Report from Pittsburgh
Inside ACAP's Medicare and Quality Meetings
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A gracious welcome from UPMC.
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On November 15 through 17, more than 100 health
plan leaders, Medicare and quality staff at ACAP-member plans came together at
the Omni William Penn Hotel in Pittsburgh for ACAP’s Medicare and Quality
meetings. The meetings featured a broad array of presentations from ACAP senior
staff, member plans and influential thought leaders. Featured speakers included:
• Thomas Pham of Inland Empire Health Plan, who provided insight into
strategies for advancing Medicare enrollment through targeted strategic
partnerships;
• Former ACAP chairman Darnell Dent, who outlined strategies for marrying
revenue management to clinical quality goals;
• Marsha Davenport and Jaya Ghildiyal of CMS, who discussed
methods for assessing quality improvement in SNPs and the Model of Care review
process;
• Chronis Manolis of UPMC, who stepped in to present on managing the Part
D benefit;
• Chad Boult of Johns Hopkins University presented on new models of care
for people with special needs;
• An overview of the Teen Screen program presented by Carrie Bandell
of Colorado Access;
• A tour of UPMC’s innovative Center for
Connected Medicine;
• A look at provider quality measures provided by Sarita Mohanty of L.A.
Care, and
• An update from NCQA on their quality agenda with respect to Medicaid presented
by Sarah Thomas.
Click here (LINK) for a full set of slides from the meeting.
ACAP also recognized a number of health plans for achievements of distinction,
including:
• Children’s Mercy Family Health Partners, for earning NCQA
Accreditation;
• BMC HealthNet Plan, for earning the highest NCQA ranking among Medicaid
plans; and
• Neighborhood Health Plan, for having the most HEDIS measures at or
above the 90th percentile.
Several plans were also recognized for excellence
in Medicare Stars quality ratings: Affinity Health Plan, CalOptima,
CareOregon, Commonwealth Care Alliance, Health Plan of San Mateo, Metropolitan
Health Plan, Partnership HealthPlan of California and UPMC for You
were recognized for top performance on the Medicare Stars ratings.
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| Hemant Lanjewar of Affinity Health
Plan accepts an award from ACAP CEO Meg Murray in recognition of the
plan's high performance on the Medicare Stars quality ratings. |
A vanguard of attendees from UPMC
for You accepts an award from Meg for high Medicare Stars
ratings. ACAP thanks UPMC
for opening their facilities to their fellow ACAP members and being
terrific hosts. |
Excellence and Accountability
CMCS Launches Medicaid.gov
The Center for Medicaid and CHIP Services (CMCS) recently launched Medicaid.gov,
a new Web site that is part of an ongoing effort by CMS to make more information
about the Medicaid program accessible and understandable to a wide audience.
Medicaid.gov will feature items of interest to ACAP-member plans, including
Federal policy guidance, pending and approved waivers, Affordable Care Act
implementation updates; state-specific program information, and improved search
capabilities.
Take a look at the site right now by visiting
Medicaid.gov.
HHS Extends Deadline for Stage 2 HIT Meaningful Use
Requirements
At an event in Cleveland this past week, U.S.
Secretary of Health and Human Services Kathleen Sebelius announced that HHS
would extend the deadline for providers to qualify for incentive payments by
meeting the
“meaningful use” requirements for health IT adoption. Health care providers
who meet Stage 1 requirements around information sharing and data capture by
2012 would not need to meet Stage 2 requirements until 2014. Stage 2
requirements had been slated to take effect in 2013.
At the same event, Sebelius noted that more than half of all office-based
physicians expect to participate in the health IT incentive program and adopt
meaningful use standards.
For more, refer to the
HHS press
release, a
Modern Healthcare article on the announcement or a related entry on the
White House blog.
CHCS Convenes Affinity Group for Charity Care
Programs
The Center for Health Care Strategies
recently announced the launch of an affinity group for 10 charity care programs
from around the country to share best practices and solutions to challenges as
the health care environment shifts following implementation of the Affordable
Care Act. The programs, which come from around the country and some of which
operate in markets shared by ACAP member plans, will also debate their roles in
state health insurance exchanges as market conditions change.
Participating programs include:
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Access to Healthcare Network of Nevada;
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CareLink of San Antonio, Texas;
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Health Advantage Program of Marion County, Ind.;
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Healthy San Francisco;
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Hillsborough County Health Care Plan of Hillsborough County, Fla.;
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Ingham Health Plan of Ingham County, Mich.;
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Kaiser Foundation Health Plan;
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Portico Healthnet of Dakota, Hennepin, Ramsey, and Washington Counties,
Minn.;
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Project Access of Buncombe County, N.C.; and
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Seton
Care Plus of Austin, Texas.
For more,
visit the
CHCS Web site.
EPA Issues Call for Nominations for National
Environmental Leadership Award in Asthma Management
Last week, the Environmental Protection Agency opened nominations for the 2012
National Environmental Leadership Award in Asthma Management. The award
recognizes health plans, health care providers and communities for their efforts
in delivering excellent environmental asthma management as part of their
comprehensive asthma care services.
Several ACAP member plans and their parent organizations are past winners of
this award, including the Monroe Plan for Medical Care, Neighborhood Health
Plan, Boston Medical Center and Children’s Mercy Hospital. For more information,
visit the EPA’s Web
site; a set of health-plan-specific criteria is available
here.
The deadline for applications is February 21, 2012.
Exchanges
HHS Issues Exchange Grants to 13 States
On Tuesday, the Department of Health and Human Services issued grants totaling
almost $220 million to 13 states to help them create the Affordable Insurance
Exchanges laid out in the Affordable Care Act. States containing ACAP member
plans that received one-year grants include Arizona, Hawaii, Maine and Michigan.
Rhode Island also received funding in the latest round of grants – but unlike
the one-year grants awarded to the other twelve states, theirs was a multi-year
“Level Two” grant, reflective of Rhode Island being further along in their
progress towards planning and implementing an exchange.
In addition, the federal government is taking further steps towards building a
Federal exchange: CGI Federal Inc. of Fairfax, Va. was awarded a contract to
build the exchange, at a cost of up to $93.7 million over a two-year period.
For more information on the planning grants, see the
HHS press
release.
Safety Net
Health Plan News
Neighborhood Health Plan CEO Deborah Enos
Profiled in Boston Globe
A recent interview with the Boston Globe highlights Deborah Enos, CEO of ACAP
member plan Neighborhood Health Plan. In the piece, she discusses the plan’s
acquisition by Partners HealthCare, Neighborhood’s ongoing efforts to reduce
health disparities, and tiered networks.
She also discussed the effect of financial pressures from state budget cuts,
where she noted that “Neighborhood Health Plan as well as all of the other major
health plans and providers who work with public-funded membership have
experienced very challenging fiscal circumstances, which is the result of the
state’s finances. And that is not getting better. Clearly, with some of the
thoughts and ideas on the horizon on the federal level, I think it is going to
be more challenging. It gives us more impetus to look for new and innovative
ways of delivering the same level of quality and service to our membership.”
Here’s the
full interview in the Boston Globe.
Texas Children’s Hospital Survey: More
Houston-Area Children Covered Through Safety Net Programs; Overall Coverage of
Children Declines
A recent survey by Texas Children’s
Hospital and ACAP member Texas Children’s Health Plan found that over the past
three years, enrollment in CHIP more than doubled while health coverage overall
for children declined in the area surrounding Houston. Among the findings of a
survey of more than 700 adults with children 18 or younger:
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Employer-sponsored coverage for children
dropped from 74 percent in 2008 to 57.8 percent in 2011, representing
400,000 children who lost health care coverage through their parents’ or
guardians’ work.
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Among respondents, health coverage through
CHIP increased from 5 percent in 2008 to 10.5 percent in 2011, and coverage
of children through Medicaid more than doubled – from 11.5 percent in 2008
to 24.6 percent in 2011.
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Overall, the percentage of insured
children in the greater Houston area dropped from 93.5 percent in 2008 to
90.7 percent in 2011, representing about 35,000 additional uninsured
children.
To see more about the survey, visit the
Texas Children’s Web site or read the coverage in the
Houston Chronicle. Texas Children’s also assembled a
YouTube video that explains the role of
safety-net programs and discusses the survey in more detail.
BMC HealthNet Enters Commercial Market
ACAP member BMC HealthNet Plan is
opening a new line of business this January: for the first time it will offer
commercial health insurance coverage in the Boston area. “We’ve been very
successful with our traditional focus on government-subsidized coverage,” noted
BMC HealthNet Plan Executive Director Scott O’Gorman. “We do, however, want to
develop new sources of revenue and we believe we can offer high quality,
affordable coverage to employers and individuals in the commercial market.”
The plan currently serves nearly a quarter million MassHealth and Commonwealth
Care members across Massachusetts. Its first customers in the commercial market
will see their coverage go effective as of January 1, 2012.
For more, see this interview on
WBUR’s CommonHealth blog.
Children’s Mercy Family Health Partners Garners
Top Prize for Community Report
Children’s Mercy Family Health Partners’ 2010 Community Report was recently
honored with a First Place award from the Missouri Association for Healthcare
Public Relations and Marketing (MAHPRM). The group’s awards recognize
achievement and quality in advertising, marketing and public relations projects
produced by hospitals and health care systems throughout the state.
The report, “What We Do,” educates and informs community residents about CMFHP’s
outreach efforts across the counties served in Missouri. The report can be
viewed at http://www.fhp.org/whatwedo.
Passport Health Plan Debuts a New Look
Passport Health Plan has rolled out a new logo to symbolize the Kentucky-based
plan’s transformation and demonstrate its enhanced focus on its mission as a
provider-sponsored, community-based plan:
To see the effect of the rebranding, visit
Passport’s Web site.
Vendor
News
MedImpact Webinar on Improving Star Ratings for Part D
Slated for Dec. 13
Given the new weighting system effective with the 2012 Plan Ratings where
outcomes and intermediate outcomes measures are weighted three times as heavily
as process measures, it's now more important than ever to know how your plan is
performing with respect to the patient safety measures and to have clinical
programs in place to improve outcomes. This webinar will provide a review of the
new Part D star rating weighting system and provide strategies for plans to work
with their pharmacy benefit manager to improve star ratings.
Join MedImpact and ACAP for this Webinar on Tuesday, December 13 at
2:00 p.m. Eastern. More details will be available in an invitation to come.
MedeAnalytics Hosts Webinar on Using Analytics
to Improve Performance Dec. 15
Medicaid plans face unique challenges
in providing care to vulnerable populations. Through performance management,
plans can ensure effective, high-quality care at the lowest cost for their
members.
Performance Management in the Medicaid World: The Role of Analytics, a
Webinar hosted by MedeAnalytics and ACAP, MedeAnalytics CMO Dr. Terry Fouts will
offer best practices and explain how analytics can help manage ER costs; reduce
admissions; evaluate providers for quality and efficiency; create, assess and
administer condition management programs; and evaluate the role of prior
authorizations.
This Webinar will take place on
Thursday, December 15 at 2:00 p.m. Eastern.
Click here to register.
ACAP PREFERRED VENDORS
340(b) Drug Pricing:
PerformRx
Actuarial and Data Services:
Cirdan
Health Systems
Analytics, Business Intelligence and Performance Management:
MedeAnalytics
Behavioral Health:
Comprehensive
Behavioral Care, Beacon Health Strategies
Business Process and IT Services:
Dell Services,
TriZetto
Business Strategy and Development:
Arpegio
Health, OptumInsight,
Optimetra
Business Process Outsourcing:
TMG
Health
Care For High Risk Members:
INSPIRIS
Care Management Technology:
Warm Health
Compliance Software:
Compliance 360
Group Purchasing:
CommonWealth Purchasing Group, LLC
Health Management Solutions:
Health Integrated
Health Technology Assessments:
ECRI Institute
Member Assessments:
INSPIRIS
Non-Emergency Medical Transportation
Management: Coordinated
Transportation Solutions
Patient Communication Services:
CommonWealth Purchasing Group, LLC
Pay For Performance:
3M
Health Information Systems
PBM Solutions:
Excelsior Solutions,
The Pharmacy Group
Pharmacy Benefit Managers:
MedImpact, Medmetrics Health
Partners, Navitus Health
Solutions
Radiology Benefits Management:
Care to Care
Reinsurance Services:
RBS
Re, Summit
Re, U.S.
Advisors, Inc.
Risk Adjustment:
DCA,
PopHealthMan
Strategic Consultants:
DeltaSigma, LLC
Strategic
Government Business Solutions:
ClearStone Solutions
Subrogation:
First
Recovery Group
TPL Subcontractors: HMS
Web Portals/SaaS: Health
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