to mark-up their SCHIP legislation.

Speaking of…the issue that has had every health care organization in Washington, DC running around in circles for weeks is the reauthorization of the SCHIP program. After being put through the ringer of continuous promises of Finance Committee mark-ups, the process finally broke down late Wednesday night after initial cost estimates from the Congressional Budget Office far exceeded the $50B provided for the package in the Congressional Budget Resolution. And that apparently didn't include the costs for other popular provisions such as citizenship documentation, ICHIA, or ExpressLane. This is somewhat ironic because most observers believed that the real budgetary playing field was between $35B and $50B. In addition, there remains an ongoing battle over offsets – the two major sources of revenue continue to be reductions in payments to MedicareAdvantage plans and increasing cigarette taxes. ACAP continues to put our $2B drug rebate saver on the table. In the end, the underlying SCHIP bill will have to be finalized until other issues can be addressed including fixing Medicare physician payments and changes to the MA SNP program. ACAP will continue to actively monitor the progress on this legislation and will keep our members informed.


 
PUBLIC POLICY AND ADVOCACY

ACAP Signs on to Children's Health Group Letter in Support of SCHIP Reauthorization

ACAP lent its name to a letter sent to Congress last week, written by the Children's Health Group (CHG), a coalition of child advocacy organizations, think tanks and provider organizations. The letter, signed by over 90 organizations, urges full funding at least $50 billion over five years – for reauthorization of the State Children's Health Insurance Program (SCHIP).

The letter explains that during the budget process, Congress created a $50 billion five-year reserve fund for SCHIP reauthorization, and it is now the responsibility of legislators to make good on that promise by passing a bill that makes use of full funding to expand access to quality health care to more children. The letter also states that "eighty-four percent of Americans polled believe that American children should have health insurance," and that "the undersigned organizations urge you to take advantage of this chance to benefit future generations of Americans."

 
ACAP Sharing Services
In 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.
 
ACAP Plans Work to Preserve and Expand SCHIP Qualifying States Provision

Community Health Plan of Washington worked with ACAP to encourage Senators to sign a letter initiated by Senator Cantwell (D-WA) promoting a special provision of the SCHIP statute which helps states that expanded children's health coverage to higher-income children prior to enactment of SCHIP. Called the qualifying state provision, this law allows 11 states to use a portion of available SCHIP allotments as increased federal matching for Medicaid expenditures for children whose family incomes exceed 150 percent of the poverty line. The 11 states include ACAP states Connecticut, Hawaii, Maryland, Rhode Island, and Washington. All Senators in qualifying states with ACAP plans signed the letter.


 
EXCELLENCE AND ACCOUNTABILITY

Recap: Provider Relations Roundtable

Participants in the Provider Relations Roundtable on June 21 discussed two issues. First, Ken Vinhateiro of Neighborhood Health Plan of Rhode Island led a discussion on contracting with ambulatory surgical centers (ASCs), stating that some physician practices have developed surgical suites and are able to perform numerous surgeries on an outpatient basis. This is a positive move for several reasons: ASCs provide physicians additional flexibility and reimbursement, allow patients to return home faster than inpatient centers and recuperate in their home environment, and increase savings in facilities costs. It was mentioned that discussions of ASCs typically fall into two issue areas, first of the monopolies that often arise from physician groups developing ASCs, and second of the potential for decreased utilization among patients served by ASCs, both of which are potential "red flags" that plans should take care to notice. Several plans described their experiences with the appearance of seeming monopolies caused by the banding together of groups of providers or the purchase of most practices in an area by a corporate provider. This was most often seen among orthopedic surgeons, but also witnessed with neurologists and gastroenterologists. Plans did not indicate they had data to prove a problem with decreased utilization among patients served by ASCs, although they agreed that watching for negative trends was important.

The second agenda item was a discussion of a study Medicaid Health Plans of America has invited ACAP to cosponsor of issues related to out-of-network provider payments. The paper would investigate disputes in terms of payment amounts between MCOs and out-of-network providers, and would detail the magnitude of the problem in terms of administrative burden and expense. The paper would also examine the consequences of set payment rates at different levels relative to Medicaid fee-for-service (i.e., out-of-network rates that are higher than Medicaid may discourage network participation, and rates that are lower may impact the willingness of providers to serve plan enrollees). Plans raised an additional and related issue, that for services not provided by plans, agreements are created with outside providers, and payment rates are often determined in advance. It was suggested that a change in law for all services mirroring the DRA provision that mandates Medicaid rates for out-of-network emergency room visits would protect health plans for services that it could otherwise provide in-network, but that it may negatively impact access for enrollees to out-of-network specialists that plans work with to provide services not otherwise covered in-network. Additional responses to the concept included difficulty defining the Medicaid rate for out-of-network and out-of-state services, the need to clarify with out-of-network providers that patients are indeed Medicaid enrollees and plans are safety net health plans, and the likelihood that providers have "core agreements" with hospitals to serve Medicaid enrollees but may not accept them directly.

 
ACAP Job Bank
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.
 
Recap: Medicare Roundtable

Strategies for managing the impending risk adjustment deadlines and assessing the impact of the 2007 Interim True-Up: Kirk Strawn, M.D., founder and president of PopHealthMan (see ACAP Vendor Alliances section) presented the work of his organization to the Medicare Roundtable. Dr. Strawn discussed that plans should review their July MMR to determine their Retro Adjustment, which is a True Up of the 2007 payment, back to January 2007. He also stated that actions taken in the next two months will determine plans' January 2008 payments, and suggested that 2006 and 2007 plans review their RAPS submission quality or obtain assistance if they have not developed tools specifically for this purpose. 2006 plans should also do targeted chart reviews for 2006 dates of service. Discussion also included doing proactive outreach to targeted members. One plan asked what type of provider can do home visits, and was told that from a risk adjustment perspective, physicians, nurse practitioners and physician's assistants can do them. Dr. Strawn also informed participants that 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.

Reminder: Medicare Committee Call on July 12 at 3PM EDT

The topic will be the development of an ACAP position on SNP standards and measures and Medicare Advantage cuts as well as update the plans on reauthorization. The call will be on Thurs July 12 at 3 pm EDT.

Reminder: Finance Committee Call on July 12 at 4 pm EDT:

Agenda items will include year to date spending.

Reminder: Executive Committee Call on July 16 at 2 pm EDT:

Agenda will include CEO Summit, future ACAP projects and ACAP staffing.

Reminder:  Program Committee  Call on July 9 at 3PM EDT

Agenda items will include a legislative update (progress on the drug rebate bills in the House and Senate, health disparities, HIT, SCHIP reauthorization, and Medicare Advantage cuts and SNP reauthorization); a review of upcoming ACAP publications, including a paper by The Lewin Group on the benefits of a pharmacy carve-in, and two new concepts ACAP will produce in partnership with Medicaid Health Plans of America (out-of-network provider payments and savings related to expansion of managed care to dual eligibles). We will also discuss the ACAP Legislative Fly-In planned for September 17 and 18 in Washington D.D.  The call will be on Monday, July 9 at 3 pm EDT. We will use the policy conference call number (1-719-457-0336) and passcode (109833).




 


NEWSFLASH

Assistant Director for Quality Management Sought for ACAP

An Assistant Director for Quality Management and Operational Support is sought for a variety of activities within the Association for Community Affiliated Plans, a non-profit trade association of 32 health plans focused on Medicaid and the Medicare SNP program. The Assistant Director will be asked to develop ACAP positions on federal policy issues related to quality within Medicaid and Medicare and vet with ACAP members, manage the ACAP Board Committee that oversees ACAP quality and operational issues, provide technical assistance to plans on Medicaid managed care policy issues, develop a quality agenda for the Association, develop benchmarking tools in conjunction with affiliated vendors, among other duties. For more information, please contact Meg Murray at 202.331.4601 or mmurray@communityplans.net.

ACAP Plans' Drug Utilization Programs Comport with Federal Drug Rebate Law

In the Spring of 2007, ACAP and Medicaid Health Plans of America jointly sponsored a survey of their member plans' drug utilization programs. The purpose of the survey was to detail how closely the plans' programs dovetail with federal requirements under the federal drug rebate program. ACAP and MHPOA support giving Medicaid health plans access to the federal rebate. In return, Medicaid health plans would be subject to the federal rebate rules on formularies and prior authorization. Senator Bingaman recently introduced the Drug Rebate Equalization Act which would give Medicaid health plans access to the federal rebate in return for being subject to the federal rebate law regarding formulary development and prior authorization.

The findings of the survey show that the Medicaid-focused plans' drug utilization programs typically are already in keeping with the federal requirements related to formulary development and prior authorization. Plans, however, typically have a positive formulary rather than a negative formulary. Thus, they tend to specify the drugs that they will cover and all other drugs are available through a prior authorization process.

Twenty-one plans filled out the survey.
 
  • Seventeen of the plans only exclude drugs that state fee for service programs are also allowed to exclude under the federal rebate program, such as drugs for anorexia, fertility, hair growth, and smoking cessation. For the four plans that do not allow access to some drugs outside of the federally allowed drugs, the categories of drugs not available include DESI drugs, athletic enhancing drugs, anti-aging drugs, mental enhancement drugs and brand name Proton pump inhibitors and nonsteroidal anti-inflammatory drugs.
  • Twenty of the plans develop formularies using a committee consisting of physicians and pharmacists, as required for state fee for service programs under the federal rebate program.
  • Sixteen plans said that a drug can be excluded from the formulary only if the drug does not have a significant, clinically meaningful therapeutic advantage in terms of safety, effectiveness or clinical outcome over other drugs included on the formulary, as allowed for state fee for service programs under the federal rebate program. An additional plan has an open formulary except for drugs related to erectile dysfunction. The remaining 4 plans do not have a written process that was available to the public.
  • Fifteen of the plans have a positive formulary (i.e., only drugs selected by the committee are included), while six have a negative formulary (all drugs are placed on the formulary except those excluded by the committee).
  • Eighteen of the plans said that excluded drugs are still available through a prior authorization process. Two additional plans only exclude drugs for erectile dysfunction, DESI drugs, athletic enhancing drugs, anti-aging drugs, mental enhancement drugs and brand name Proton pump inhibitors and nonsteroidal anti-inflammatory drugs. One plan did not answer the question.
  • Sixteen of the plans' prior authorization programs have a policy of dispensing a 72-hour supply of a covered outpatient drug in an emergency situation, as required by the federal drug rebate law for fee for service programs.
The survey also asked several general questions about the plans' drug programs.
 
  • Eighteen of the plans impose maximum quantity limits or limits on refills.
  • Only two plans use mail order pharmacies.
  • Six plans in four states (RI, MA, OH and PA) responded that their states are considering carving drugs out of the capitation rate.
A factsheet discussing the drug rebate program can be found on the ACAP website at www.communityplans.net. The survey results can also be found in our members only section under surveys.

Hudson Health Plan Receives Award from Case Management Society of America

Hudson Health Plan received the Case Management Society of Americas (CMSA) Award for Excellence in Adherence Management (AEAM). The award, presented at the Societys annual conference held in Denver this week, recognizes Hudson Health Plan for improving its case management program by using CMSAs Case Management Adherence Guidelines (CMAG) and its Web-based tool, The CMAGTracker.

"Hudson Health Plans mission is to promote and provide access to excellent health services for all people, and we support innovations that can improve the quality of care received by members," Georganne Chapin, CEO of Hudson, stated. "The CMAGTracker has profoundly changed the way our nurse case managers work, giving them new tools and techniques to assess compliance and uncover problems that might have gone undetected in the past."

Hudson Health Plan has eight nurse case managers, assisted by 10 bilingual assistants, who work under the Vice President for Clinical Services to manage patients with diabetes, asthma, HIV/AIDS, lead-poisoning, disabilities, complex and special needs, as well as prenatal programs and services for expectant mothers. The Plan has maintained a rigorous case management outreach program since 1998, but until last year, there was no standalone case management application. Furthermore, the team did not have a tracking tool for member medications. Nurse case managers kept handwritten notes on member medication use or made notations in a non-reportable data field in the utilization management system, neither of which made the data retrievable in any meaningful way.

Margaret (Peggy) Leonard, MS, RN, C, FNP, Cm, Vice President for Clinical Services at Hudson Health Plan, credits CMAGTracker for helping Hudson Health Plan to get to the root of compliance problems faster. "We can reach insights with two questions that used to take five," she explains.

While case managers had always asked if members were taking their medications, they now are trained to explore the topic more deeply. In one telling example, a member said she was taking her asthma medications Prednisone and Singulair - but the case manager quickly found out the member didn't take Singulair daily, as directed, because she didn't have symptoms every day. Additionally, the patient was avoiding taking Prednisone when her asthma flared up because it was a steroid and, she said, the newspaper said it was bad. The case manager was able to explain why Prednisone wasn't the same steroid abused by athletes, and that Singulair has to be used daily to ward off symptoms. In a follow-up call a month later, the patient said she was taking Singulair daily and she actually noticed that her asthma symptoms had disappeared.

Alameda Alliance Introduces "Mr. Tooth" to Promote Early Dental Care for Kids

Alameda Alliance for Health recently introduced their new program "Mr. Tooth," a kid-friendly mascot that is a key component of the Alliance's new community-based dental health outreach program called Smart Smiles. "Mr. Tooth" has appeared at close to a dozen schools and community events in Alameda County, and is scheduled to visit several more in the coming months. During his visits, "Mr. Tooth" entertains kids while he helps them and their parents better understand the importance of early dental care. "Mr. Tooth" and the Smart Smiles program also helps parents find local, affordable dental care services for their children up to 19 years of age.

"We know that many things influence a child's progress and success in school, including good health," said Ingrid Lamirault, CEO for Alliance. "Children must be healthy to learn, and children with poor oral health are not healthy. We're committed to outreach programs like Smart Smiles because they have a positive impact in the community and because they are vital to the Alliance's mission of serving Alameda County residents of all ages."

Smart Smiles was created specifically to help parents comply with a new state law requiring their children to have a dental checkup – performed by a licensed dentist or registered dental health professional – by May 31 of their first year of enrollment in public kindergarten or first grade. This new legislation, AB 1433, was signed into law by Governor Schwarzenegger on September 22, 2006, and became effective on January 1, 2007. Smart Smiles is the first of several health-related programs that will be part of the Alliance's Kids Health Matters series.

MDwise Chosen to Negotiate Contract for SSI Program

MDwise was chosen to enter into contract negotiations to provide care management services for the Indiana SSI Program on behalf of the Family and Social Services Administration's (FSSA's) Office of Medicaid Policy and Planning.

According to Charlotte MacBeth, MDwise president, "MDwise maintains a unique collaborative relationship with our fully integrated health care delivery systems, as well as community organizations. Our robust network of hospitals, physicians and other safety net providers stands ready to build upon our successful statewide Hoosier Healthwise managed care model and will now begin to serve aged, blind and disabled (ABD) Medicaid members."

Under the new contract, which is slated to begin Oct. 1, 2007, MDwise will perform care management, Indiana Chronic Disease Management Program (ICDMP) call center functions and prior authorization functions for its assigned Indiana Care Select membership. The plan will paid on a non-capitated basis.

MDwise will supply its SSI members with programs designed specifically for Indiana, yet bolstered by best practice national experience. To do this, MDwise has partnered with AmeriHealth Mercy to use PerforMED(sm), AmeriHealth Mercy's care management product. PerforMED has been proven to generate positive clinical outcomes and financial results for its clients using a population-based approach to care coordination for the ABD population.

According to MacBeth, MDwise chose to work with AmeriHealth Mercy because both health plans are provider-sponsored, mission-driven and member-focused, holding as a central tenet the belief that success will be measured by how well the companies help people get care, stay well and build healthy communities.

"We believe MDwise's local history and community ties, excellent member and provider services, and enduring focus on quality improvement bolstered by the intensive care management approach and prior authorization functions that will be supplied by AmeriHealth Mercy -- create a winning combination to produce the comprehensive care coordination system desired by the State for the Indiana SSI population," said MacBeth.

With the addition of the Indiana SSI Program, MDwise will expand its focus on Medicaid members in Indiana. MDwise has a variety of programs and capabilities to meet the special medical and social needs of the Medicaid population. Its services are currently provided to more than 283,000 Hoosier Healthwise members in partnership with over 1,400 primary medical providers and a statewide array of specialists, hospitals and other providers.

Pay-For-Performance in Medicaid Managed Care: Money Talks, But Only If There's Enough of It, and Only If Plans Talk to Providers as Well

Pay-for-performance can work in a Medicaid managed care setting, but only if plans place enough dollars at stake and communicate well with providers, researchers from Mathematica Policy Research say in a Health Affairs Web Exclusive published at the link below: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.4.w516

In work supported by the California HealthCare Foundation (CHCF), the Mathematica authors describe the results of a 2003-05 P4P demonstration aimed at improving the timeliness of well-baby care. The demo, the Local Initiative Rewarding Results (LIRR) Collaborative Demonstration, funded by the CHCF and the Robert Wood Johnson Foundation, involved seven California Medicaid managed care plans operating in different regions.

Five of the plans implemented various new incentives for physicians and other primary care providers, while two did not. The specific goal of all five incentive programs was to ensure that providers saw infants for six well-baby check-ups in the infants' first fifteen months of life. The plans, which requested anonymity in reporting results, varied greatly in size. The smallest had 72 primary care providers serving infants, while the largest had more than 2,000 such providers.

LIRR Demo: Modest Results, But A Guide For The Future

Despite these results, the LIRR demo was a pioneering effort that will enable P4P programs in the Medicaid managed-care arena to be better designed in the future, say Mathematica senior health researcher Suzanne Felt-Lisk and coauthors. Had the plans in the LIRR "known what we know now -- the critical importance of up-front strong provider communications plans and the importance of clear and timely support and feedback to providers on their performance -- and had they designed their incentives to better take into account the amount of change they were asking of providers, we suspect that their programs might have been more effective," say Felt-Lisk and her coauthors, Mathematica health researcher Gilbert Gimm and research analyst Stephanie Peterson. "Plans were generally optimistic about building on what they had learned and were planning to retain the incentives, at least for the short term, at the close ofthe demonstration."

The overall results of the LIRR demonstration were mixed at best: In four out of five plans, the incentives did not produce significant effects. In only one plan, referred to as "Plan D," might the new incentives (in concert with existing incentives) have had a dramatic effect, although data constraints prevented the Mathematica researchers from confirming a causal relationship.

Successful Plan Had Good Communication With Providers, Provided Adequate Monetary Incentives

Plan D was the one plan where provider incentives appear to have yielded significant results. According to provider interviews conducted by Felt-Lisk's team, Plan D conducted good communications with providers, both around the well-baby incentives and in general.

In addition, Plan D provided "stair-step" well-baby incentives, meaning that providers achieved bonuses for each additional well-baby visit, with a maximum award to each provider of $470 per baby on top of the provider's regular capitated payment. Moreover, before entering the LIRR demonstration, Plan D was already offering providers an incentive for conducting well-baby visits, so many providers were in the habit of reporting administrative data on such visits to the plan.

In contrast, Plan B, in which the LIRR demo incentives had no effect, offered physicians $100 for reaching six well-baby visits for each infant, less than one-fifth of Plan D's maximum award. Further, Plan B offered providers no money for any well-baby visits short of the ultimate goal of six for each infant. Finally, Plan B had no existing incentives for well-baby visits; as a result, going into the LIRR demo, providers reported administrative data on such visits to Plan B at only half the rate of such reports to Plan D.

The LIRR demonstration also revealed several other factors crucial to the success of P4P in the Medicaid managed-care context:
 
  • Patient Characteristics. Across all plans, providers reported that the characteristics of low-income parents often made timely well-baby visits difficult to achieve. Providers noted that low-income parents tended to be focused on economic subsistence and often lacked adequate transportation. Moreover, these parents tended to be more mobile and less likely to see the same provider for the fifteen-month period in which the six well-baby visits should take place.
  • Provider Characteristics. Patient outreach is the major activity necessary to improve well-baby visit rates, but many providers lacked the staff, funds, and technology necessary to perform such outreach. Many provider offices relied on monthly lists from plans identifying patients due for well-baby visits, even though these lists were sometimes out-of-date.
  • Plan Coordination. "The incentives would have been much stronger if competing plans in the same market area had jointly implemented them, to touch a higher proportion of each physician's patient caseload. This approach was deemed not feasible by the LIRR plans during the demonstration period because of the history of some plans' fierce rivalries," Felt-Lisk and coauthors say.
  • Combined Approach. The Mathematica researchers suggest that "the next logical step may be to abandon the idea that any single approach alone will be enough to dramatically improve health care for low-income populations and instead to test approaches that bring provider incentives, . . . member incentives, and technical assistance [to providers] to bear simultaneously on areas of critical importance to the population."
Christianson: Mathematica Study Offers Chance to Compare Different P4P Programs Using the Same Measure

"Because they were able to compare the experiences of different P4P programs that use the same performance measure for similar populations of patients, Felt-Lisk and colleagues' study generates findings that are instructive to policymakers," Jon Christianson, the James A. Hamilton Chair in Health Policy and Management at the University of Minnesota, says in a Perspective on the Mathematica paper. "They underscore again that effective communication with physicians is essential for the success of P4P programs and that policymakers need to build enough resources and time into the implementation process to accomplish this." http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.4.w528

The Mathematica findings also "highlight the need to consider the ‘starting point' for physicians when designing rewards," Christianson notes, referring to the fact that providers were already in the habit of reporting data on well-baby visits to Plan D before the LIRR incentives were put in place. "Finally, they at least suggest that physicians in resource-constrained practices serving low-income patients may have difficulty responding to financial incentives and improving their performance even when payment is based on simple, widely accepted performance measures."

Peggy Oehlmann Says Goodbye to ACAP

Peggy Oehlmann will be leaving ACAP shortly to care for her ever-growing family. (She is pregnant with twins, plus has a six year old son.) "I have enjoyed working with each of you, and will miss working with so many great health plans and people dedicated to serving low-income populations." Peggy said in a note to ACAP members.

If you have questions about ACAP QM issues, please contact the following people: For staff roundtables, or the ACAP Supporting the Safety Net Award, or CAHPS submissions, or the NCQA Medicaid HEDIS purchase, please contact Pat Barta at patbarta@communityplans.net.

For all other issues, including benchmarking, or questions about upcoming ACAP meetings, please contact Meg Murray (mmurray@communityplans.net) or Christina Boye (cboye@communityplans.net).

New York Board Meeting

The final board meeting of the year will be held at the Brooklyn Bridge Marriott in Brooklyn, NY on November 5 & 6, 2007. The room rate at the Brooklyn Bridge Marriott is $259 per night.  In order to get the special rate let them know that you are with the ACAP Meeting.

If you have already booked your room at the Brooklyn Bridge Marriott please call the hotel and confirm that they have your reservation, especially if you booked it online.  There was an instance of an online transaction not reserving rooms at the hotel for a reservation made online.

Brooklyn Bridge Marriott

333 Adams St
Brooklyn, NY 11201
Phone: 1-718-246-7000
Fax: 1-718-246-0563
Toll Free: 1-888-436-3759

Please book your rooms ASAP! 



 


ACAP VENDOR ALLIANCES

ACAP Announces PopHealthMan as First ACAP Preferred Risk Adjustment Vendor and Preferred Medicare Advantage Consultant

PopHealthMan's unusual name is derived from "Population Health Management" and its mission is to assist those who provide care for high-risk and vulnerable populations. For this reason, PopHealthMan specializes in meeting the unique needs of Special Needs Plans. PopHealthMan provides SNP plans with the tools and expertise required to manage the Medicare Risk Adjustment process which is proving vital to the success and sustainability of all SNP programs. PopHealthMan's founder and president, Kirk Strawn M.D., is a board certified family physician. He trained at the University of Iowa and completed his family medicine residency in Scottsdale, Arizona. He has 17 years of managed care experience, working at the CIGNA Medical Group, a multispecialty staff model. There he was the Medical Director of Population Health Management where he designed, implemented and managed high-risk patient management systems as well as disease management, health promotion and other quality improvement programs.

PopHealthMan has clients in a number of states and its headquarters are located in Phoenix, Arizona. Contact Royce Brownfield M.B.A. royce.brownfield@pophealthman.com or Kirk Strawn M.D. kirk.strawn@pophealthman.com for more information or call toll free 866.288.7104.

Elizabeth Darrow of PopHealthMan will be an ACAP Preferred Medicare Advantage Consultant. Previously Elizabeth had worked on Medicare issues for MercyCare and was very involved in ACAP's SNP roundtables. Elizabeth currently leads PopHealthMan's Medicare Advantage and MA SNP consulting operations. She consults in the areas of operations, compliance, benefit designs and sales and marketing strategies. Additionally, Elizabeth serves as coach and guide to prepare health plans for CMS monitoring visits by conducting mock reviews and interviews with applicable staff and, when necessary, to develop and implement corrective actions. In addition to serving as a consultant to ACAP's SNP plans, Elizabeth will contribute to and lead ACAP roundtable discussions on relevant Medicare Advantage topics of interest and concern and will present at various conferences throughout the year. Contact Elizabeth Darrow at elizabeth.darrow@pophealthman.com 480-505-9466


 
Upcoming Events

July Events

 
Mon Tues Wed Thurs Fri Sat/Sun
 
 
 
 
 
30/1 



Independence Day


7/8 

Program Committee Call
10 
11 
12 
Quality Management/Disease Management Directors Roundtable

Medicare Committee Call

Finance Committee Call
13 
14/15 
16 
Executive Committee Call
17 
Medicare SNP Roundtable Call
18 
Policy Roundtable Call
19 
20 
21/22 
23 
ACAP Board Meeting
24 
ACAP CEO Summit
25 
ACAP CEO Summit
26 
27 
28/29 
30 
31 
 
 
 
 

August Events

 
Mon Tues Wed Thurs Fri Sat/Sun
 
 



4/5 




10 
Deadline for Data Submission for Sherlock Financial Metrics
11/12 
13 
14 
15 
Asthma Data Due to CHCS
16 
17 
Deadline for Data Submission for Sherlock Operational Metrics
18/19 
20 
21 
22 
23 
24 
25/26 
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