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• John Lovelace, Chair of ACAP
• Meg Murray, CEO of ACAP

The recently finalized Medicaid managed care “mega-regulation” significantly updates plan requirements for developing and maintaining networks adequate to meet the needs of an increasingly diverse enrollee population. The regulation also includes new, more stringent rules regarding the frequency with which provider directories must be updated. These two initiatives have great potential to impact enrollee access to care.

This session highlighted how two California Safety Net Health Plans employ innovations around telemedicine, provider communications, and provider directory improvements to benefit the care of Medicaid enrollees.

• Amy Shin, CEO, Health Plan of San Joaquin
• Liz Gibboney, CEO, Partnership HealthPlan of California

Research has shown that social determinants have a larger impact on health and health outcomes than health care services. Since their inception, ACAP health plans have recognized the importance of social supports in meeting the needs of their members.

As the needs of their members have become increasingly complex, Safety Net Health Plans have continued to expand their focus on social determinants. This session explored this evolving role from two plans, including insights from Janette Conway, a housing specialist and winner of the 2016 ACAP Making a Difference Award.

• Karin VanZant, Executive Director, Life Services Program, CareSource
• Janette Conway, Housing Specialist, Neighborhood Health Plan of Rhode Island

The Financial Alignment Initiative (FAI) has made great strides in improving access to care and coordination of care for dual-eligible beneficiaries. ACAP’s Medicare-Medicaid Plans (MMPs) account for more than a quarter of all enrollment in the FAI.

ACAP engaged the Center for Health Care Strategies (CHCS) to conduct a study of the accomplishments and innovations ACAP-member MMPs have made in the FAI in areas such as rebalancing long-term care, working with housing providers, connecting enrollees to community-based resources, and implementing value-based contracting strategies. Project staff from CHCS presented the highlights and key takeaways from this study.

• Michelle Herman Soper, Director of Integrated Care, Center for Health Care Strategies, Inc.

This award honors a community-based organization or individual whose work clearly goes beyond the norm and whose services are recognized as best practices which stand as a model for replication in the safety net environment. The aim is to reward unique ways of thinking and innovative ways of performing underlined by data depicting success.

This year’s award was presented to the Illumination Foundation. The Illumination Foundation aims to provide targeted, interdisciplinary services for the most vulnerable homeless clients in Orange and neighboring counties in California to break or prevent the cycle of homelessness. The foundation provides services including housing, workforce training, education, healthcare, and recuperative care in an effort to close gaps in available services.

• Paul Leon, CEO and President, Illumination Foundation

Value-based payment is a strategy to move from the long-standing fee-for-service system that rewards volume to a model that aligns payment and objective measures of quality in order to lower costs and improve care. This session featured two health plans that have implemented transformative alternative payment models to improve the delivery of maternity care via episode payment, and drive value into the delivery of long-term care services and supports.

• Michael Schrader, CEO, CalOptima
• Karen Love, Executive Vice President and Chief Operating Officer, Community Health Choice

The newly minted Medicaid managed care “Mega Reg” published by the Centers for Medicare and Medicaid Services includes strong focus on critical trends in health care coverage and payments, such as value-based purchasing and invigorated quality standards. As health insurance coverage in general continues to evolve in these areas, CMS is likely to increase its expectations for Medicaid plans to develop more sophisticated payment structures as well. While the regulation will heavily impact health plans, the regulation also drives states to advance their Medicaid programs.

In this session, Vikki Wachino discussed CMS’s vision for Medicaid managed care and Medicaid health plans, as well as plans’ opportunities to work with their states to develop meaningful innovations in the payment and quality space.

• Vikki Wachino, Deputy Administrator and Director, Center for Medicaid and CHIP Services

Individuals with behavioral health conditions frequently have co-occurring medical conditions. These members use more health care services and have higher associated costs. Many ACAP plans either have developed or are developing projects aimed at tackling problems associated with the need for improved integration between physical and behavioral health services, including improved integration between mental health and substance use disorder services. This session highlighted a health plan’s efforts to move from collaboration to integration.

• Paul Mendis, Chief Medical Officer, and Jill Lack, Director of Behavioral Health, Neighborhood Health Plan

Meg Murray, ACAP

The Centers for Medicare & Medicaid Services took a great step forward towards creating a more equitable Medicare Advantage payment system for low income Medicare beneficiaries in the 2017 final notice. Sean Cavanaugh spoke about these recent developments in addition to the agency’s future work on the Star Rating system and Medicare and Medicaid integration for dual-eligible beneficiaries.

• Sean Cavanaugh, Deputy Administrator & Director, Center for Medicare, CMS

Recent media coverage has centered around the role of large commercial insurers in the Health Insurance Marketplaces, yet there is a significant role—and opportunity—for smaller, community-based issuers that have historically offered Medicaid coverage. Jocelyn Guyer spoke to the importance of having such crossover issuers and Ken Janda discussed his plan’s experience as an overlap issuer—including pricing, plan design, and mission.

• Jocelyn Guyer, Managing Director, Manatt Health Solutions
• Ken Janda, President and CEO, Community Health Choice

At a recent Milbank Fund meeting, several ACAP CEOs in states with Delivery System Reform Incentive Payment (DSRIP) waivers met with state Medicaid directors to explore how states and plans can work together to achieve DSRIP goals. While much of the discussion centered around how existing Medicaid managed care programs are overlaid with new provider relationships and payment arrangements, additional conversation focused on the future of value-based purchasing initiatives in Medicaid after the DSRIP waivers run their course.

• Joe Manger, Director, Regulatory Affairs Government Programs, Horizon NJ Health
• Chris Koller, President, Milbank Memorial Fund

For several years, the health care world has been abuzz with how to manage steeply growing pharmacy costs. Depending on the states in which they operate, Medicaid health plans have often been left to foot very costly drug bills.

Recognizing the groundbreaking potential of new high-cost drugs to treat and cure chronically ill patients, including those impacted by Hepatitis C and HIV/AIDS, payers are seeking balance between drug costs and inpatient costs, chronically ill patients and cures. This session looked at how plans are using intensive care coordination, value-based purchasing, and other innovations to ensure that high-cost drugs lead to positive outcomes for both patients and plans.

• Dr. Eric Berman, CMO, VNSNY CHOICE Health Plan
• Terry Leach, Vice President of Pharmacy, Amida Care