 October 3, 2007 |
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Upcoming ACAP Calls
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 4: Medicare SNP 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 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 Horizon NJ Health Prestige Health Choices Santa Clara Family Health Plan Total Care University Physicians Health Plans Virginia Premier |
| HIGHLIGHTS |
ACAP Conducts 2nd Legislative Fly-In On September 18th, representatives from 10 ACAP member health plans traveled to Washington, DC to participate in our second Legislative Fly-In of 2007. These individuals scheduled and attended nearly 40 meetings with Senators, Representatives, and their staffers, and promoted ACAP’s top legislative priorities, including the Drug Rebate Equalization Act of 2007 (DRE), SCHIP reauthorization and Medicare SNP standards and reauthorization. Although ACAP members and staff continue to work through the storm of follow-up work generated by the Fly-In, the meeting has already produced several positive outcomes, including two new sponsors for the DRE, thanks to NHPRI and CareOregon. Nearly half of all ACAP plans have attended a Legislative Fly-In in 2007. The first lobbying day, held early February, resulted in success when CareSource convinced the office of Representative Bart Stupak to be lead sponsor on the DRE. ACAP plans to hold Fly-In events in February and September of 2008 as well. ACAP Medicare SNP Plans Meet On September 17th, 45 of ACAP’s CMOs, Medicare Directors and other interested staff from 18 plans attended our Medicare SNP meeting focused on models and care and care management. This was ACAP’s fourth Medicare SNP meeting, and the first joint meeting with the Medicare Directors and CMOs. Participants discussed a range of topics related to models of care and care management, including:
ACAP plans to hold additional Medicare meetings in 2008 so stay tuned. |
| PUBLIC POLICY AND ADVOCACY |
SCHIP Reauthorization Struggle Reaches Fever Pitch Months of action, “hurry-up-and-wait,” partisan bickering, and veto threats culminated this week in the House of Representatives and the Senate voting on a compromise agreement reauthorizing the Children’s Health Insurance Program. After both the House and Senate passed their very different versions of the legislation in August, Congressional negotiators have been working on developing a compromise agreement upon which both the closely-divided Senate and the Democratically-controlled House could agree. After Congressional Democratic leaders determined that the only chance of overriding a Presidential veto was to pass a version of the bill that closely adhered to the more limited SCHIP-only package produced by the Senate, the effort began in earnest to find strong support in Congress among Democrats and moderate Republicans. When the vote was finally held on Tuesday night, the legislation passed by a vote of 265-159 – 25 votes short of the 290 to override a veto. The Senate’s Thursday vote on the compromise package yielded a 67-29 victory. In what has become a seemingly daily ritual, the White House issued another veto threat of the compromise legislation on Tuesday, garnering criticism even from Congressional Republicans.
An analysis of the vote leads ACAP staff to believe that its possible to move enough votes in the House to override a veto. Forty-five (45) Republicans voted in favor of the CHIP compromise and against the wishes of both President Bush and the House Republican Leadership. Eight Democrats voted against the package and 9 members of Congress either did not vote or voted “present.” That means that, if the House Democratic Leadership could convince the 12 Democrats who voted nay/DNV to change their vote, only 13 Republicans would be required to change their vote to override the veto. An analysis of the Republican Representatives voting against CHIP shows that many come from rust belt states (whose economies may increase demand for children’s health coverage for the working poor) or states with a strong history of supporting public health insurance. ACAP will analyze the list for our members and will begin working with plans to turn up the heat on Representatives who voted against this bipartisan compromise.
Meanwhile, Congressional Democrats on Tuesday introduced a stopgap spending bill (HJ Res 52) that would fund at current levels the budgets of Cabinet departments and government agencies until November 16. The continuing resolution also would temporarily extend SCHIP after the expected Bush veto by providing $5 billion in funding for 2008, while Congress and Bush continue to debate reauthorization and expansion of the program. New Jersey Files Lawsuit Against Bush Administration, New York and Seven Other States Will also Files Eight states initiated legal challenges Monday against the Bush Administration for violating provisions of the federal State Children’s Health Insurance Program (SCHIP) by publishing an August 17 policy guidance limiting coverage to children living at or below 250 percent of the poverty level. In a letter to state Medicaid directors, Federal health officials informed states that they will no longer receive federal matching funds for children in families with incomes above 250 percent of the poverty level unless states meet several tests that are believed to be nearly insurmountable. These tests include proving that 95% of children with family incomes below 200% of the poverty rate have insurance coverage and that private insurance coverage rates of children with family incomes above 250% of poverty have not decreased by more than two percentage points.
New Jersey’s Governor Jon S. Corzine, who estimates that 10,000 children will lose health insurance under the new rules, filed suit in federal court in Trenton Monday. Governor Corzine on September 12 sent a letter to President Bush threatening legal action and vowing to continue to enroll New Jersey children in FamilyCare (New Jersey’s SCHIP program) despite the federal guidance. New Jersey covers children in families with incomes up to 350 percent of the FPL and has the highest eligibility level in the country. Earlier in the season, Governor Ted Strickland of Ohio joined Senator Sherrod Brown in sending a letter to Health and Human Service Secretary Mike Leavitt demanding the administration reverse course, stating that the Bush policy would prevent thousands of children access to health insurance.
In a statement released Monday, New York governor Eliot Spitzer said that he intends to file a lawsuit if President Bush makes good on his repeated threats to veto H.R.976, the Children’s Health Insurance Program Reauthorization Act, which would provide new funds to all states for their SCHIP programs through 2012. New York will be joined by Maryland, Illinois and Washington, and Arizona, California and New Hampshire will file amicus briefs in the case. Three weeks ago the federal health officials denied a request by New York to cover more children in SCHIP by raising the income eligibility level from 250 percent of the poverty rate to 400 percent.
All eight states contend that the new eligibility policies, which do not have the strength of statute or regulation, will either force out children in the program or leave tens of thousands without coverage who would be eligible.
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. ACAP signed on to a letter circulated by the American Academy of Pediatrics and the Children’s Health Group urging President Bush to support the SCHIP program and not veto the reauthorization agreement that both chambers of Congress passed last week. The letter stresses the bipartisan roots of SCHIP, stating that it has been a "cost-effective means of ensuring that children receive appropriate preventive care, and, in partnership with Medicaid, has improved child health outcomes and significantly increased access to health services." More than one hundred additional organizations cosigned the letter. |
| EXCELLENCE AND ACCOUNTABILITY |
Recap: Pharmaceutical Roundtable, September 27, 2007 Jennifer Babcock, ACAP Assistant Director for Policy, presented an overview of the House and Senate actions on the Medicaid Prescription Drug Rebate Equalization Act of 2007. She also presented an overview of two new reports produced for ACAP by The Lewin Group - Programmatic Assessment of Carve-In and Carve-Out Arrangements for Medicaid Prescription Drugs and Financial Assessment of Carve-In and Carve-Out Arrangements for Medicaid Prescription Drugs -- which provide useful information on the benefits of maintaining a drug carve-in. In addition, she gave an update on the CMS requirement that all drug prescriptions for Medicaid enrollees be written on tamper-resistant prescription pads. Jenny emphasized that the requirement for the use of a tamper-resistant prescription pad does not apply when a managed care entity pays for the prescription. So for most of the plans, the tamper-proof prescription blanks are a non-issue unless their state mandates it. Catherine Pappas, PharmD, Director of Pharmacy at NHP MA, then summarized key points in two articles: "As Drug Payment Model Changes, Confusion Grows among Insurers" (Managed Care, February 2007), and "The Arrival of Average Sales Price" (Biotechnology Healthcare, June 2007). Two fairly recent laws and a pending out-of-court settlement will have an effect on how much the government and health plans pay for drugs. Purchasers are hopeful that life after "average wholesale price (AWP)" will be simpler, fairer, and, with luck, easier to grasp.
ACAP Job Bank
New York Health Plans
Demonstrate Increased PerformanceACAP 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 New York Department of Health recently released the 2006 performance information from more than 30 health plans certified by the Department to serve commercially and publicly insured (Medicaid, Child Health Plus and Family Health Plus) managed care members. In a September 19th press release, NY Health Commissioner Richard F. Daines, M.D., said, "The increase in health plan performance that we are witnessing translates into improved health care and thereby healthier New Yorkers. Even in areas where rates of performance are not yet where we would like to see them, we still are encouraged by the upward trends. We will continue to work with plans across the state to improve care and patient satisfaction." For plans serving members enrolled through Medicaid, increases were noted between 2000 and 2006 on a number of measures including customer service, early prenatal care, timely postpartum visits, children ages 12 through 21 years receiving primary care visits, screening for cervical cancer, dilated retinal examinations for members with diabetes and mental health visits within 30 days of an inpatient stay. While satisfaction with care went down slightly for commercial plans, members enrolled though Medicaid demonstrated an increase in the level of satisfaction with their health plan. The full text of the report can be found at http://www.nyhealth.gov/health_care/managed_care/reports/eqarr/2007/. |
| NEWSFLASH |
ACAP Presents Awards for Support of Medicaid to Representative Jay Inslee and Staffer Nick Shipley At ACAP’s 2007 CEO Summit, held July 24 and 25, The Honorable Jay Inslee, Democratic Congressman from Washington State, was presented with the ACAP 2007 Congressional Leadership Award. The award was presented by Hugh Ewart, Policy Analyst at Community Health Plan of Washington and long-time acquaintance of Mr. Inslee. Inslee thanked ACAP and remarked on a number of health policy issues pertinent to Medicaid managed care organizations, including health information technology and its impact on cost savings and quality improvements. Inslee mentioned that safety net plans are a natural partner in the drive to expand use of HIT, and also discussed H.R. 4157, the Health Information Technology Bill, which he supported and which passed in the House in the last Congress. Inslee then discussed the most salient health policy topic of the season, SCHIP reauthorization, and confirmed the Democratic Congress’s commitment to reauthorizing the program in such a way that will cover as many eligible but uninsured children as possible. Inslee derided the President’s veto threat, and also stressed that he has worked closely with the Chairmen of both the House Committee on Energy and Commerce and the Ways and Means Committee to mitigate concerns about harm to SNPs threatened by Medicare Advantage cuts. Mr. Inslee was given a plaque thanking him for his "strong and consistent support of Medicaid and the safety net health plans that serve millions of Americans who rely on the program for care." Inslee’s Legislative Director Nick Shipley was also awarded ACAP’s 2007 Congressional Staff Leadership Award. ACAP Welcomes University Physicians Health Plans (UPHP) in Arizona as Its Newest Member University Physicians Health Plans (UPHP) which runs 2 Medicaid plans in Arizona has become a new ACAP member. ACAP now represents 35 health plans with 4.2 million members in 19 states. UPHP is a division of University Physicians Healthcare. University Physicians Healthcare (UPH) is a nonprofit corporation made up of the faculty of the University of Arizona College of Medicine. In addition to the Health Plan Division, UPH has a faculty practice plan and operates University Physicians Hospital at Kino (formerly the county run hospital in Pima County). University Physicians Health Plans (UPHP) is comprised of University Family Care, an Arizona Medicaid HMO plan in Pima county and University Physicians Healthcare Group, a state sponsored small business product for businesses with 1-50 employees without insurance at the time of application. University Family Care has 9000 Medicaid lives and 9000 lives in the state sponsored small business product. In addition to the above two products, they took over the management of Maricopa Health Plan in October, 2005 through a contract with Maricopa Integrated Health System (MIHS), a special health care taxing district in Maricopa County. They are contracted through 2010 to manage the Plan for MIHS. The Maricopa Health Plan has 36000 Medicaid lives. Effective January, 2008 through a joint venture with UPH and MIHS, they will be operating a Medicare Special Needs Plan for dual eligibles. University Physicians Care Advantage will be the product in Pima County and Maricopa Care Advantage in Maricopa County. They are not capitated for long term care. As a Health Plan organization and an Arizona Medicaid plan contractor they have very rigorous performance measures for Medicaid utilizing HEDIS measurements. Historically UPHP has performed above the benchmark and often exceeds the goal on those measures. In this past year they have adopted PDSA quality process improvement modeling for operations throughout the health plan. They are in the final stages of the design of an Integrated Care Model, ensuring all touches throughout the member’s experience facilitate ease of access to care, removing barriers, and providing alternatives. They are also nearly complete with a redesign of their case management and disease management programs, combining them to form a Condition Management Program that will span all aspects of members’ clinical needs including Behavioral Health integration. UPHP has always performed well during the annual Medicaid Operational and Financials Reviews and are deemed to be "best practice" in several areas of plan operations. Kathy Oestreich is the CEO of the Maricopa Health Plan and CEO of UPHP. ACAP Says Goodbye and Thank You to Pat Barta Pat Barta will be leaving ACAP at the end of September. As most of you know, Pat Barta has been assisting ACAP with organizing and conducting our Roundtable calls and other projects. She has done an outstanding job. Speaking on behalf of ACAP staff and all our members, we wish Pat the best of wishes in her future endeavors! Please direct any questions or comments concerning the Roundtables to Deborah Kilstein at dkilstein@communityplans.net. Hudson Health Plan to Participate in Grant Project Focused on HIT Gov. Eliot Spitzer has announced $9.5 million in grants to four regional collaborations of health plans and providers to develop model programs that will help the state study innovative ways to provide higher-quality and more affordable patient-centered health care. Two of the grants are being directed to the Hudson Valley. The funding will support two-year projects focused on improving care for patients enrolled in both private and public health insurance plans. The funding will place special emphasis on treating heart attacks and managing heart disease, diabetes management and infection control, among other things. The projects will study and test incentive programs, including performance-based payments to physicians, hospitals and clinics that provide high-quality care to their patients. Pay-for-performance initiatives are being implemented across the country and have been credited with reducing medical errors and saving patients' lives. The state funding will pay project costs and help fund rewards to providers. Insurers are required to, at a minimum, match state funding for the projects. Participating health plans will select the incentive structure they use, but typical incentives include bonuses or increases in reimbursement rates provided to physicians, hospitals and clinics based on their performance meeting various measures of quality. The four projects receiving the grants are: Taconic Health Information Network and Community Regional Health Information Organization (Hudson Valley). THINC RHIO will explore improving the portability of patient records by combining health data from health plans, hospitals, pharmacies and laboratories with information gathered from electronic health records to create a complete and easily accessible picture of a patient's medical history. The project initially will target performance in antibiotic use, diabetes management, heart attack and infection control in inpatient settings. This Hudson Valley-based project involves regional health plans (MVP, CDPHP, CIGNA, Empire Blue Cross-Blue Shield, Hudson Health Plan and Aetna) and area hospitals. New York Health Plan Association (Capital Region and Hudson Valley). HPA is a statewide collaboration involving 12 health plans - Aetna, Affinity, CDPHP, Elderplan, GHI HMO, HealthNet, HealthNow, HIP, Hudson Health Plan, Independent Health Association, MV, and Oxford. HPA will partner with physician, business and consumer groups, Capital District hospitals and regional health information organizations to improve performance in ambulatory care measures statewide, including acute heart attack measures in the Albany/Schenectady area and diabetes measures in the Hudson Valley. Independent Health Association Inc. (Buffalo). This health plan will partner with regional plans HealthNow and Univera to implement a pay-for-performance program targeting improved provider performance in acute heart attack treatment, diabetes management, antibiotic use, and infection control. Montefiore Medical Center (Bronx). This provider of health services will partner with Aetna, Affinity Empire Blue Cross-Blue Shield, HealthFirst, HealthNet, 1199 SEIU Benefit and Pension Funds, Oxford health plans and a network of community-based providers to improve inpatient and outpatient care for residents with heart disease and its associated risk factors, including smoking and obesity. Oregon Health Forum to Recognize Dave Ford with a Visionary Leadership Award Oregon Health Forum will commend three Oregon health care leaders December 5 at the 2007 Health Care Leadership Awards Dinner. David Ford, president and CEO of CareOregon, will be recognized with a Visionary Leadership award. Other honorees include the following: Dr. Peter Kohler, president emeritus of Oregon Health & Science University, will receive the Lifetime Leadership award and Dr. Tina Castañares, family physician at La Clínica del Cariea and medical director for Hospice of The Gorge, Hood River and The Dalles, will be awarded the Community Leadership award. Alameda Alliance for Health Chief Medical Officer Honored On September 7, 2007, the Asian Health Services paid tribute to Dr. Arthur Chen, MD, as part of their "Tribute to Advocacy Heroes" fall fundraiser. Dr Chen is the Chief Medical Officer at Alameda Alliance for Health. The purpose of the tribute is to honor the leadership and commitment of individuals who have made AHS a model community health center of multicultural health. Dr Chen’s professional career has been devoted to public service and advocating for health services for the underserved. Lisa Chimento Named Executive VP of The Lewin Group Ingenix recently announced that Lisa Chimento has been named executive vice president of The Lewin Group, effective September 7. Lisa replaces Ron Johnson, who is retiring. Lisa joined The Lewin Group in 1994 and has become a nationally-recognized expert on Medicaid and managed care. She has worked with more than two dozen state purchasers on a range of Medicaid purchasing and performance improvement efforts, including Medicaid benefit and eligibility studies and modeling; cost containment analysis; and managed care, disease management, and case management initiatives. Regarding Lisa’s promotion, Lewin wrote "As a promotion from within the organization, this change represents a new chapter for Lewin, building on this group’s rich history and powerful brand. Lisa is the ideal leader to move the team forward as The Lewin Group deepens its traditional areas of expertise and expands into related territory. Specifically, Lisa will continue to develop our consulting strengths serving our public sector clients, while also helping us broaden the application of the unbiased measurement and evaluation services that are our hallmark." Lisa has worked closely with ACAP on a number of projects, and ACAP wishes her well. German Chancellor Fellowship Program Accepting Applications for 2008-09 Germany’s Alexander von Humboldt Foundation awards ten German Chancellor Fellowships annually to young professionals in the private, public, not-for-profit, cultural and academic sectors who are citizens of the United States. The program sponsors individuals who demonstrate the potential to strengthen ties between Germany and their own country through their profession or studies. Prior knowledge of German is not a prerequisite. The German Chancellor Fellowship provides for a stay of one year in Germany for professional development, study, or research. Applicants design individual projects and decide at which institutions or organizations to pursue them. Successful candidates have come from such fields as government, social and policy sciences, law, journalism, communications, management, finance, economics, architecture, public service, the humanities, the arts, and environmental affairs. Candidates from the life sciences and engineering will be considered if their topics have a compelling social or humanistic dimension. The program begins September 1 and lasts twelve months. It is preceded by language classes in Germany. Monthly stipends range from 2,000 to 3,000 EUR, and allowances are available for accompanying family members, travel expenses, and introductory German language instruction in the United States. Candidates must possess a bachelor’s degree and be under 35 years of age at the start of the award. Application deadline for 2008-2009 awards: October 31, 2007. The German Chancellor Fellowship provides for a stay of one year in Germany for professional development, study, or research. Applicants design individual projects and decide at which institutions or organizations to pursue them. Meg Murray, CEO of ACAP, was a Fellow in 1992-93. Applications and information for U.S. citizens: www.humboldt-foundation.de/en/programme/stip_aus/buka.htm  |
| Upcoming Events |
October Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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6/7 |
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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 |
13/14 |
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15 |
16 |
17 |
18 Compliance Officer Roundtable |
19 Medicare Conference Call |
20/21 |
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22 Program Committee |
23 QM Committee |
24 |
25 Quality Manager/Disease Management Roundtable Finance Committee Call @ 4 pm EST |
26 |
27/28 |
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29 |
30 Executive Committee Call @ 3 pm EST |
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, CEO, 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 |