| |
ILLINOIS ANNOUNCES MEDICAID MANAGED CARE PILOT
The state of Illinois is planning
a pilot project to enroll Medicaid recipients in six counties in
managed care, an effort being criticized by advocates for the
developmentally disabled.
Illinois' Medicaid agency announced Monday it's seeking
proposals from managed care organizations to run the program. It
would affect 40,000 adults with disabilities and older adults in
DuPage, Kane, Kankakee, Lake, Will and suburban Cook counties.
The state expects the program to save taxpayers nearly $200
million in its first five years.
CENTENE CORPORATION TO ACQUIRE MEDICAID HEALTH PLAN IN SOUTH
CAROLINA
Centene Corporation announced
that its South Carolina subsidiary, Absolute Total Care, has
signed a definitive agreement to acquire Columbia-based Carolina
Crescent Health Plan (CCHP), the state's largest non-profit
Medicaid managed care organization, from University Health
Services, Inc. (UHS). CCHP serves more than 40,000 Medicaid
members in 46 counties across the state.
Consistent with Centene's stated goal of growing its South
Carolina plan to cover between 10-15 percent of the eligible
Medicaid population, Absolute Total Care expects to provide
managed care services for approximately 90,000 Medicaid members
after the acquisition, or approximately 13 percent of the
state's eligible Medicaid population. The transaction is
contingent on receiving approval from state regulators and is
expected to close in the third quarter of this year.
The addition of the CCHP membership to Absolute Total Care will
enable the company to leverage its care management capabilities
across nearly twice as many members, with the potential to
significantly improve health outcomes and reduce costs for the
state's Medicaid members. Absolute Total Care will work closely
with CCHP to ensure a seamless transition for members, providers
and other stakeholders.
"The expansion of our South Carolina operations is consistent
with our strategy to effectively and prudently deploy capital to
grow our business," said Centene Chairman and Chief Executive
Officer Michael F. Neidorff. "Like all accretive acquisitions,
this transaction will allow us to leverage our business platform
and systems across a broader member base, enabling us to provide
better service at lower cost to our customers. Our ongoing
leadership in providing managed care by working locally with the
state, the health care providers and our members serves to
improve health outcomes in a cost effective manner."
7TH ANNUAL WORLD HEALTH CARE CONGRESS
The 7th Annual World Health Care
Congress (WHCC) to be held April 12-14, 2010 in Washington, DC,
will convene over 2,000 CEOs, senior executives and government
officials from all sectors of health care including the nation's
largest employers, hospitals, health systems, health plans,
pharmaceutical and biotech companies, and leading government
agencies.
ACAP members can save $200.00 off the current registration fee.
To receive the reduced ACAP rate, contact WHCC at 800-767-9499
with code ESJ482 (not applicable on gov’t/military rates). Learn
more at
www.worldhealthcarecongress.com.
COST-SHARING REQUIREMENTS FOR MEDICARE ADVANTAGE PLANS VARY
WIDELY FROM PLAN TO PLAN AND FROM TRADITIONAL MEDICARE
A new analysis from the Kaiser
Family Foundation, "Medicare Advantage 2010 Data Spotlight:
Benefits and Cost-Sharing,” found that 79% of MA plans in 2010
have a limit on out-of-pocket spending for Part A and Part B
services, while traditional Medicare does not. Kaiser found that
the share of all MA plans with any limit on out-of-pocket
spending has increased from 66% in 2008 to 79% in 2010. However,
among MA plans with limits, the share with limits of $5,000 or
more increased from 2% in 2008 to 10% in 2010; among regional
PPOs the share increased from 28% to 61%, according to the
study. When it comes to cost sharing for inpatient hospital
care, MA plans typically apply fixed-dollar copayments, in
contrast to traditional Medicare, which has an inpatient
deductible ($1,100 in 2010 per episode of illness) and no
coinsurance for inpatient hospital stays of up to 60 days,
according to Kaiser. The study reported that 93% of MA plans
provide unlimited days of hospital care, in contrast to
traditional Medicare, which has annual limits and “lifetime
reserve” days. According to Kaiser, 94% of MA plans require
enrollees to share in the costs of inpatient care. Among those
plans, 81% impose copays, 2% impose coinsurance, and 11%
(primarily PPOs to distinguish between in-network and
out-of-network care) use both. The foundation added that 6% of
all MA plans have no cost-sharing requirements. Among MA plans
charging copays for inpatient care, 79% charge a copay per day,
16% charge a copay per stay, and 5% charge both copays per day
and stay in 2010, the study found. For more on the study, visit
www.kff.org/medicare/8047.cfm.
CMS ANNOUNCES PROPOSED REALIGNMENT
CMS announced that as part of its
commitment to providing quality care and quality customer
service to all people who rely on Medicaid, CHIP and Medicare,
the Agency is considering a realignment to allow the Agency
to better focus on three key areas: beneficiary services,
program integrity, and strategic planning.
First, CMS announced two new positions at CMS, including a new
Principal Deputy Administrator, Marilyn Tavenner, and a Deputy
Administrator for Program Integrity, Peter Budetti. In addition,
realigned areas include:
- The Center for Medicare
combines Medicare fee-for-service, managed care, and the
prescription drug benefit. The Center will report directly
to the Administrator and be led by the Deputy Administrator,
Jonathan Blum, and two Deputy Center Directors. Existing
groups/staffs of the current Center for Medicare Management
and Center for Drug and Health Plan Choice will be realigned
intact under the new Center.
- The Center for Medicaid and
State Operations (CMSO) is renamed the Center for Medicaid,
CHIP and Survey & Certification. The Center will report
directly to the Administrator and be led by the Deputy
Administrator, Cindy Mann, and two Deputy Center Directors.
Existing groups/staff will remain in the renamed Center
except for the Medicaid Integrity Group, which will be
realigned under the Center for Program Integrity.
- The Center for Program
Integrity realigns the (Medicare) Program Integrity Group of
the Office of Financial Management (OFM) and the Medicaid
Integrity Group of the Center for Medicaid and State
Operations (CMSO). The Center for Program Integrity will
report directly to the Administrator and be led by the
Deputy Administrator and the Deputy Center Director. The two
groups will move intact under this Center and be renamed the
Medicare Program Integrity Group and the Medicaid Program
Integrity Group, respectively. As mentioned above, Peter
Budetti will serve as the Deputy Administrator for Program
Integrity.
- The Center for Strategic
Planning realigns the Office of Research, Development, and
Information (ORDI) and the Office of Policy (OP). This
Center will report directly to the Administrator and be led
by the Deputy Administrator. Existing groups/staff in ORDI
and OP will be realigned intact under this new Center.
- The Office of External
Affairs & Beneficiary Services realigns the Office of
Beneficiary Information Services (OBIS) with the Office of
External Affairs (OEA) thereby allowing CMS to integrate and
better leverage its communication, call center and web
resources; ombudsman services; and extensive network of
partners to enhance service to beneficiaries. This Office
will report directly to the Administrator and be led by the
Office Director, Teresa Niño, and two Deputy Office
Directors. Existing groups/staffs in OBIS and OEA will be
realigned intact within the new Office.
The role of Acting Administrator and Chief Operating Officer
will continue to be filled by Charlene Frizzera.
 |
VENDOR ALLIANCES |
SUMMIT RE RENEWS AS ACAP PREFERRED VENDOR
Summit Re is a managing general
underwriter and reinsurance advisor, working with managed care
plans from coast to coast. The company helps health plans
analyze, manage and transfer risk to protect their financial
stability. Summit Re represents Swiss Re, a leading and highly
diversified global reinsurer with more than USD 23 B in annual
premiums. Summit Re and Swiss Re have an exclusive arrangement
for the provision of HMO and provider excess loss coverage.
Summit Re was founded on the following principals of operation:
- Practice consistent but fair
underwriting.
- Deliver benchmark customer
service.
- Offer value-added managed
care programs to complement those of its clients.
- Provide products and
services to assist clients who want to expand into other
insurance programs
Summit Re and Swiss Re personnel
are experienced and possess the skills necessary to help clients
meet their strategic objectives. The team includes seasoned
FSA-level actuaries, registered nurses and certified public
accountants. These professionals, and others at Summit Re, work
to provide flexible, customized solutions. This includes not
only risk transfer protection, but also more sophisticated
approaches that focus on the efficient use of capital.
Summit Re markets directly to health plans. Direct contact leads
to a thorough understanding of the risk that Swiss Re and the
client are assuming and allows Summit Re to work with the health
plan to best match the excess loss coverage to the plan’s needs
and objectives. This direct interaction is particularly
important due to complex product structures and the fact that
needs continuously evolve. In addition, understanding the plan’s
unique business strategies and having direct contact with the
plan’s management staff allow Summit Re to match other products
and services to the plan’s needs.
Summit Re’s primary focus since its inception in 1999 has been
excess medical business. As such, it has had extensive exposure
to catastrophic claims of all nature, from complex newborns to
severe trauma. Summit Re has developed a full array of managed
care services that are designed to offer cost savings, primarily
through appropriate care management that is focused on clinical
outcomes. The program is called “Summit ReSources” because the
services truly are indispensible resources for clients. The
services provided through Summit ReSources include:
- Medical management
consulting
- Consultative care management
- Comprehensive evaluations of
clients’ medical management policies and procedures
- Cost management, such as
bill audits, provider contract analysis and claim
negotiations
- Specialty services,
including access to organ transplant networks, and neonatal,
chronic kidney disease, congenital heart disease management
- Training and education.
Summit Re is a market-leading
expert in HMO reinsurance. Its years of experience and
trend-setting product solutions have long been the industry
standard for managed care reinsurance. For more information,
please contact Anne Cavanaugh, assistant vice president, (260)
469-3003,
acavauaugh@summit-re.com, or visit the company’s web site,
www.summit-re.com.
|
|
