 December 4, 2007 |
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Upcoming ACAP Calls
November 29: CMO Roundtable December 4: Medicare SNP Roundtable December 13: Chief Information Officers 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 Carolina Crescent
Children's Mercy Family Health Partners |
| HIGHLIGHTS |
Monroe Plan and Neighborhood Health Plan of Rhode Island Ranked in Top 5 in NCQA Annual Rankings for "America’s Best Health Plans" U.S. News & World Report and the National Committee for Quality Assurance (NCQA) unveiled the third edition of America’s Best Health Plans, an annual ranking of U.S. health maintenance organizations and point-of-service plans. Coinciding with the November launch of "open season," when many families face health plan selection options, the rankings were published in the November 5 issue of U.S. News. The 2007 online edition of America’s Best Health Plans includes data and information on nearly 550 commercial, Medicare, and Medicaid health plans, as well as identifying 150 plans that chose to report no data. The rankings are based on more than 100 aspects of clinical performance, such as a plan’s ability to help diabetic members meet a blood pressure target number, and customer satisfaction, such as how satisfied members are with specialists they see. Congrats to ACAP members NHPRI and Monroe Plan who were in the top 5 of Medicaid plans. The Top 5 Medicaid Plans:
Click Here for the entire article and rankings. Click Here for the US News and World Report Online Article and Rankings. 2007 NCQA Awards Recognize Monroe Plan Seven health plans participating in Center for Health Care Strategies (CHCS) initiatives to reduce disparities and improve health care quality were selected by the National Committee for Quality Assurance (NCQA) for the 2007 "Recognizing Innovation in Multicultural Health Care Award" including Monroe Plan/Execllus BlueCross BlueShield, Rochester Region (HMO), N.Y. The seven plans were among nine managed care organizations that were chosen for this national recognition out of 35 submissions. University of Pittsburgh Medical Center and ACAP member Monroe Plan for Medical Care were chosen for pilot projects undertaken in CHCS' Medicaid-focused workgroup on Improving Health Care Quality for Racially and Ethnically Diverse Populations. The workgroup was funded by the Robert Wood Johnson Foundation and The Commonwealth Fund. "These plans have made great strides in using data to uncover disparities and implementing tailored approaches to address the identified gaps in care," said Stephen A. Somers, PhD, president of CHCS. "We applaud the winning plans for their commitment to reducing inequalities in care and for sharing their experiences to help other organizations learn from their successes." Within Excellus/Monroe’s Medicaid member population, Neonatal Intensive Care Unit (NICU) admission rates are higher for African American teens compared to the Caucasian teen population. The costs of such admissions are significant both in terms of financial and developmental repercussions. In light of this, Excellus/Monroe Health Plan initiated a program which gave pregnant African American teens face-to-face contact with outreach workers with common cultural background and experience. Through social risk and substance use assessments, regular home visits, and the development and implementation of unique care plans, the initiative addressed the individual care needs of each participating member. Additionally, Excellus/Monroe gave providers incentives to complete a prenatal registration form which facilitated risk stratification and initiated outreach. Focus groups were also conducted, providing a framework for quality improvement. The results of this initiative were twofold: NICU admissions decreased and Excellus/Monroe saw a large return on investment. Admissions rates for African American teens decreased from 17.2% to 15.2% in 2004 and in 2006, rates continued to decrease down to 12.9%. In 2004, relative to all other ethnicities combined, African Americans were 3.75 times more likely to have a NICU admission. In 2005, this ratio dropped to 2.08 and in 2006, it dropped to 1.92. Click Here for descriptions of other awardees programs. New Report Shows That Seven More States Are Considering Carving Drugs Out of Medicaid Managed Care A report released last week by the National Association of State Medicaid Directors (NASMD) confirms that in 2007, 11 states maintained a full carve-out for prescription drugs in Medicaid with another 7 considering doing it. The report, 2007 State Perspectives, Medicaid Pharmacy Policies and Practices, is the second in an annual series on Medicaid pharmacy issues and uses data from NASMD's survey of all states and territories. The 11 states whose Medicaid programs fully carve drugs out are Delaware, the District of Columbia, Illinois, Iowa, Nebraska, Nevada, New York, Tennessee, Texas, Utah and West Virginia (ACAP states are bolded). Nine states carve some drugs out of managed care. These are California, Florida, Hawaii, Maryland, Michigan, Oregon, South Carolina and Washington. Eight states said that they use the state’s federal rebate levels when setting the capitation rate, instead of the plans’ experience. According to an ACAP study by the Lewin Group, under the drug rebate, states receive between 18 and 20% discount on brand name drug prices and between 10 and 11% for generic drug prices. Medicaid-focused MCOs, on the other hand, typically only receive about a 6% discount on brand name drugs and no discount on generics. This discrepancy is one reason why ACAP has championed the Drug Rebate Equalization Act to ensure that all plans can receive the federal rebate and not be penalized if states base their capitation rates on the federal rebate levels.
Click Here for
ACAP's Drug Carve Out Report |
| PUBLIC POLICY AND ADVOCACY |
Don't Hold Your Breath for CHIP, But DRE Gains Traction with Medicare Despite the national attention and energy given to CHIP reauthorization by a wide array of stakeholders this year, Congressional efforts to arrive at a compromise that would draw a sufficient number of Republicans votes to override a Presidential veto without repelling a larger number Democratic votes have so far fallen flat. Ongoing discussions on the Hill have led to nothing, except, it seems, diminishing attention by a previously energized stakeholder community. Meanwhile, the President continues to oppose the tobacco tax, while stating their real aim is to cover the “right” children (meaning those with family incomes less than twice the federal poverty rate) in CHIP. The Senate has only just sent forward the bill passed by both chambers early in November, which President Bush is expected to veto soon. The President signed a continuing resolution in November which will level-fund states for CHIP until December 14. The Congress may be forced to produce additional continuing resolutions throughout the fiscal year, but because these provide many states with a bare minimum of funds to continue their programs, states are expected to begin to experience shortfalls in the spring. As a result of the politics and uncertainty, ACAP has long since abandoned CHIP as a vehicle for passing our Drug Rebate Equalization Act (DRE). Other advocacy organizations are calling for Congress to give up on long-term reauthorization and focus solely on short-term funding fixes instead. Fortunately, both chambers of Congress are also developing legislation that would rectify a physician payment reduction scheduled for January 2008, and we have received reliable intelligence that the DRE has a good chance of being used as a payfor for this legislation. (ACAP members were asked in mid-November to take action to contact all members of Congress to promote the DRE as a funding source for the Medicare package.) At the same time, the DRE gained another cosponsor in the House – Pennsylvania Representative Chaka Fattah – courtesy of one of ACAP's newest members, Amerihealth Mercy. Also deserving of special mention regarding the DRE is Neighborhood Health Plan of Rhode Island, whose CEO Mark Reynolds was honored at ACAP's November Board meeting for achieving 100 percent participation on the DRE among the Rhode Island Congressional delegation. Lastly, a critical member of House Democratic leadership, Rahm Emanuel, has also become a cosponsor, which will provide traction to our march toward passage.
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. Our sources tell us that the House Medicare language is identical to that in the House’s earlier CHIP reauthorization bill, which includes reauthorization of the Special Needs Plans (SNP) and standards for SNPs. Our sources say that SNP reauthorization is also included in the current draft of the Senate Medicare bill. |
| EXCELLENCE AND ACCOUNTABILITY |
Network Health Executive Director Posts Churning Article on WBUR Commonhealth Blog Network Health's Executive Director Christina Severin, has posted an article on the WBUR Commonhealth blog called "The Cost of Missed Coverage," which highlights key issues impacting involuntary disenrollment and churning. The article can be found at http://www.wbur.org/webblogs/commonhealth/?p-24.
ACAP Job Bank
American Academy of
Pediatrics Article Shows Medicaid Quality Is Higher in Managed CareACAP 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. An article published December 2005 in the journal Pediatrics describes a decline in health care quality for children in the Colorado Medicaid program when the State moved away from Medicaid managed care to a fee-for-service delivery system. The study found:
Factsheet: Medicaid-Focused Health Plans Cover Over 50% of All Medicaid Capitated Lives for the First Time. More Than 40% Are Enrolled in ACAP Plans! ACAP staff have produced a fact sheet on the enrollment trends for Medicaid-focused health plans. As of June 30, 2006, nearly 10 million beneficiaries were enrolled in Medicaid-focused health plans (MFHPs), for the first time making up half of the total number of Medicaid health plan enrollees in fully-capitated managed care. Collectively, ACAP plans serve over 4 million of these lives. MFHPs serve managed care enrollees in Medicaid, SCHIP and other public insurance programs for low-income and vulnerable populations, but do not serve commercial health insurance enrollees. The factsheet further provides information on Medicaid-focused health plans’ enrollment trends and market participation, and how these numbers differ from their commercial counter parts. For example, the number of Medicaid-only health plans as a proportion of all Medicaid-serving health plans has increased from 32 percent to 46 percent since 1998. Also, the number of Medicaid enrollees in Medicaid-focused plans has increased as a percentage of all MMC enrollees (including commercial) from 39 percent to 50 percent since 1998, and the number of Medicaid enrollees in Medicaid-focused plans has nearly doubled in size (a 96 percent increase) where as the number of commercial Medicaid health plan enrollees has increased only 35 percent since 1998.
Click Here for
Full Fact Sheet
Click Here for Full Fact Sheet Click Here for Article in JAMA
Click Here for ACAP's Response Recap: Chief Medical Officers Roundtable On November 29, 2007, 8 plans participated in the Chief Medical Officers Roundtable. Dr Renee Rulin, Medical Director for Commonwealth Care Alliance presented on evaluating behavioral health carve-outs as outlined in the Fact Sheet "Medicaid and health plan contracting for behavioral health services - the role of carveouts." The Fact Sheet was developed based on a survey of 18 ACAP plans from 12 states. Dr. Rulin presented information on the use of carve-outs by state Medicaid programs and the use of vendors by Health Plans. This led to a discussion of how health plans should evaluate the effectiveness of carve-outs based on program goals, financial performance and efficiency (value). The real need is for care coordination and contract decisions should be made based on the impact on the appropriateness of the care model. The call ended with a discussion of the role ACAP could play including the development of potential integration measures and an evaluation tool for behavioral health vendors with an emphasis on patient outcomes.
Click Here for Behavioral Health Report |
| NEWSFLASH |
Elizabeth Ward Says Goodbye to ACAP Elizabeth Ward will be leaving ACAP to care for family. "I have enjoyed working with each of you, and will miss working with so many great health plans and people." The ACAP staff and the Board would like to thank her for all of her dedication and hard work she has put into the association over the years. Liz has been a valuable asset and we are very sad to see her leave. She will be sorely missed and has done an outstanding job developing our SNP agenda. We are currently recruiting for a fulltime replacement. If you have questions about Medicare issues, please contact Meg Murray (mmurray@communityplans.net) or Christina Boye (cboye@communityplans.net). ACAP CEO Debates LTC Managed Care at NASMD Conference Meg Murray, CEO of ACAP, defended the merits of LTC managed care in a mock debate with John Folkemer, the Medicaid Director in Maryland. Under the previous Governor, Maryland had proposed a LTC managed care pilot. John gave the reasons why the pilot project had difficulties to begin with and then did not get implemented, including difficulties getting CMS, provider and advocacy approval. Meg Murray, Mary Kennedy of EverCare and Barbara Johansson from Molina Health jumped in to convince John that, in fact, LTC managed care was working in AZ, FL, MA, MN, WA, TX and NY. An evaluation of Medicaid LTC managed care by Kane and Homyak for CMS found that in Minnesota enrollees had fewer hospital admissions and days, fewer preventable hospital admissions, and fewer emergency room visits than control group members. At the end of the debate, John conceded the points and ‘fessed up that, in fact, Maryland was again going to attempt LTC managed care. CMS Agrees to ACAP Proposal to Collect Medicaid HEDIS Data Nationally….Finally – After several years of requesting that CMS again collect HEDIS data nationally, at the NASMD conference in response to a question from Meg Murray of ACAP, Dennis Smith agreed that CMS would fund this project. The collection and publication of the data measures is directly aligned with the CMS Value-Driven Health Care efforts and the Federal Government Performance Act Goal based on the Medicaid Quality Improvement Program (MQIP) as Meg’s question pointed out. The collection and publishing of data from all Medicaid managed care plans that collect HEDIS or HEDIS-like data will assist the federal government in identifying trends in the quality of care provided by managed care plans. It would allow comparisons across time, across state and region, across type of plan and between the commercial and Medicaid populations. Having this data could help prevent the type of misleading article that recently was published in the Journal of the American Medical Association, Quality of Care in Medicaid Managed Care and Commercial Health Plans by Landon et al. While the article pointed out that unsurprisingly commercial HEDIS scores were higher on average than Medicaid HEDIS scores, it did not address at all the unsung story of the progress made by Medicaid health plans to provide care exceeding the lower quality ratings historically ascribed to the Medicaid fee for service program. See article above ACAP's response to JAMA article on Medicaid HEDIS Scores. A letter of support for the collection of HEDIS data nationally drafted by ACAP was signed by the National Association of State Medicaid Directors, Center for Health Care Strategies, National Committee for Quality Assurance, Medicaid Health Plans of America, Alliance for Community Health Plans, New York State Coalition of Prepaid Health Services Plans, American Academy of Pediatrics, National Association for Community Health Centers, and Local Health Plans of California. Stay tuned for more information!
Former Colorado Access
CEOs Launch DeltaSigma, LLC
DeltaSigma, LLC P.O. Box 632273, Littleton, CO 80163-632273 Don Hall: 720.849.2480 don.hall@deltasigmallc.com, Sherry Rohlfing: 303.907.0144 sherry.rohlfing@deltasigmallc.com, www.deltasigmallc.com Indiana Says Kids Get Better Mental Health Care from Managed Care Indiana's Human Services chief told a state panel that Hoosier Healthwise is delivering better psychiatric treatment to needy children since it switched to a managed care system in January. Hoosier Healthwise provides medical and psychiatric care to more than 500,000 low-income Indiana children. That care is managed through three insurers: Indiana-based and ACAP member MDWise, Anthem and St. Louis-based Managed Health Services. Each of the three partners with managed behavioral health organizations to provide psychiatric care. Secretary Mitch Roob of the Family and Social Services Administration presented the data, including statistics showing the three Hoosier Healthwise insurers had approved outpatient care for 89 percent or more of minors diagnosed with mental illnesses during the first eight months this year. That compared with about 40 percent under fee-for-service in 2006. The commission last month had requested extensive data on how well Hoosier Healthwise was providing managed psychiatric care following complaints that insurers too often were rejecting requests for treatment. Representatives of the insurers said they were taking steps to deliver better care to kids. Michelle Brochu, vice president of operations at Comprehensive Care Corp., or CompCare, the managed behavioral health organization working with MDWise, said her company has added more staff and made other changes to better handle claims from doctors and other providers. CompCare also has a full-time discharge planner working with parents to ensure children receive follow-up mental health care once hospital stays have ended. "That patient still needs support and still needs services," Brochu told the commission. CareSource Recognized for Workplace Diversity CareSource was recognized for its corporate diversity efforts at the National Conference for Community & Justice’s (NCCJ) 30th annual Friendship Dinner on Monday, October 22, 2007. Pamela B. Morris, President and CEO of CareSource, accepted on behalf of the company the Greater Dayton Workplace Diversity Award from the NCCJ Board of Directors, the Dayton Area Chamber of Commerce, the Greater Dayton Commission on Minority Inclusion, and Frank Gates Higher Ground. The award is presented annually to businesses who have demonstrated diversity programs that have an impact on recruitment/retention; include senior leadership and stakeholders; human and financial resources dedicated to the success of the initiative; process and/or product innovation as it relates to the diversity initiative; and evidence that the diversity effort is an integral part of the strategic plan and is incorporated into day-to-day business. According to Morris, "Diversity has been part of CareSource since it was founded 18 years ago. We are proud to have developed an environment where each individual’s unique talents and perspectives are understood, valued, respected and leveraged." CareSource CEO Named Ernst & Young Entrepreneur Of The Year 2007 National Winner Pamela Morris, President and CEO of CareSource Management Group, has been named the Ernst & Young Entrepreneur Of The Year 2007 national award winner in the Health Services category. A panel of independent judges selected the national award winners in 10 categories from approximately 400 regional award recipients. In June 2007, Morris won the South Central Ohio & Kentucky region Entrepreneur of the Yearâ Award, which made her eligible for national consideration. “When I think of what makes a true entrepreneur – innovation, financial flexibility, personal commitment – Pam Morris has continually demonstrated that she has what it takes to be recognized as one of America’s leading entrepreneurs,” said J. Thomas Maultsby, chairperson of CareSource Management Group’s Board of Directors. In 1989, Morris pioneered CareSource (then known as Dayton Area Health Plan), which was the state’s first mandatory Medicaid managed care program. Overcoming numerous obstacles including amending a federal law, Morris has established CareSource as a company that continues to evolve and thrive. With more than 553,000 members, CareSource is the largest Medicaid HMO in Ohio, and the 4th largest Medicaid HMO in the country according to HealthLeaders-InterStudy, a healthcare business information company that analyzes health plans, specific geographic healthcare markets, and the managed Medicare and Medicaid markets. “This award honors our nearly 800 employees who keep the dream alive and make a difference in the lives of our members everyday,” Morris said. Now in its 21st year, the Entrepreneur of the Year Awards, sponsored by Ernst & Young LLP, recognize leaders and visionaries who demonstrate innovation, financial success and personal commitment as they create and build world-class businesses. In receiving this award, Morris joins an impressive list of successful entrepreneurs. Past winners of the national Ernst & Young Entrepreneur Of The Year Award in their respective categories include Michael Dell, Dell Computer Corporation; Jim McCann, 1-800-FLOWERS; Jeff Bezos, Amazon.com; Howard Schultz, Starbucks Coffee; and Leon F. Gorman, L.L. Bean.
CHCS Releases Report
Identifying Quality Improvement Strategies with Cost-Saving
Potential Grants Available to Educate Consumers on the Use of Generic Drugs Prescription Access Litigation is offering grants to nonprofit organizations to undertake consumer education campaigns about the safety, value and effectiveness of generic prescription drugs. The campaign is known as Generics are Powerful Medicine . The Request for Proposal and other information can be found on the Generics are Powerful Medicine website, www.genericsarepowerful.org. The applications for grants must be postmarked by January 15, 2008. EPA Accepting Applications for Award Program that Recognizes Exemplary Asthma Management Programs If your health plan is successfully addressing the management of environmental triggers as a part of your comprehensive asthma management program, you should consider applying for EPA’s National Environmental Leadership Award in Asthma Management. The National Environmental Leadership Award is presented to health plans and providers with exemplary asthma management programs that have shown exceptional leadership in improving asthma through the management of environmental asthma triggers. Recipients of the National Environmental Leadership Award are selected through a highly competitive process and are judged on established criteria. Winners are honored at EPA’s Communities in Action for Asthma-Friendly Environments National Asthma Forum from May 1-2, 2008, in Washington, D.C. and these programs' achievements will be highlighted throughout the year. Visit www.asthmaawards.info to learn more about the award and apply. The deadline for submitting an application for the 2008 National Environmental Leadership Award is February 1, 2008. State Health Rankings Released United Health Foundation, American Public Health Association and Partnership for Prevention recently released “America’s Health Rankings – A Call for Action for People & Their Communities.” For the last 18 years, this report has provided an annual assessment on the health of each state by ranking the states on a number of health determinants including personal behaviors (smoking, binge drinking, obesity, high school graduation rates), community environment (violent crime, occupational fatalities, infectious disease, children in poverty), public and health policies (lack of health insurance, per capita public health spending, immunization rates), clinical care (prenatal care, primary care physicians, Medicare preventable hospitalizations) and health outcomes (poor mental health days, poor physical health days, infant mortality, cardiovascular death, cancer deaths, premature death). This year, Vermont was ranked number one. This compares to Vermont’s ranking of 16 in 1990. The full report can be found at http://www.unitedhealthfoundation.org/ahr2007l. Effectiveness of Treatment and Realigning Incentives Key to Country’s Fiscal Health On November 8, 2007, the New England Journal of Medicine published an article entitled “Addressing Rising Health Costs – A View from the Congressional Budget Office.” According to the article, the fiscal health of the country will be determined by the growth of health care costs. Opportunities to constrain costs without adverse health consequences include generating more information about the relative effectiveness of medical treatments and realigning fiscal incentives for both providers and consumers to demand effective care. The article notes that “One approach that might improve the cost-effectiveness of disease-management and care-coordination strategies involves more accurately targeting these efforts toward the patients who would benefit the most. Indeed, the concept of better targeting is inherent in all the options considered here, from enhanced research on treatments to the designing of financial incentives. As medicine moves toward increasingly targeted therapies, the options for shifting insurance designs in the same direction merit consideration as policymakers grapple with the serious financial challenges faced by our public and private health insurance programs.” The article can be referenced at http://content.nejm.org/cgi/content/short/357/19/1885??eaf . CMS Unveils New Web Site on Medicare and Medicaid Integrated Care Systems The Centers for Medicare and Medicaid Ser vices (CMS) recently unveiled a new web site to serve as a centralized repository for resource information on the design and development of integrated care delivery systems. The website includes tools and reference materials including but not limited to information on program authority for integrated programs; state guides on integrated models, marketing, enrollment and quality; information on support for long term care capitated programs; program design checklists; reimbursement primer; information on an integrated Medicare and Medicaid appeals process; and related CMS guidance. The web site can be accessed at http://www.cms.hhs.gov/IntegratedCareInt/02_Integrated%20Care%20Roadmap.asp#TopOfPage.
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| Upcoming Events |
December Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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26 |
27 |
28 |
29 Chief Medical Officers Roundtable |
30 |
1/2 |
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3 |
4 Medicare SNP Roundtable |
5 |
6 Chief Financial Officers Roundtable |
7 |
8/9 |
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10 |
11 |
12 |
13 Chief Information Officers Roundtable |
14 |
15/16 |
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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, Chief Executive Officer, 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 |