VillageCareMAX Joins ACAP as its Sixtieth Member Plan 

In early November, ACAP welcomed VillageCareMAX as the Association’s 60th member Safety Net Health Plan.  

VillageCareMAX is a relatively new managed long-term care (MLTC) health plan operating in New York City; it began enrolling members on June 15, 2012 and currently serves about 2300 members. Its mission is to promote healing, better health and well-being to the fullest extent possible.

The plan was the first new MLTC health plan approved by the State of New York in several years, and the first in a new initiative by the Department of Health to expand managed care resources for Medicaid recipients.

The plan is operated by its parent organization, VillageCare, which offers a full complement of community and residential care programs for older adults and persons living with HIV/AIDS. As a long-time provider of services for frail seniors in the New York community and as one of the oldest AIDS providers in the nation, VillageCare has witnessed dramatic changes both in the care implications of aging and in the needs of those living with HIV/AIDS.

The plan covers a wide spectrum of long-term care services, ranging from home health care, social/environmental supports, and adult day health care to dental benefits, audiology and care in a skilled nursing facility. The plan is led by CEO Emma DeVito. Karl Dehm, who is familiar to many in the ACAP family, returns to the fold as the plan’s Assistant VP for Operations and Regulatory Affairs.

Join ACAP in welcoming VillageCareMAX to the family of Safety Net Health Plans!

Public Policy & Advocacy

This Was The Week That Was Big for Health Reform
When it’s all said and done, we could look back at the second week in November 2013 as one of the most pivotal in the history of the Affordable Care Act – the week when a string of bad news came to a head, a popular President’s credibility was damaged, and the fiercest advocates of the ACA were forced to make significant concessions about the workability of the law.

The Administration released the enrollment numbers for the first month under the ACA – a total of only 500,000 in Medicaid and the federal and state health insurance exchanges.  But that number was overshadowed by the fact that only 106,000 Americans signed up through the primary coverage mechanism – the exchanges – and only about 25% of that number came from the 36 states operating through the Federal marketplace.  Even though the Administration had indicated that the numbers would be low, Congressional Republicans and the press piled on despite low expectations and problems with the healthcare.gov Web site.  The numbers only served to highlight the fact that addressing the Web site—which continues to be slow or in some cases, non-functioning—must be the Administration’s top priority if they hope to get out of the bad news doldrums in which they are currently stuck. 

The travails of the Web site and low enrollment numbers paled in comparison to the political damage being inflicted by the relentless press and partisan hammering on health insurance cancellations sent throughout the country as a result of insurers coming into compliance with ACA requirements.  Some Democrats, already skittish from the failure of the Web site, panicked about the political impact of the cancellations and whether their currently insured constituents would have coverage come January 1.  House Republicans scheduled a vote on legislation by Energy and Commerce Committee Chair Fred Upton that would allow insurers to continue offering their grandfathered plans to current and new enrollees.  Senator Mary Landrieu was providing cover for vulnerable Senate Democrats by introducing legislation to require health insurers to offer currently grandfathered but cancelled plans to their current enrollees whether the insurer wanted to or not. 

Fearing a very real Democratic revolt on the Hill, the Obama Administration came up with an administrative fix that would allow insurers to continue offering their cancelled plans to current enrollees—provided that state insurance commissioners allowed it, and the insurers wanted to continue to offer them.  However, as of week’s end, it does not appear that this will be sufficient to quell Congressional Democrats’ concerns as it becomes increasingly likely that the House and Senate will schedule votes on bills to address this problem.  ACAP will continue to follow these developments.

In addition to the ACA activity, the House and Senate budget conferees held their second public meeting on Wednesday.  The meeting was dominated by testimony from Congressional Budget Office Director Doug Elmendorf, who was called to outline the budget issues facing the country.  Although the parties still appear to be far apart and unlikely to come to any big agreements on tax increases or entitlement cuts, consensus may be emerging in providing one- or two-years of relief from the federal budget sequester.  Both sides appear interested in providing some relief, although it is unclear how the two sides will agree to offset any changes in overall discretionary spending levels.  The Budget conference has a non-binding deadline of December 13 to produce a conference agreement. 

Leadership in Advocacy Award Nominations Open Through Nov. 25
Time is running out for plans to send in nominations for ACAP’s second annual Leadership in Advocacy Award. This award helps Safety Net Health Plans to show appreciation for their local Medicaid advocates--and at the same time allows ACAP to highlight the good working relationships our plans have with local advocates to those here in Washington. 

The winner of the Leadership in Advocacy Award will receive a plaque, a donation to charity in their name, and will be asked to join ACAP in Washington for an award ceremony during the February Fly-In.  More information is available here; nominations must be submitted electronically to Kathy Kuhmerker no later than November 25, 2013. 

Mary Kennedy Surveys the Long, Winding Road to Integration for Duals in Generations Article
The recently-released Summer 2013 edition of Generations, the journal of the American Society on Aging, featured an article by ACAP Vice President for Medicare and Managed Long-Term Care Mary Kennedy that surveys early and current initiatives to better integrate care for dual eligibles. The road to integration has thus far been uneven; while their have been some successes in Mary's home state of Minnesota, but programs in other states have faced regulatory and implementation hurdles. "If developing integrated programs for dual eligibles were easy, states would have already done so," she points out.

While the establishment of the Medicare-Medicaid Coordination Office (MMCO) was a tremendous step forward and has resulted in significant effort to make a shared-savings model work across several states, the new demonstration initiatives could have better leveraged the experience of states that had tried to integrate care for duals in the past.

And plans face implementation challenges in the future: timelines are unclear, and had to invest in hiring and training staff before enrolling members or receiving payment. In many cases, they had to reinvent care management processes and coordinate a wide range of functions within the plan. Most importantly, in many cases it remains to be seen whether rates and risk-mitigation mechanisms will be adequate to allow plans participating in new demonstration programs to build sustainable systems of care--especially as plans operate in an environment of budgetary belt-tightening at the Federal and State level.

Nevertheless, there is reason for optimism: "Integrated models developed within the demonstrations, or by states in partnership with Dual Special Needs Plans, offer tremendous opportunity to improve care for a very fragile population," she writes. "Plans look forward to implementation of these models over the next year and to working with stakeholders to improve care."

The entire article is available here. A subscription is required.

Excellence and Accountability

An Update from ACAP’s Substance Abuse Collaborative Meeting in Dallas
On October 29 and 30, the 16 members of ACAP’s Substance Abuse Collaborative convened in Dallas to discuss the many issues that affect Substance Use Disorder (SUD): substance abuse, pain management, screening and identification, and quality measurement, among others. 

The meeting featured a wide range of outside experts: Health Integrated CMO Sam Toney discussed the evidence base for patient engagement strategies to address prescription drug abuse, including a health coaching model developed by Health Integrated. Leigh Fischer of SBIRT Colorado Peer Assistance Services described SBIRT: it’s an acronym for “Screening, Brief Intervention, and Referral to Treatment,” which identifies patients at risk for overuse prescription drugs and provides opportunities for early intervention.

Eric Haram, Director of Outpatient Behavioral Health at Mid-Coast Hospital in Brunswick, Maine, discussed the evidence around medication-assisted treatment and when it’s most successful in addressing substance use disorders; he held a separate session that discussed appropriate use of opioids for pain management and strategies to mitigate risk of appropriate use moving to inappropriate use.

Junqing Liu of NCQA outlined NCQA’s plans for measures in development addressing quality of care and substance abuse, and discussed some measures currently in the field-testing stage. The meeting concluded with breakout sessions for plans to work together to develop 2014 action plans.

The Collaborative, which was funded through a grant from the Open Society Foundations (OSF), will run through 2015, at which point a publication will be developed to share collaborative members’ successes, challenges, and practices that can serve as a model for other plans. We will keep you apprised of the Collaborative’s development here at ACAP Community News.

Meg Murray to Serve on Advisory Panel Aimed at Improving Access, Care Coordination
ACAP CEO Meg Murray was recently named to a panel that will advise a coalition of organizations working to respond to new demands for access to quality health care under the Affordable Care Act and suggest pathways for safety net organization to respond to such demands.

With the support of a $1.8 million grant from the Community Benefit arm of Kaiser Permanente, the partnership—led by America’s Essential Hospitals, the National Association of Community Health Centers, and the George Washington University School of Public Health and Health Services—will assess safety net providers’ capacity to serve greater numbers of patients, provide tools and support to build capacity, and evaluate progress towards improvements in care. The partnership will focus its efforts on five states: Colorado, Georgia, Michigan, Ohio, and Virginia.

The advisory panel, which will provide input and guidance on the partnership’s efforts, will meet for the first time in November. More information on the initiative is available here. 

Deborah Kilstein Presents at DC Health Quality Meeting
On November 8, ACAP Vice President for Quality and Operational Support Deborah Kilstein made a presentation to the District of Columbia Association for Healthcare Quality at its annual conference in Washington.

Her presentation, entitled “Medicaid Managed Care Quality - Where are We Today and Where We Need to Go,” provided an overview of the various markets served by ACAP plans, gave a historical overview of Medicaid MCO performance on HEDIS and CAHPS measures, and highlighted larger trends in plan performance. She then described broader trends going forward in Medicaid managed care: shifts in demographics and the increase in dual eligibles, new practices among plans to establish patient-centered medical homes, pay-for-performance initiatives, hotspotting and other delivery system reforms. She concluded with an overview of ACAP’s efforts to promote continuous eligibility through the Stabilize Medicaid and CHIP Coverage Act, H.R. 1698 in the House of Representatives. 

An Update on the Care Harbor Free Clinic
In the last edition of ACAP Community News, we let you know about the annual Care Harbor event in Los Angeles, co-sponsored by ACAP member L.A. Care.

A quick update: Over the four days of the free clinic, stretching from Halloween to Sunday, November 3, more than 4,000 uninsured or underinsured patients saw volunteer clinicians to meet a wide range of needs. A quick summary is available in this article from Southern California Public Radio; a more in-depth look from Kaiser Health News here, and an L.A. Daily News opinion piece pointing out that free clinics are no substitute for coverage here. 

Disparities Solutions Center Seeks Applications for 2014-2015 Leadership Program
The Disparities Leadership Program (DLP) is a year-long, hands-on executive education program focused exclusively on helping health care leaders achieve equity in quality. The program is designed to help participants translate the latest understanding of the problem of disparities into realistic, actionable solutions.

Health plans are encouraged to participate. Some ACAP plans have participated in the past; here's a list of past participants. It's typical for two or more participants from a given organization to participate in the initiative as a team.

The program has three goals: to arm health care leaders with a rich understanding of the causes of disparities and the vision to implement solutions and transform their organization deliver high-value health care; to help leaders create strategic plans to advance their work in reducing disparities in a customized way, with practical benefits tailored to every organization; and to align the goals of health equity with health care reform and value-based purchasing. 

To read more about the Disparities Leadership Program (DLP), visit the Disparities Solutions Center Web site. Notices of intent to apply are due December 15.

Safety Net Health Plan News

IEHP Disburses First Set of PCP Rate Increase Funds
On October 18, ACAP-member plan Inland Empire Health Plan issued its first set of payments to primary care providers that reflected higher reimbursement rates as spelled out under the Affordable Care Act.

The increases, which are intended to bring rates for primary care doctors who serve Medicaid (in this case, Medi-Cal) patients in line with rates paid to doctors participating in Medicare for two years, are a feature of the Affordable Care Act aimed at ensuring an adequate supply of primary care physicians as Medicaid programs in many states expand their eligibility criteria.

IEHP’s payments, which exceeded more than $7 million in all for 392 physicians, cover the first quarter of 2013. Further payments are anticipated in November. IEHP initiated the increase in spite of not yet receiving funds from the State of California to compensate for the higher rates.

“We are pleased to make these early payments to our providers and will continue to make payments to them for the Medicare rate increase. I only wish we could have started even earlier,” said IEHP Chief Executive Officer Dr. Bradley Gilbert in a release.

Monroe Plan, Excellus Reach Agreement to Keep Coverage for MMC Members in Central New York
Last week, Excellus BlueCross BlueShield and ACAP member Monroe Plan for Medical Care announced an agreement in conjunction with Rochester-area health care providers that would enable the Excellus to continue offering coverage to more than 100,000 Medicaid Managed Care and Family Health Plus members in Monroe, Ontario, Wayne, Livingston, Seneca, Yates and Orleans counties.

In October, Excellus had announced plans to withdraw from Medicaid managed care in New York, citing losses in excess of $100 million in 2013. However, the plan reached an agreement with providers that would allow for continued operations, and would result in the Monroe Plan for Medical Care to continue to deliver medical management and administrative services to its members in Monroe, Ontario, Wayne, Livingston, Seneca, Yates, Orleans and Broome counties.

More information is available in this story in the Rochester Democrat – Chronicle.

New Report Details UPMC for You Partnership to Improve Care for Medicaid Mothers and Children in Allegheny County
ACAP-member plan UPMC for You is a founding member of the Allegheny County Maternal Child Health Care Collaborative, a group of more than 30 organizations in and around Pittsburgh dedicated to improving health care and health outcomes for Medicaid-eligible parents and their young children in Allegheny County.

A new report entitled Perspectives on the Allegheny County Maternal and Child Health Collaborative detail’s the group’s efforts to address depression and its cascading effects on not only parents but their children; as the report notes, “[t]he effects of parental depression and childhood developmental delay are closely intertwined, and these issues are more prevalent among low-income and minority families than the general population. This disparity is as real in Allegheny County as it is nationally.”

The report features not only the involvement of the various collaborative partners but also the individual stories of caregivers and organization members detailing their experiences. The report also includes a downloadable toolkit for implementing parental depression screening, referral, and treatment across systems.

And for those with iPads, the report also comes in the form of an app from the iTunes store; you can use it to access video features and more.

Further information is available in this blog post from UPMC for You President John Lovelace.

Partnership Featuring NHP Announces $6m in Grants to Community Health Centers
Recently, ACAP-member plan Neighborhood Health Plan (NHP) and Partners HealthCare, announced that their joint Partnership for Community Health would provide $6 million in competitive grant funding available over two years for local community health centers in Massachusetts. The new grant program is aimed at funding initiatives among CHCs that promote improvements in care at CHCs across the state. 

“We believe that CHCs are vital community assets in a continuously evolving health care landscape,” said Deborah C. Enos, president and CEO of Neighborhood Health Plan. “This funding serves as a catalyst for change by meeting the unique needs of the CHCs and supporting innovative work to improve the health and wellness of the populations they serve.” 

The $6 million in program funding will enable the CHCs to develop projects that focus on operational innovation and service excellence in one of four targeted areas: data and decision support, operational improvement, shared services, and engagement and communication. A previous round of funding distributed more than $4 million to 49 CHCs across the state. Funding decisions for this round will be announced in March 2014. 

For more information, visit NHP’s Web site. An announcement of the new funding is available here.

Safety Net Health Plan People

CareSource’s Janet Grant To Lead Aetna Medicaid in the Great Plains
Recently, Janet Grant was introduced as the new Head of the Great Plain Region of Aetna Medicaid. In her new responsibilities, Janet will lead five health plans, and oversee development for a region spanning eleven states ranging from Texas to North Dakota.

Janet’s move brings to a close her 12-year tenure at ACAP-member plan CareSource, where she served as the plan’s Executive Vice President for External Affairs and Corporate Compliance Officer. She was a fixture at ACAP events for a number of years, and all of us here will miss her contributions, energy and insight. We wish her the best in her new role.



ACAP Meetings

ACAP Roundtable Round-Up

Here’s this month’s crib notes on ACAP’s most recent Roundtable calls.  Summaries are available on ACAP’s Roundtable page, and list of upcoming calls is available on ACAP’s Member Calendar.

Some links include “a recording.” This generally means that you’ll see a phone number and passcode to access a recording of the call; most recordings are available for 30 days after the date of the original call.

You need an ACAP logon see these summaries, the Roundtable page, or the Member Calendar. ACAP plan staff encountering logon difficulty should contact Jeff Van Ness.

October 30 - ACA Action Biweekly Expansion/Exchange Call
ACAP’s recurring discussion on Exchange and Medicaid Expansion with plans featured significant conversation on the call about draft comments ACAP will submit later this month on proposed rules around the Basic Health Program. If you have input, email Jenny Babcock with your suggestions by November 20.

CareOregon’s Rose Englert explained the Fast Track program Oregon is using to enroll individuals in the Oregon Health Plan (Medicaid). Oregon received CMS approval to use SNAP (food stamps) and HealthyKids (Medicaid/CHIP mix) income eligibility information to identify people who are not currently enrolled in OHP but are or will be eligible under thanks to the ACA’s Medicaid expansion. The state sent letters to 260,000 presumptively eligible people at the end of September; so far 55,000 - 65,000 have indicated interest in enrolling. The link includes slides and a recording.

November 7 - Leadership in Advocacy Award Informational Call
This call was for interested plans to review the 2014 ACAP Leadership in Advocacy award process, and to answer questions about the award. The link includes slides. 

November 7 - Networking Call on Dual Integration/MLTC Initiatives
ACAP's regular networking call series featured a special presentation on Minnesota’s Memorandum of Understanding with CMS on D-SNPs. Other topics included recent reports on Star ratings and ACAP’s upcoming Medicare meeting in Scottsdale. The link includes slides from the call.

November 14 - ACAP Call with Plans: Comments on SNP Model of Care
This call discussed proposed scoring standards for the SNP Model of Care Criteria issued by NCQA on behalf of CMS. The deadline for comments is November 22; plans are urged to submit their own comments directly to NCQA and provide feedback to Mary Kennedy should they wish elements of their comments to be included in ACAP’s response. The link includes a PDF of the proposed criteria. 

November 14 - STAR Ratings call with ACHP
In conjunction with the Alliance of Community Health Plans (ACHP) and ACAP jointly presented a call for plans regarding Star ratings that featured an analysis of areas of care plans can target to improve their Star rating in future years. The link includes slides from the call. 

November 15 - PCP Rate Increase Networking Call
This recurring call reviewed and discussed how the PCP rate increase is being carried out in the different states and current status of the implementation. A wide range of topics were discussed on the call, ranging from contract amendments (at the state, plan and provider level) to frequency and nature of payments to the reconciliation process.  

Vendor News

A Roundup of Recent Vendor Education Series Webinars
ACAP recently held several entries in its ongoing Vendor Education Series, which are a chance for staff at ACAP-member plans to learn from Preferred Vendors on topics of interest and ask meaningful questions. Summaries of recent Webinars follow. Most include the slide deck from the call and recordings, should you wish to catch up on Webinars you missed.

November 14 - "Sales" is not a Dirty Word: Surviving in a Much More Competitive World Where Your Members Will Choose a Health Plan
hosted by Delta Sigma

This Webinar discussed how moving into new markets means that health plans will more than ever sell direct to consumers. Success in this new world means understanding the need for crisp, meaningful messaging; the essential ingredients for sales success and confronting the impact of price on the selection process.

November 12 - The Critical Difference:  HIPAA Security Evaluation vs. HIPAA Security Risk Analysis
hosted by Clearwater Compliance 

This Webinar discussed compliance with the HIPAA Security Rule – both on its own terms, and as amended by subsequent legislation (the HITECH Act and ARRA). Compliance involves many steps and considerations; starting on the right foot is key to success. 

The Webinar focused on the two distinct assessments you must complete by law; both are required by the HIPAA Security Rule.  It explained the difference between compliance assessment, security evaluation, risk assessment, risk analysis, and compliance analysis, and clarified the requirements of the HIPAA Security Rule.

November 5 - Member Engagement In a Post-ACA World
hosted by HTMS

This Webinar provided an opportunity discuss innovative approaches to proactive member engagement, and provided a context for the conversation by way of an overview of members engagement across the industry.

October 31 - Medicare Advantage Risk Adjustment and Health Insurance Exchanges:  What You Should Know And Be Thinking About for 2014
hosted by PopHealthMan 

This Webinar focused on upcoming changes in the Medicare Advantage Risk Adjustment Process, implications and challenges associated with the new Blended Model, changes in HCC codes, the impact on revenue forecasts and projections, and elements of a successful Risk Adjustment program.

It also featured a thought-provoking update for plans participating in Health Insurance Exchanges centered around Edge Server provisioning and implementation; risk adjustment and risk selection, member assessments and next steps.  

ACAP STRATEGIC ALLY
Health Integrated | about the Strategic Alliance

ACAP PREFERRED VENDORS

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