Excellence and Accountability

Network Health Earns Multicultural Health Care Distinction from NCQA
ACAP-member plan Network Health recently earned Multicultural Health Care Distinction from the National Committee for Quality Assurance. Network Health is one of only 10 health plans nationally to receive this distinction, joining ACAP member plans AmeriHealth Mercy and Denver Health.

NCQA offers the Multicultural Health Care Distinction to organizations that engage in efforts to provide culturally and linguistically appropriate services and reduce health care disparities. Guidelines for the award are modeled after the federal Office of Minority Health culturally and linguistically appropriate service standards.

“Network Health is proud to earn NCQA’s Multicultural Health Care Distinction for our efforts to promote and support cultural competence,” said Christina Severin, Network Health president. “NCQA’s Multicultural Health Care Distinction reflects Network Health’s dedication to improving the health and well-being of our members and their diverse communities.”

For more information, see NCQA’s Web site.

Deborah Kilstein Serving on ONC Technical Expert Panel
ACAP Vice President for Quality Management and Operational Support Deborah Kilstein is serving on a Technical Expert Panel under the auspices of CMS’s Office of the National Coordinator (ONC) for Health Information Technology to look at performance measures for electronic health systems.

ONC contracted with Booz Allen Hamilton, the National Committee for Quality Assurance and Mathematica Policy Research to respecify and test existing performance measures for electronic health record systems.  The effort focused on children’s health measures relevant to the Children Health Insurance Program Reauthorization Act (CHIPRA) and CMS’s Electronic Health Record Incentive Program.

Six eMeasure specifications have been developed that cover childhood developmental screening, immunizations for adolescents, and blood pressure screening. The technical panel will review and discuss concepts for future eMeasures in an effort to expand the number of child health measures that have been specified for electronic health systems.

Spotlight on ACAP Making a Difference Award Nominee: Elizabeth Keogh of VNSNY CHOICE
Elizabeth Keogh, a rehabilitation consultant at the VNSNY CHOICE Managed Long Term Care plan and a member of the organization’s interdisciplinary care management team, is responsible for the health and safety of 300 plan members and their families. She was among the nominees for ACAP’s 2011 Making a Difference Award.

Elizabeth Keogh of VNSNY CHOICE Health Plan.

In her work at VNSNY CHOICE, Elizabeth designs strategies to help health plan members be as active in the community and as functional and self-sufficient as possible. She contributes extensively to Community Health Fairs and provides educational workshops based on posture, balance and fall prevention among the elderly.

One member in particular has benefited from Elizabeth’s work: a 70-year old dual eligible Medicaid recipient who was faced with the long-term effects of a gunshot wound. The wound left him paralyzed; he and his family were struggling to navigate the insurance and health care systems to obtain a motorized wheelchair. Elizabeth was persistent in reaching out to medical equipment vendors, rehabilitation centers and others to assure that the member received the appropriate device to help him be as independent as possible.

“Elizabeth strives to ensure all the clients she encounters attain maximum function to enable them to remain in the community,” said VNSNY CHOICE President Christopher Palmieri in nominating her. “She places the interests of the members she serves above all, and pursues her goals relentlessly until she achieves an outcome that is favorable to her members.”

ACAP congratulates Elizabeth Keogh on her nomination for the Making a Difference Award!

Managed Healthcare Executive Highlights Efforts of Amida Care to Coordinate Care for Patients with HIV/AIDS
The cover story of the most recent edition of Managed Healthcare Executive magazine looks at the efforts to treat and manage HIV/AIDS in the United States. The story focuses on the efforts of ACAP-member plan Amida Care, a Medicaid SNP devoted to caring for persons with HIV/AIDS. The plan uses intensive care management techniques to maximize treatment adherence among its members—a must for those with HIV/AIDS—and points to its success through fewer, shorter hospitalizations and reduced emergency room use, two drivers that have led the plan to achieve a cost savings of about 25 percent.

“Any health plan that wants to actively expand their membership to include people with HIV needs HIV-specialist primary care providers. It needs an active care management component to find and re-engage its members in primary care and support services and not wait for individuals to enter emergency rooms and hospitals as a point of re-engagement, which is too late. That kind of approach will result in advanced disease,” says Amida Care CEO Doug Wirth in a Q&A that accompanies the article. And, there are great opportunities given today's HIV medication to engage people early, deal with the psychosocial drivers of healthcare costs, and achieve quality health outcomes that will yield cost savings.”

To read the article in full, visit Managed Healthcare Executive’s Web site.

German Chancellor Fellowship Program Seeks Potential Leaders to Study for a Year in Germany
A German Chancellor Fellowship allows prospective leaders who have earned at least a Bachelor’s degree and demonstrated outstanding leadership potential in their career to spend a year carrying out a project of their own design in cooperation with a host in Germany.

The program is under the patronage of the German Chancellor (currently Angela Merkel) and also incorporates an intensive language course in Germany, a four-week introductory seminar in Bonn and Berlin, a study trip around Germany and a final meeting in Berlin. These activities provide additional insights into the social, cultural, economic and political life of Germany.

Candidates from all professions and disciplines, but especially individuals in the humanities, law, social sciences and economics, are eligible to apply to the Alexander von Humboldt Foundation directly. The Humboldt Foundation grants up to ten German Chancellor Fellowships annually for prospective leaders from the U.S., China and Russia.

The Chancellor Fellowship “is considered a prestigious fellowship and the alumni of the program typically have gone on to very successful careers,” according to the program’s promotional materials. ACAP’s own Meg Murray was a fellow under this program, resulting in a number of published articles on the German health care system. Proof positive that truth in advertising still exists.

The deadline for applications for the Chancellor Fellowship is October 15.

 

CareSource Wins Bid to Care for Duals in Ohio
ACAP-member plan CareSource, in an alliance with Humana Inc., was recently named by the Ohio Department of Job and Family Services as one of the plans that will serve dual eligibles in Ohio. These bids were awarded by region; CareSource was awarded contracts in the Cleveland, Akron and Youngstown markets, which serve an aggregate of 56,000 duals. Each market will be served by two plans; Cleveland will be served by three. The plans selected by Ohio will enter into agreements with Ohio and the Centers for Medicare & Medicaid Services to serve this population.

“We applaud the State, the Office of Health Transformation and CMS for constructing a program to solve these important issues,” said CareSource CEO Pam Morris in a statement. “We are honored to be chosen to assist the State and look forward to working with Humana to improve the quality of care and create a cost-savings solution.”

For more information, see this announcement from CareSource and Humana, or related coverage in the Columbus Dispatch.

Oregon CCOs Open Their Doors
The state of Oregon is remaking its Oregon Health Plan program for low-income residents through a shift in the way health care resources are apportioned and flow through the state. The State is moving from contracting directly with Medicaid managed care organizations to working through coordinated care organizations (CCOs), local organizations that will be given a fixed budget to provide physical, mental and eventually dental care. CCOs will provide the same benefits as had been offered under the Oregon Health Plan, and will be accountable for meeting the health needs of the community and providing care that meets or exceeds set benchmarks for quality and service.

The CCOs have been opening for business over the past two months. Seven CCOs launched on August 1; four more, including Health Share of Oregon, the state’s largest CCO, opened on September 1. ACAP-member plan CareOregon, which had previously contracted directly with the State, is now providing a wide range of support services to these new entities, performing traditional health-plan functions, such as contracting with providers and processing claims.

For more information about the CCO initiative, see news coverage in the Portland Business Journal or the Oregon Health Policy Board’s Web site.

L.A. Care’s Elaine Batchlor to Lead Martin Luther King Hospital
Longtime L.A. Care Chief Medical Officer Dr. Elaine Batchlor was recently named as the first chief executive of Martin Luther King Hospital, a new nonprofit hospital set to open in the Willowbrook area of Los Angeles in 2014.

In a note announcing the move, L.A. Care CEO Howard Kahn said, “We will certainly miss Elaine, but are thrilled about this new opportunity for her, and for MLK, which is an incredibly needed resource in South Los Angeles. During her 8 ½ year tenure as Chief Medical Officer with L.A. Care, Elaine has been my partner in developing this organization into what it is today.  We shared a vision and she was instrumental in improving access to quality healthcare in the low-income communities served by L.A. Care and like those served by MLK Hospital.” 

Dr. Batchlor’s leadership at L.A. Care was marked by accomplishments including the plan’s successful effort to earn NCQA accreditation; creation of HITEC-LA; disease management and quality improvement programs; and the distribution of millions of dollars in performance-based incentives for physicians and grants to support community benefits programs.

ACAP congratulates Dr. Batchlor on her new role, which she is set to take in October. Refer to this L.A. Times article for more information.

Tom Early Returns to the ACAP Family as Elderplan’s new EVP, Managed Plans
Tom Early, who had been CEO of Health Plus until its acquisition earlier this year, was recently hired by ACAP-member plan Elderplan as its executive vice president of managed plans. In his new role, he will be responsible for operations, medical informatics, IT, compliance and medical management.

Elderplan is part of Metropolitan Jewish Health Systems, an organization which includes nursing homes, home care, hospice and palliative care among its business lines.

Tom has been an active member and supporter of ACAP since its founding; accordingly, we’re glad to see he’s back in the ACAP family of health plans.

Five ACAP-Member Plans Participating in CMS Primary Care Initiative
In late August, the Centers for Medicare & Medicaid Services announced that 500 primary care practices had been chosen for a new Comprehensive Primary Care Initiative in an effort to improve access and lower health care costs.

CMS would under the program pay practices a care management fee to support closer care coordination for Medicare fee-for-service beneficiaries. At the same time, a number of participating health plans – including ACAP members CareOregon, CareSource, Colorado Access, Horizon NJ Health and Hudson Health Plan – are providing support by providing a care coordination fee of their own.

The Comprehensive Primary Care Initiative is a four-year effort administered by the CMS Innovation Center. For more information about the program, visit the CMS Web site.

CalOptima’s Circle of Care Awards Recognize Mission-Driven Providers
On August 29, CalOptima honored small group of dedicated health care professionals for their commitment to providing high-quality health care services to vulnerable Orange County residents at the organization’s Circle of Care Awards.

“Our mission is to provide access to quality and compassionate health care for the Orange County residents most in need,” said Gertrude Carter, M.D., CalOptima Chief Medical Officer. “Without the dedication, commitment and generosity of these providers, CalOptima wouldn’t be able to fulfill this mission. The Circle of Care Awards is our way of saying thank you to the providers who support our community.”

The 2012 Circle of Care Award recipients include more than 20 health professionals and 11 organizations, all of which play a pivotal role in providing safety-net services for Orange County’s at-risk populations.

For a complete list of award winners, see CalOptima’s statement.

Network Health Introduces Tousignant as Director of Business Development
ACAP-member plan Network Health recently named Ann Tousignant as its new director of business development. Tousignant’s duties at Network Health will include building a strategy for diversification, putting together plans for business expansion, and building relationships with potential partners.

Tousignant’s experience in health care includes work at Blue Cross Blue Shield of Massachusetts, VHA Healthfront, ASK A NURSE and Boston’s Faulkner Hospital. For more information, click here.

ACAP Meetings and Events

Meg Murray on RWJF Panel Looking at Impact of Managed Care on Cost, Quality
ACAP CEO Meg Murray will be featured on a Robert Wood Johnson Foundation Webinar next week that looks at the impact of managed care on costs and quality in the Medicaid program.

States are turning to managed care to cover high-cost populations such as the disabled and dual eligibles. States across the country are implementing new managed care initiatives, but often without evidence-based guidance regarding their potential impact. A new report from the Robert Wood Johnson Foundation’s Synthesis Project examines the available evidence on the impact of managed care on cost, quality, and access to care, and suggests directions for new research.

The report will be presented by Michael S. Sparer, PhD, JD, of the Columbia University Mailman School of Public Health. Meg will be joined on the reactor panel by former Texas Medicaid Director Billy Millwee.

The Webinar is scheduled for Tuesday, September 11 at 1:00 p.m. Eastern and is open to the public. Click here for more details and to register for the Webinar; registration is free.

Join Meg Murray at the 2012 Medicaid Managed Care Conference in Washington
The 2012 Medicaid Managed Care Conference, scheduled for October 4-5 at the Four Points Sheraton in Washington, DC, will feature ACAP CEO Meg Murray and other health care thought leaders.  

This comprehensive, high-level conference will introduce the pioneers of Medicaid health reform implementation. Medicaid leaders from states and health plans nationwide, as well as government and non-governmental agencies will highlight their strategies for tackling the challenges presented by Medicaid reform. Results from the latest pilot programs and initiatives will be presented.

Readers of ACAP Community News can register for the conference at a discount of $300 off the regular rate by entering the discount code EHX300 at the conference Web site, www.2012medicaid.com.

We hope to see you there! 

Join ACAP at the 2nd Annual Health Insurance Exchange Congress
ACAP invites you to the 2nd Annual Health Insurance Exchange Congress, taking place November 13-14, 2012 at the Hotel Sax Chicago. The Health Insurance Exchange Congress will bring together Health Plans, States and the Federal Government to address the opportunities and challenges presented by the implementation of health insurance exchanges. At the event states and plans that have first-hand experience creating and competing on exchanges will share insight into qualified health plans, risk adjustment mechanisms, the basic health program option, benefit design, IT considerations and more. State representation includes Oregon, Maryland, Utah, Massachusetts, Vermont, Washington, California, Colorado, Connecticut and Rhode Island.  

ACAP plan staff are entitled to a discount on registration, receiving 25% off the standard rate. Click here to register and be sure to use Priority Code XP1710ACAP to apply your discount.

ACAP Roundtable Round-up
Following are brief summaries of ACAP Roundtable calls that have occurred since the last edition of ACAP Community News. Links to presentations are limited to ACAP members; contact Tim Murphy if you’re having trouble logging on.

August 22 – Networking Call on 2013 Stars Ratings
ACAP Vice Presidents Deborah Kilstein  and Mary Kennedy conducted a networking call to discuss the 2013 Stars Ratings process and the Quality Improvement Projects for Special Needs Plans.  The link includes slides and FAQs around the Stars ratings process.

August 23 - CMO Roundtable: Reducing Elective Deliveries Before 39 Weeks
Dr. Eugene Toy, Vice Chair of Academic Affairs, Director of General Gynecology, and Director of Ob/Gyn Residency at The Methodist Hospital in Houston joined ACAP to discuss the research supporting efforts to reduce elective deliveries before 39 weeks.  A growing body of medical evidence indicates that gestation even a few days short of a full 39 weeks can lead to short- and long-term health risks.  He was be joined by Dr. Fred Buckwold, CMO at Community Health Choice, who discussed the efforts to implement the Texas Medicaid policies to reduce elective deliveries prior to 39 weeks. Slides from the call are included in the link.

August 31 - ACAP Issuer Engagement: Teleconference with CCIIO
The Center for Consumer Information and Insurance Oversight (CCIIO) at the US Department of Health and Human Services has invited ACAP and our members to participate in monthly meetings beginning in August regarding the Exchange, and, in particular, the Federally-facilitated Exchange. The first of these meetings was held on Friday, August 31. These calls will be held monthly.

September 6 – CFO Call on Plan Reserves
With the enrollment of individuals with disabilities and dual eligibles into managed care, the advent of Medicaid expansion, the establishment of health insurance exchanges and (hopefully) the basic health program, health plan reserves have become a critical issue. ACAP hosted a Roundtable call for CFOs to discuss plans’ reserve needs/issues, and to obtain input into an ACAP proposal under development to establish a federal loan guarantee program to support the reserve needs of safety net health plans. Slides from the call are included in the link.

September 6 – Duals Integration/MLTC Initiatives Networking Call
This call discussed in detail the first state memorandum of understanding released by CMS for the duals financial alignment demonstration. This memorandum of understanding, reached with Massachusetts, previews what plans in other states may expect to see as the duals demonstrations roll out. Slides from the call are included in the link.