Health Services for Children with Special Needs, Inc. (HSCSN) has joined ACAP as its 37th plan. HSCSN is an innovative care management network coordinating health, social, and education services for the pediatric Supplemental Security Income (SSI) and SSI-eligible populations of Washington, DC. The plan is part of the HSC Health Care System and reports to the Executive Vice President for the System, John Mathewson. HSCSN is not-for-profit, as is the HSC Health Care System.

Benefits to members and their families include traditional Medicaid benefits plus expanded health care services including individualized care management; 24-hour access to care coordination; outreach services; respite care; medically necessary home modifications; and mental, behavioral, and developmental wraparound services.  Read More...

3/11 Medicare Committee Call

3/12 Medicare Roundtable

3/13 Chief Operating Officers Roundtable

3/17 Program Committee Call

3/17 Quality Management Committee Call

3/18 Finance Committee Call

3/20 Pharmacy Roundtable

3/25 Executive Committee Call

3/26 Policy Roundtable

3/27 Compliance Officers Roundtable (** Note this is a NEW Date**)

4/1-4/3 ACAP Board, CFO, and Medicare Meeting San Jose, CA (Click Here to Register and View Agendas)

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CalOptima

CareOregon
Care Source
Carolina Crescent Health Plan, Inc.
Children's Mercy Family Health Partners
Colorado Access
Commonwealth Care Alliance
Community Health Network of Connecticut
Community Health Plan
Contra Costa Health Plan
Denver Health

Health Plan of San Mateo
Health Plus
Health Right

Health Services for Children with Special Needs
Horizon NJ Health
Hudson Health Plan
LA Care Health Plan
MDwise
MercyCare
Monroe Plan for Medical Care, Inc.
Neighborhood Health Plan of Massachusetts
Neighborhood Health Plan of Rhode Island
Network Health

Prestige Health Choice

Santa Clara Family Health Plan
Total Care
University Physicians HealthCare

UPMC Health Plan
Virginia Premier Health Plan, Inc.

On February 28, 2008, thirteen ACAP health plans participated in the CMO Roundtable call that focused on health plan management of radiology services. The call started with a brief overview of the issue. The featured presenter on this call was Dr. Thomas Hui, Medical Director of Horizon NJ Health who described an initiative in development at the health plan that focuses on the patient safety aspect of monitoring radiation exposure. This was followed by an open discussion that included the role of provider and member education.

Marketing Roundtable

On March 6, 2008, a Marketing Roundtable was held that focused on the health plan websites as an integral component of the plan’s marketing strategy. A panel of Marketing Directors from ACAP health plans provided an overview of how the company website fits into the health plan’s overall marketing plan. They discussed how the website has evolved over time; how successful the website has been as a marketing tool and the plan’s measure of success; how the website addresses the needs of diverse populations; and what changes they anticipate in the future.

NCQA Issues Proposed Changes for 2009

On February 14, 2008, NCQA issued proposed changes for the 2009 HEDIS and CAHPS measures. The changes include: five new effectiveness of care measures (Immunizations for Adolescents, Care for Older Adults, Medication Reconciliation, Body Mass Index Assessment for Adults, Body Mass Index Percentile Assessment, and Counseling for Nutrition and Physical Activity for Children and Adolescents); revisions to three existing measures (Antidepressant Medication Management, Breast Cancer Screening, Childhood Immunization Status); and revisions to the Child Version of the CAHPS Health Plan Survey. Two of the new measures are specific to Medicare (Care for Older Adults and Medication Reconciliation). More details including the proposed measure specifications can be found on the NCQA website at www.NCQA.org. NCQA will accept public comments on the proposed changes until March 14, 2008 at 5 pm. ACAP plans to submit public comments. To insure we captured ACAP member concerns, a call was held on March 7, 2008 to discuss the 2009 proposed changes.

NCQA Posts Special Needs Plan Information/ Medicare Roundtable Discussion on March 12

The Centers for Medicare & Medicaid Services (CMS) has contracted with NCQA to evaluate Medicare Special Needs Plans (SNPs). The evaluation approach includes the collection of SNP-specific HEDIS quality measures and Structure & Process (S&P) measures. NCQA recently revised their website to add a Special Needs Plan section which contains all SNP related information including upcoming training for SNPs. ACAP will host a Medicare Roundtable with NCQA on March 12.

AHRQ to Hold Audio Conference on Consumer Financial Incentives in Health Care March 13

The U.S. Agency for Healthcare Research and Quality (AHRQ) invites all comers to participate in a free, live audio conference Thursday, March 13 from noon to 1:15 pm EST on the topic of consumer financial incentives in health care. The 75-minute audio conference will provide a thorough overview of findings from AHRQ's new publication Consumer Financial Incentives: A Decision Guide for Purchasers. Speakers will discuss the available evidence, share a variety of applied examples, and address questions from participants. Application of consumer incentives to the public sector will be specifically illustrated with a Medicaid case example. The audio conference will feature two distinguished panel members - Adams Dudley of the Institute for Health Policy Studies at UCSF, and Ann Robinow, an Independent Consultant. The event is free, but a simple registration is required and space is limited. Please go to http://academyhealth.org/ahrq/cfiaudio/ to register. 

March 11 Medicare Committee Call

March 12 Medicare Roundtable

March 13 Chief Operating Officers Roundtable

March 17 Quality Management Committee Call

March 17 Program Committee Call

March 18 Finance Committee Call

March 20 Pharmacy Roundtable

March 25 Executive Committee Call

March 26 Policy Roundtable

March 27 Compliance Officers Roundtable (** Note this is a NEW Date**)

April 1-3 ACAP Board, CFO, and Medicare Meeting San Jose, CA (Click Here to Register and View Agendas)

April 17 Chief Information Officer Roundtable (**Note this is a NEW date**)

April 10 Quality/Disease Management Roundtable

April 24 Human Resource Directors Roundtable
 

The Agency for Healthcare Research and Quality recently released the 2007 National Healthcare Quality Report and the 2007 National Healthcare Disparities Report. This is the fifth edition of the reports that measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. Complete copies of the reports can be found at http://www.ahrq.gov/qual/qrdr07.htm.

NASHP Holds First of a Series of Webinars on the Medical Home

On March 6, the National Academy for State Health Policy (NASHP) held the first of four free webinars to focus on the patient centered medical home model. The program focused on different reimbursement methods states are currently using to support patient centered medical home in Medicaid and SCHIP programs. NASHP and the Patient Centered Primary Care Collaborative (PCPCC) have partnered to work on an initiative to advance patient-centered medical homes. This one-year project is supported by The Commonwealth Fund and is based on the joint principles of the Patient Centered Medical Home Model (PCMH) developed by the AAP, AAFP, ACP, and AOA, among others. These principles include: personal physician; physician directed medical practice; whole person orientation; coordinated and/or integrated care; quality and safety; enhanced access to care; and payment that reflects value. In recent months, several states have considered or passed new legislation or regulations to promote the PCMH.

CMS Issues Checklist for Onsite Reviews on Potential HIPAA Security Violations

On February 20, 2008, the Office of E-Health Standards and Services (OESS) within CMS posted a document entitled Information Request for Onsite Compliance Reviews. According to the CMS website, “OESS recently procured contracted services to assist with onsite compliance reviews related to potential HIPAA Security Rule violations. To ensure that the industry has an idea of the type of information OESS might request during these reviews, OESS developed a sample security checklist, which highlights several areas of vulnerability associated with the security of electronic protected health information.” The document outlines who might be interviewed as part of an onsite review, what documents may be requested including policies and procedures and evidence that certain standards were followed; as well as other documents such as the risk management plan. To review the entire document, click http://www.cms.hhs.gov/Enforcement/025_GeneralEnforcementInformation.asp#TopOfPage

Commonwealth Fund Issues Guidance on Developmental Screening Instruments

The Commonwealth Fund issued a guide entitled Pediatric Developmental Screening: Understanding and Selecting Screening Instruments. The purpose of the report is to provide practitioners with guidance on choosing the right screening instrument for their practice. It includes a section that compares various screening instruments including information on clinical utility as well as sensitivity and specificity by population and age. There is also an interactive web feature that can be used by providers to assist in the selection of an appropriate screening tool.

Health Care Spending Expected To Double By 2017, Reaching $4.3 Trillion And Consuming Nearly One-Fifth Of The Economy, Federal Report Says

By 2017, U.S. health care spending is expected to nearly double from 2007’s projected level, reaching $4.3 trillion and consuming 19.5 percent of the nation’s gross domestic product (GDP), federal analysts report in today’s Web-Exclusive edition of Health Affairs. The ten-year estimates follow last month’s report from the government that health spending in 2006 surpassed $2.1 trillion for the first time, accounting for 16.0 percent of GDP.

“Health care is expected to consume an expanding share of the U.S. economy over the next decade, meaning policymakers, insurers, and the public collectively face some difficult decisions about the way health care is delivered and paid for,” said Centers for Medicare and Medicaid Services (CMS) economist Sean Keehan, one of the authors of the government’s annual health care projection report. “With the implementation of the Medicare Part D benefit behind us, a focal point of the next ten years will be the impending movement of the baby-boom generation into Medicare,” he continued.

Health care spending is expected to hit $2.2 trillion in 2007, growing on average 6.7 percent through 2017 and outpacing economic growth by about 1.9 percentage points each year, say Keehan and his fellow economists and actuaries from the CMS Office of the Actuary. Steady health spending growth coupled with what analysts project to be somewhat lower economic growth of about 4.7 percent annually is expected to result in a gradual increase in health spending as a share of GDP.

Medicare And Medicaid

Although the outlook for national health spending growth calls for continued stability for the next ten years, the authors note that they expect the leading edge of the baby-boom generation to begin to affect the Medicare program. Over the next decade, a slowdown in growth in private spending is expected to be offset by accelerating growth in public-sector spending, partially attributable to the baby-boomer generation enrolling in Medicare. The CMS analysts say that this increase in the number of Medicare enrollees is projected to contribute 2.9 percentage points to growth in Medicare spending by 2017.

By 2017, Medicare spending is expected to account for $884 billion, or just over one-fifth of all national health spending. This is up from the projected spending level of $427 billion in 2007, when Medicare spending growth is expected to slow to 6.5 percent. The projected 2007 growth rate indicates a significant deceleration from 18.7 percent growth in 2006, when new spending associated with the Medicare prescription drug benefit was added. Also contributing modestly to the expected slowdown from 2006 to 2007 are smaller increases in Medicare Advantage (MA) plan payments due to risk adjustments to those payments.

The CMS analysts project that growth in private health care spending will rebound to 6.3 percent in 2007 following the somewhat slow growth of 5.4 percent in 2006 that was related to the implementation of Medicare Part D. After peaking at 6.6 percent in 2009, growth in private health care spending is expected to slow through 2017 to 5.9 percent.

Medicaid spending also is expected to continue to rise at a faster rate than overall health spending during the coming decade. Medicaid expenditures are projected to grow 8.9 percent in 2007 to $338.2 billion. Aside from the one-time transition effects of shifting prescription drug costs for those dually eligible for both Medicare and Medicaid to Medicare Part D, this rebound is also influenced by continued strong growth (above 10.0 percent) in spending for home health care and other personal care services. Moreover, as a result of improved fiscal conditions at the time, states were expected to increase provider payment rates to hospitals and physicians in 2007 more than in recent years. Medicaid spending in 2008 is projected to grow 6.8 percent and reach $361.2 billion. For the next decade, it is expected to grow at an average of 7.9 percent per year, reaching $717.3 billion, or 16.8 percent of national health spending, by 2017.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w145

Medicare/Medicaid Integration

As part of its New Freedom Initiative, CMS has issued a website called “Roadmap to Integrated Care.” This site includes all CMS guidance, letters, requirements and other documents for states to develop integrated care initiatives with health plans. This “roadmap” is the culmination of several years’ effort to develop and organize this material in one place. For more information, see: http://www.cms.hhs.gov/IntegratedCareInt/02_Integrated%20Care%20Roadmap.asp.