 September 10, 2007 |
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Upcoming ACAP Calls
Sept 18: Cancelled: Medicare SNP Roundtable Sept 27: Pharmacy Director Roundtable. Note: New date. Oct 9: Policy Roundtable Oct 11: Chief Operating Officer Roundtable Oct 18: Compliance Officer Roundtable Oct 22: Program Committee Oct 25: Quality Manager/Disease Management Roundtable Nov 1: Chief Financial Officer Roundtable Nov 8: Human Resources Roundtable Nov 13: Medicare SNP Roundtable Nov 15: Marketing and Communications Roundtable Nov 29: Chief Medical Officer Roundtable Dec 13: Chief Information Officer Roundtable Dec 20: Provider Relations Roundtable
Upcoming Events Calendar
 
ACAP Links
 
ACAP Members
Affinity Health Plan Alameda Alliance for Health AlohaCare AmeriHealth Mercy 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 Keystone Mercy 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 NJ Health Prestige Health Choices Santa Clara Family Health Plan Total Care Virginia Premier |
| HIGHLIGHTS |
ACAP Welcomes Deborah Kilstein Deborah Kilstein has joined ACAP as Director for Quality Management and Operational Support. Debbie has over 30 years of experience in working with the publicly insured. She is a former Medicaid Director and Deputy Commissioner for the Department of Human Services in New Jersey. She has worked at the Center for Health Care Strategies and, most recently, with Horizon NJ Health, an ACAP-member health plan. We are very happy to have her on board and are excited to take advantage of her Medicaid expertise. Debbie’s new ACAP email is: dkilstein@communityplans.net and she can be reached at 609-818-0009.  |
| PUBLIC POLICY AND ADVOCACY |
Congress Gears Up for SCHIP Reauthorization; ACAP Promotes Drug Rebate Equalization After an unusually eventful August recess (its not every day that a Senator resigns and then doesn’t resign), Congress is preparing for the final pushes of the year that will lay the groundwork for next year’s presidential and Congressional elections. Congress has fallen behind on its professed schedule to pass FY08 appropriations bills even while the President has threatened to veto just about every appropriations bill out there. Likewise, Congressional health committees are working on FDA reauthorization legislation, as well as reauthorizing the Children’s Health Insurance Program. On the Congressional CHIP reauthorization language, House and Senate staff has been "preconferencing" their two versions of the legislation with an eye on the September 30 deadline of the expiration of authorization. Few details are known about the progress on the reauthorization and the political calculations are complicated. President Bush has threatened to veto both bills, but the Senate bill (which is significantly smaller in cost and scope than the House bill) passed with enough votes to override a veto. By contrast, the House CHIP package was narrowly passed and lacks 50 or so votes for an override. Given that, several House Republicans have recently expressed support for the Senate package. Although the initial discussions seem to be bipartisan, there is an increasing sense that the Democrats may move without the Republicans if it is perceived that the Republicans will continue to obstruct progress on the legislation. Specifically, Senate Republicans have refused a motion to appoint conferees until they have a commitment that the size and scope of the conference package will not exceed the Senate’s. Although Congressional Democrats deny it as an option, many observers believe that it will be difficult to complete work on CHIP before the September deadline (not to mention a likely presidential veto) and that a short term extension of the program may be necessary. ACAP is finalizing a letter to conferees outlining our positions on various issues in each of the bills. Most pressingly, ACAP is addressing the threat of the increasing of the drug rebate from 15% to 22% without the additional inclusion of our legislation extending the drug rebate to Medicaid health plans. The letter will also address House provisions related to the reauthorization and creation of standards for the Medicare Advantage special needs plan program. ACAP had a busy August meeting with Congressional staff trying to garner support for H.R.3041/S.1589, the Drug Rebate Equalization Act. Specifically, ACAP has met (and continues to meet) with Congressional staff on the House and Senate Medicaid Committees, as well as urging our member plans to be proactive in communicating with their members. While many of these meetings were encouraging, it is clear that ACAP plans must continue to be vocal and persistent if we hope to succeed. We hope that these efforts, coupled with the numerous health plans that have committed to attend the Congressional Fly-In on September 18th to raise awareness among their House and Senate members, will give ACAP the momentum we need to get the DRE included in the final version of the CHIP reauthorization legislation.
ACAP Sharing Services
ACAP Signs Letter
Urging President not to Veto SCHIP BillIn 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 related news, ACAP agreed to sign on to a letter promoted by First Focus and the National Association of Community Health Centers related to SCHIP reauthorization. The letter, addressed to President Bush, urges the Administration to support the SCHIP program and not veto the conference bill that will likely be passed by Congress before the end of September. The letter stresses that SCHIP has been a vital program for low-income children in working families whose parents earn too much to qualify for Medicaid but too little to purchase private health insurance, and states that millions of uninsured children are relying on the President to sign SCHIP reauthorization into law so that they are able to keep their health coverage. The letter also mentions the strong bipartisan roots of the program: the original legislation was cosponsored by Senators Hatch (R-UT) and Kennedy (D-MA), and was enacted by a Republican-led Congress and signed into law by a Democratic President. CMS Issues New Guidance for States Expanding Children’s Health Coverage CMS stealthily released a State Medicaid Director letter late in the evening August 17 providing new guidance related to coverage of children with family incomes above 250 percent of poverty, commonly called the “Crowd-Out SMD. The guidance, signed by Center for Medicaid and State Operations Director Dennis Smith, requires states planning to cover children with incomes above 250 percent of the FPL to meet several new tests, including:
States will also have to ensure that cost-sharing requirements in the public programs are not substantially lower than in private coverage.
Although the letter states that "we would not expect any effect on
current enrollees," CMSO sources say that states already covering
children above 250 percent of the FPL will be impacted, although
they also suggest that the Administration still lacks a clear sense
of how it will apply some of the tests to these states. (ACAP member
plans operate in several high-eligibility states, including
Connecticut, Maryland and New Jersey.) CMS is accepting applications for grants to support establish alternate non-emergency services providers. Only state Medicaid agencies can apply for these grants, which are due September 21, but states have the flexibility to partner with a variety of health care providers and groups, including health plans. Contact your state Medicaid agency if you are interested in partnering in this grant program. The CMS guidance on the Non-ER Provider Grant program is available here: http://www.nasmd.org/SMD_letters/docs/SMD_NonER_Provider_Grant_Announcement.pdf In Busy End-of-Summer, CMS Issues Rules Impacting Medicaid MCOsDuring the waning days of summer, while Congress recessed and much of the nation vacationed, CMS issued guidance on numerous Medicaid- and Medicare-related topics. Those directly impacting MCOs follow:
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| EXCELLENCE AND ACCOUNTABILITY |
Reminder: Asthma Benchmark Project The 11 plans participating in the CHCS Asthma Benchmark project are reminded that your data are due to the Center for Health Care Strategies by the close of business on September 10, 2007. Please forward the data to JeanHee Moon (jmoon@chcs.org), Nannan Wang (nwang@chcs.org) and Pat Barta (patbarta@communityplans.net).
ACAP Job Bank
ACAP to Host CMO/Medicare
Meeting and Legislative Fly-InACAP 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. The CMO/Medicare Meeting will be held on September 17th, 2007 in Washington DC for ACAP CMOs and Medicare Directors. The focus of the meeting is care management and models of care, and the agenda can be found by clicking here. This meeting is scheduled in tandem with ACAP’s next legislative fly-in, which will be in Washington, DC on September 18th and will focus, in part, on educating Congressional Members and staff about ACAP’s Medicare SNPs. Emphasis during the legislative fly-in will also be placed on advocating for SCHIP reauthorization, passage of ACAP’s Drug Rebate Expansion Act of 2007, and inclusion of safety net health plans in health information and health disparities legislation. To register for the CMO/Medicare meeting or the Legislative Fly-In, please click here: http://www.regonline.com/Checkin.asp?EventId=140355. For additional information, contact Liz Ward (CMO/Medicare Meeting), Jenny Babcock (Legislative Fly-In), or Christina Boye. |
| NEWSFLASH |
Famed Photographer, Bruce Davidson, Completes Photo Series on CareOregon Legendary photographer Bruce Davidson this year completed a photo series called "We the People" for ACAP member CareOregon. Davidson created two sets of prints, which will be on view at CareOregon's Portland offices and also at the Department of Human Services building. Like his previous projects, "We the People" finds the heroism and poetry in the lives of those struggling just to get by. Born in 1933 in Oak Park, Ill., and a graduate of Yale University, Davidson has created some of photography's most powerful documentary projects of our time, many of them concerned with social issues facing minorities and the poor in his home base of New York. He was one of the foremost figures during photography's golden mid-century period and a 49-year member of Magnum Photos, the most prestigious photographic cooperative. According to Davidson, “The main purpose of this project was to show legislators and politicians where they should spend their money and to visualize -- make visible -- that which is invisible. When Hurricane Katrina hit, we didn't realize there were so many people who were living in borderline (situations). They didn't have cars, no savings and many didn't have medical plans. So, there's a whole strand of people in the United States that remain invisible, below the radar. I think it's good to see what they are like.”
CareOregon states that the goal of the exhibition is to show that
Oregonians receiving help from Medicaid and Medicare are "our
children, our neighbors, our family and friends," and that
Davidson’s "evocative imagery" captures the "profound vision of
CareOregon: healthy Oregonians regardless of their income or social
circumstances." South Carolina will move more than 550,000 Medicaid beneficiaries to managed care plans starting Nov. 1, the Columbia State reports. State officials say the shift will improve preventive care and provide beneficiaries with a primary care physician, which will reduce costs associated with care received in hospital emergency departments. Beneficiaries who do not choose a managed care plan will be automatically assigned one. The enrollment process is expected to be finished by the end of 2008.
Insurers who offer the plans will receive a payment for each Medicaid beneficiary they enroll. Carolina Crescent of South Carolina, one of ACAP’s newest members, will be among those insurers to enter the Medicaid market in the State.
Access this story and related links online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=46959
Dr. Craig Thiele Joins
CareSource Management Group
ACAP Board Member Georganne Chapin Publishes Views on Health Care Reform An article on real health reform by Georganne Chapin, ACAP Board Member and CEO of Hudson Health Plan, was published in The Journal News of New York State on August 7, 2007. The full text of this article follows: Real health-care reform means covering everyone and streamlining system By GEORGANNE CHAPIN Published in The Journal News, Community Views 8/7/07 Between Michael Moore's new movie "Sicko" and the nation's longest-running presidential campaign, debate over the future of American health care is now in the spotlight with an intensity not seen since the earliest days of the Clinton administration. The lines are clearly drawn. On one hand are Mr. Moore and others who have brought the idea of a federally funded national health-care system to a wider American audience. On the other are those who raise the specter of "socialized medicine" - including President Bush, who has threatened to veto an expansion of the State Child Health Insurance Program (SCHIP), and now candidate Rudolph Giuliani, who thinks that we should use the tax code to help people buy insurance through private providers. Advocates for a national system tend to focus on our universal entitlement to health care, and they want to reduce or even eliminate the middlemen who drive up costs and add no value. Conversely, the only entitlement that matters to the champions of so-called free markets is the one that enables them to skim profit from the various models currently under consideration, including government-financed programs. Fully aware that taxpayers are already footing the bill for well more than half of the country's health care, private players are lining up at the door to see who can get the biggest handout. Thus, the pharmaceutical industry- already raking it in with Medicare Part D, which forbids bargaining for lower pharmaceutical prices - is now running big ads on national television promoting the expansion of the federally funded SCHIP - which, no surprise, in every state covers prescription drugs. Oh, and there's also the fight over Medicare Advantage, a program that costs way more than "regular" Medicare, and gives the mark-up to commercial insurers. In the Hudson Valley, we have our own version of interest-group warfare. The lines were drawn very succinctly by your July 22 editorial ("Sicko' paying so much: A homegrown alliance tackles insurers and begins to make gains'') about Westchester County Association's Bill Mooney and his Suburban Health Care Alliance, a group that is attempting to siphon-off profits from private insurers and give the money to hospitals. The editorial mistakenly- and significantly, because it perpetuates a skewed view of what's really going on- characterized Mr. Mooney's efforts as health "reform." This good guy-bad guy (hospitals vs. insurers) analysis is appealing in its simplicity, but does not take us very far toward understanding or solving the health-care problems of the Hudson Valley, the state or the nation. Simply put, locally and nationally hospitals are not only the most expensive sector of the health-care system, but they also have only a negligible impact on the health status of the community. By the time people arrive at a hospital they are really sick, and their health costs can be astronomical. Despite our president's optimistic "alternative" to funding children's insurance ("After all, you just go to an emergency room"), ERs are no one's medical home, and they're simply not a place to get basic primary and preventive care. By pressuring insurers into turning over their profits to hospitals, Mr. Mooney and the alliance appear to be replicating a model created by Congress called the Community Reinvestment Act, which compels banks to put money into areas that previously had been redlined in return for being granted permission for mergers and other regulatory concessions. However, the record of forcing industries to pay social costs is not very promising. After years of regulation, litigation and fines, the cigarette industry is still marketing to children. And in banking itself, the practice of sub-prime lending is now wreaking havoc on many of the same communities that were supposed to benefit from reinvestment. Health insurance companies will inevitably look to compensate for their social tithing in other ways. Hospitals might get a few dollars more to subsidize their inefficient cost base, while our primary-care providers, public-health departments, community health centers and others who are in a position to prevent illness and maintain good health community-wide will continue to struggle. Real health-care reform will only occur when our leaders coalesce not around which sector deserves to get the most money, but rather around how to cover everybody, and streamline both health care and the health-care bureaucracy in order to get the most benefit for the most people. Still, I am grateful to Mr. Mooney, his colleagues and The Journal News for raising the issue. And while I don't agree with the paper's characterization of "Sicko" as "ham-handed" it is also true that sometimes the only way to get someone's attention is with a blunt instrument. CareOregon Awards Grants to Clinics to Strengthen Care CareOregon awarded grants worth about $100,000 to four clinics in Oregon including Legacy, Central City Concern and OHSU's Richmond Clinic in Portland, and Virginia Garcia Memorial Health Center in Cornelius. Each clinic serves a large proportion of low-income patients. The goal of the grants is to field test strategies to enhance primary care, build stronger and more lasting relationships with patients, and prove that the strategies will improve care and save money. The four clinics with grants from CareOregon hope to prove they can provide better care -- and save money. One way is to have medical assistants, nurses and pharmacists provide some of the care traditionally handled by physicians, who cost more. Another is to allow patients to consult with doctors and nurses by telephone and e-mail, freeing up physician time for patients who require hands-on care. The terms of the grant call for each clinic to measure results, for instance, by tracking how effectively patients get preventive care. The clinics are also figuring out ways for CareOregon to pay doctors, nurses and other caregivers for work not covered under current reimbursement systems, such as consulting with patients by e-mail and developing databases to keep track of patients' health. "We want to build something that can be used in any primary care practice, anywhere," says Dr. David Labby, medical director of CareOregon. Whether primary care doctors can muster the political clout to gain a larger share of health care dollars remains uncertain. The federal Medicare program, the largest single source of funding for health care, is rolling out a pay-for-performance system that will reward primary care doctors for success in managing patients' health. Officials with Oregon's Medicaid program say they are eager to consider requests for giving plans such as CareOregon more flexibility in paying primary care doctors. Some commercial insurers, such as Providence Health Plans, have begun paying doctors for e-mail consultations with patients. NHP CMO Co-Writes Article on Importance of Data Collection for Resolving Disparities in Health An article on racial and ethnic disparities in health care and the importance of good data collection to solve them by Dr. Paul Mendis, CMO of Neighborhood Health Plan, was published in The Boston Globe August 7, 2007. The article was co-written by Dr. James O’Connell, chairman of the Clinical Issues Committee at the Massachusetts League of Community Health Centers and president of the Boston Health Care for the Homeless. The full text of this article follows: Equal Access, Equal Care By Paul Mendis and James O'Connell Published in Boston Globe August 7, 2007 We know that infant mortality rates of African-Americans eclipse those of other ethnic groups; that Latinos die from asthma at a rate four times higher than whites and, from a recent Harvard study, that unconscious racial bias affects the way doctors care for African-American heart attack victims. We do not know why. There are social and economic costs of inequities in quality of healthcare. Disparities result in the loss of millions of dollars each year in additional expenditures and lost productivity due to poorly managed care, complications, delayed diagnoses and treatment, and misdiagnoses. Often, underserved populations need greater support and a different approach to health education to use the healthcare system effectively and advocate for their rights. Provision of broader health insurance coverage (as with our healthcare reform effort) is an important component of providing access to services, but does not ensure access to services that are delivered in a culturally competent, linguistically appropriate manner. In order to figure out the full breadth of healthcare disparities, and why they exist and what can be done to eliminate them, we must address a critical, yet controversial issue: the gathering of race and ethnicity data on medical patients. Collection of such data can raise difficult issues such as fear of prejudice, selective treatment, and profiling. However, it is the only way to accurately define the problem and convince the public and healthcare providers that disparities do indeed exist. The Commonwealth is actively taking steps to address this issue. The Health Care Quality and Cost Council will require all health insurance companies to begin gathering and reporting quality and performance measures by next spring. Both health insurers and hospitals will be required to show they are reducing racial and ethnic disparities in the delivery of healthcare. The Massachusetts Joint Legislative Commission to Eliminate Racial and Ethnic Health Disparities will release its report soon and a special council mandated by the state's healthcare reform law will be convened this fall to carry on the commission's work. Neighborhood Health Plan and the Massachusetts League of Community Health Centers have already made noteworthy progress in this area. With a decades-long track record of working with racially and ethnically diverse patient populations, we launched a partnership more than two years ago to establish a system for collecting such data from our members and patients. Our efforts have replicated the finding that African-American women are less likely to receive mammogram screenings than white women. We've also found that differences exist between the care diabetic Puerto Ricans receive compared with Dominicans. And that Latinos as a whole are less likely to refill medications and continue treatment for depression compared with other ethnic groups. Armed with such information we are beginning to tackle the next layer of this multilayered challenge. Sometimes it is as straightforward as getting the right information to patients in a format they can understand. Other times it is addressing cultural norms on both the part of the healthcare provider and the patient that are interfering with care. As the state develops regulations for health plans to begin the collection of race and ethnicity data, we offer this advice: Build upon existing relationships with clinical care givers familiar with serving racially and ethnically diverse populations. Aim to help overcome fears of discrimination or profiling. Demonstrate the highest ethics in any data collection by limiting how these data are used and for what purposes. Collaborate with healthcare providers and community organizations to bridge the gaps where disparities exist. By establishing a careful, broad-based data collection system, Massachusetts will build a resource not only to identify specific healthcare disparities, but also to make progress in determining why they exist. If we can answer that question, Massachusetts can take great pride in providing truly comprehensive access to quality, efficient care -- regardless of race, ethnicity, or socioeconomic differences. New CHCS Issue Brief Promotes Strategies to Address Racial Gaps in Care A new issue brief from CHCS called From Policy to Action: Addressing Racial and Ethnic Disparities at the Ground-Level and authored by January Angeles, MPP, and Stephen A. Somers, PhD, was released in August. Racial and ethnic minorities in the United States tend to have poorer access to care and receive lower quality care than non-minorities. The Institute of Medicine’s 2002 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care generated national awareness of the need to reduce inequalities in care. In response, many of the nation’s health care stakeholders are seeking to reduce health disparities by improving health care services, delivery, and access for members of racial and ethnic groups. This issue brief, which draws from CHCS efforts funded by The Commonwealth Fund and the Robert Wood Johnson Foundation, reports on practical strategies that purchasers and plans nationally are implementing to address documented gaps in care. It highlights the need for standardized collection of race, ethnicity and language data, culturally competent approaches, as well as the involvement and commitment of multiple stakeholders. CHCS Issues Call for Proposals for New Multi-Stakeholder Demonstration and Evaluation of the Business Case for Quality CHCS announced a new multi-stakeholder initiative for Medicaid-led teams to test and evaluate the effectiveness of targeted interventions at improving quality and reducing costs. This initiative is the second phase of CHCS’ efforts to demonstrate the business case for quality, following the original demonstration that ended in 2006. This second phase also aims to identify financing misalignments that impede investments in quality as well as strategies for correcting them. Interventions will focus on either high-risk childhood asthma or congestive heart failure (CHF) among adults. Participating teams will be comprised of a state Medicaid agency and at least two other stakeholders including Medicaid health plans, hospital systems, safety net providers, or other purchasers. CHCS will select up to five multi-stakeholder teams to participate in this four-year initiative, which will include an independent evaluation. Participating teams will be required to incorporate a rigorous study design including equivalent control/comparison groups. For more information, to download the Call for Proposals, and/or to register for a Prospective Applicant Call to be held on September 18, 2007 from 2:00-3:30 pm ET, please visit the Initiative page. Proposals are due October 12. Hcheq Electronic Medicaid Application System Licensed by Westchester County The Westchester County Department of Health has partnered with the Hudson Center for Health Equity & Quality (Hcheq) to license Hcheq’s Facilitated Enrollment Electronic Application (FEEA), the first fully electronic application for New York’s three public health insurance programs, Georganne Chapin, Founder and President of Hcheq, announced today. Hcheq, an independent not-for-profit organization that promotes the delivery of high quality health care for all people, develops information technologies to improve the quality, safety, and efficiency of medical care, particularly by streamlining clinical and administrative practices. "The application completely revolutionizes the Access NY Health Care enrollment process by automating a paper-based system that is time-consuming, error-prone, and costly," explained Ms. Chapin. "It eliminates inefficient manual processes that prevent New Yorkers from getting timely access to health care, and provides quick and efficient enrollment of individuals into Medicaid Managed Care, Child Health Plus, and Family Health Plus," she said. Westchester County Commissioner of Health Joshua Lipsman commented, "With FEEA, the County’s Facilitated Enrollment program is taking a great leap forward. We believe using the application will increase enrollment and retention of individuals in health insurance programs in Westchester County." The Westchester County Department of Health serves as the county’s lead Facilitated Enrollment agency working with community-based organizations (CBOs). Under New York State’s Facilitated Enrollment program, CBOs and health plans are authorized to seek out those in need of health insurance, counsel them about their options, and assist them in completing the application. Now the Department of Health will be able to use FEEA to enroll people at its own office and through the Westchester Children’s Association and the Hispanic Coalition of Westchester County. A grant from the Westchester Community Foundation is funding FEEA training and implementation at these three locations. Bypassing Paper-Based Problems The current eight-page Access NY application requires complex calculations and extensive documentation. Manually transcribed data must be entered into computer systems numerous times – by the Facilitated Enroller, the local Department of Social Services, and New York State. Illegible entries, miscalculations, and missing documentation clog the system with delays. In contrast, FEEA overcomes those barriers and facilitates the process. It produces the application in a form accepted by New York State. It stores documents such as birth certificates electronically, so they are available when individuals have to recertify their eligibility in 12 months. FEEA also is capable of transmitting applications electronically to local Departments of Social Services once they have the capability to receive electronic submissions. Hudson Health Plan, a not-for-profit health plan and Facilitated Enroller based in Tarrytown, NY, initially developed the application to automate the enrollment process for its own organization, and now uses it to process all of its applications. Hudson Health Plan has found that FEEA has reduced enrollment processing time by 40 percent, by reducing error rates and eliminating illegibility. The recertification process, which used to take 40 minutes, can sometimes be completed in only five minutes. "The bottom line is that FEEA is simpler, quicker, and more efficient," explained Ms. Chapin. "It automatically verifies enrollment eligibility and allows our representatives to enroll twice as many members as before. By streamlining the enrollment process, our representatives can focus on getting families the health care they need." The Westchester County Department of Health released the following press release: Article Finds Special Needs Children Enrolled In Managed Care More Likely to Receive Therapeutic Services In an article published in the Summer 2007 issue of the Health Care Financing Review, researchers evaluated the effects of enrollment in a partially capitated managed care plan versus enrollment in the fee for service option on the use of therapeutic services by children with special health care needs. The study was conducted by researchers from The RAND Corporation, Georgetown University and the University of Maryland. Utilizing telephone surveys, the researchers found that a higher percentage of children from the District of Columbia enrolled in the partially capitated managed care plan were regular or frequent users of therapeutic services in the school setting. While only a small percentage of children received therapeutic services outside the school setting, children enrolled in the fee for service option were less likely to receive services in either setting. The researchers attributed the disparities to the availability of case management and care coordination in the managed care setting, a feature that is absent or minimal under the fee for service option.
Click Here for Download of Article |
| Upcoming Events |
September Events |
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10 Deadline for Asthma Benchmark Data Submission by Participating Plans to the Center for Health Care Strategies |
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15/16 ACAP CMO/Medicare Meeting and Legislative Fly-In, Washington, DC |
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17 ACAP CMO/Medicare Meeting and Legislative Fly-In, Washington, DC |
18 ACAP CMO/Medicare Meeting and Legislative Fly-In, Washington, DC CANCELLED: Medicare SNP Roundtable |
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27 Pharmacy Director Roundtable. Note: New date. |
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8 ACAP Trip to Germany Columbus Day |
9 ACAP Trip to Germany Policy Roundtable |
10 ACAP Trip to Germany |
11 ACAP Trip to Germany Chief Operating Officer Roundtable |
12 ACAP Trip to Germany |
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18 Compliance Officer Roundtable |
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22 Program Committee |
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25 Quality Manager/Disease Management Roundtable Finance Committee Call @ 4 pm EST |
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30 Executive Committee Call @ 3 pm EST |
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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 |