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ACAP Comments on Proposed Actuarial Standard of Practice
In a May 15 letter to the Actuarial Standards Board of the American Academy of Actuaries, ACAP provided input on a new draft of a proposed actuarial standard of practice that addresses rate development for Medicaid managed care plans. The standard of practice provides guidance to actuaries -- whether they work for states or for Medicaid health plans -- when developing and certifying capitation rates.
Among the issues ACAP highlighted in its feedback:
- When defining actuarial soundness, the differing environments in which plans operate must be taken into consideration.
- Definitions of actuarial soundness as written in the guidance may not adequately address new reimbursement models, such as patient-centered medical homes, accountable care organizations, and bundled payments. As such risk arrangements become more common, actuaries need to incorporate this information into their base data to maintain the accuracy of their actuarial assessments.
- The logic used to set rates should be transparent. MCOs should have the ability to review capitation rate development processes and have access to a data book which includes baseline data, adjustments to the baseline data, actuarial assumptions, risk adjustment methodologies and data, and the development of capitation rates.
- The guidance should state explicitly that rates should be made appropriate for each individual health plan through an actuarially sound risk adjustment process that is robust enough to reflect variations among the populations MCOs serve and the quality of data used.
- Actuaries should take data quality, sensitivity and robustness of the risk adjustment model used by the state into consideration when certifying rates to adequately address adverse selection and other factors (provider network makeup and payment rates), that can affect the composition of an MCO’s enrollees.
- Medical care and case management costs should be included as medical expenses, not administrative expensive. These services are crucial to improving and maintaining members' health and well-being.
- Changes in medical practice, including newly approved drugs and devices, may present a situation in which base data and capitation rates may need to be adjusted.
The letter is available in full here.
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Chart: Average Months of Enrollment in Medicaid
Owing in part to "churn", the average Medicaid enrollee has coverage through the program less than 10 months of the year. That's why ACAP strongly supports H.R. 1698, the Stabilize Medicaid and CHIP Enrollment Act, and S. 1980, the Medicaid and CHIP Continuous Quality Act, which would guarantee 12 months' enrollment for all who qualify.
See how your state compares by using interactive maps at coverageyoucancounton.org.
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Up This Week: the Medicaid Managed Care Congress
The 2014 Medicaid Managed Care Congress kicks off on Tuesday in Baltimore. Co-chaired by ACAP Vice President for Medicaid Policy Kathryn Kuhmerker, the Congress features more than 300 state officials and health plan executives.
Speakers at the Congress include:
- Drew Berenato, AmeriHealth Caritas
- Eric Berman, AmeriHealth Caritas
- Geralynn Boone, Horizon NJ Health
- Lynn Bradford, MDwise, Inc.
- Susan Coakley, BMC Healthnet Plan
- Andrea Gelzer, AmeriHealtCaritas
- Diane Jankowski, AmeriHealth Caritas
- Lynn Kryfke, Children's Community Heatlh Plan
- Kathy Kuhmerker, ACAP
- Peggy Leonard, Hudson Health Plan
- John Lovelace, UPMC for You
- Meg Murray, ACAP
- Ken Pariseau, NHPRI
- Stephen Ringel, CareSource
- Scott Streator, CareSource
- Bob Thompson, Univera Community Health
We hope to see you in Baltimore! Full details are available online at www.MMCCongress.com.
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Registration Open for the Healthcare Quality and Equity Action Forum
The Healthcare Quality and Equity Action Forum is set to take place on June 19 and 20 in Boston at the Seaport Boston Hotel and is convened by The Disparities Solutions Center at Massachusetts General Hospital.
The Forum will provide the background, key drivers, and strategies to improve quality and achieve equity in a time of rapid healthcare system change. Leaders from multiple disciplines and healthcare organizations—including those from health plans, healthcare systems, and children’s hospitals, to name a few—who work in the areas of quality and safety; disparities, diversity and equity; health policy; and health care design and delivery, will find the Forum to be a unique and highly valuable experience.
Speakers include:
Deborah Enos, MSPH, CEO & President, Neighborhood Health Plan
Joseph Betancourt, MD, MPH, Director, Disparities Solutions Center (Keynote Speaker)
Carolyn Clancy, MD, Assistant Deputy under Secretary for Health for Quality, Safety and Value, Veterans Health Administration, Former Director of AHRQ (Keynote Speaker)
Peter Slavin, MD, President, Massachusetts General Hospital
John Halamka, MD, MS, Chief Information Officer, Harvard, Beth Israel Deaconess Medical Center
Joseph Kvedar, MD, Director, Center for Connected Health, Partners HealthCare
David E. Miller, DDS, Chief, Division of Oral Health, Illinois Department of Public Health
J. Emilio Carrillo, MD, MPH, Vice President, Community Health, NewYork-Presbyterian Hospital
Winston Wong, MD, MS, Medical Director, Community Benefit, Kaiser Permanente
James Corbett, JD, MDiv, Senior Vice President, Community Health and Values Integration, Centura Health
Elizabeth Mort, MD, MPH, Senior Vice President, Quality and Safety, Massachusetts General Hospital
The Forum will also feature alumni from the Disparities Leadership Program, which has been profiled in previous editions of ACAP Community News. To register for the Forum, visit their Web site.
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Amy Thomas: Technology May Influence State Marketplace Decisions
With one enrollment cycle under our collective belt, the returns on the implementation of Marketplaces under the Affordable Care Act have far greater variation than most would have expected. A Commonwealth Fund blog post authored by ACAP's Amy Thomas and Sarah Dash of Georgetown University's Center on Health Insurance Reforms surveys the landscape of states seeking to transition their Marketplaces and predicts that few, if any, new state-based marketplaces will be created in 2015. (Amy worked on this blog post at Georgetown before she came to ACAP.)
The post emphasizes a point that we now know intuitively: a smoothly-operating Web site is central to a successful Marketplace. Accordingly, they posit, technological considerations are likely to weigh heavily on states' decisions going forward -- especially given the compressed time cycles surrounding Marketplace establishment grants and filing deadlines for 2016 open enrollment (!).
The blog post is available in full at the Commonwealth Fund.
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ACAP Seeks a Program Associate
Know somebody in Washington - or someone who wants to be in Washington - with an interest in health policy addressing Medicaid managed care?
The Program Associate provides policy and research support on projects addressing Medicaid, CHIP, Marketplace Qualified Health Plans and Medicare Special Needs Plans for low-income populations. It's an outstanding opportunity to be a part of a leading organization committed to increasing access to quality health coverage and services for low-income people. Successful candidates must have excellent verbal, computer, organizational, writing and interpersonal skills, the ability to perform independently in a fast-paced environment under general supervision, and will customarily and regularly exercise judgment and discretion.
More information about the Program Associate position is available here. Applications for this position are closing soon.
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Santa Clara Family Health Plan Call Center Garners Recognition
Earlier this month, the call center at Santa Clara Family Health Plan (SCFHP) was recognized by BenchmarkPortal as one of the top 100 small call centers in North America.
The BenchmarkPortal Top 100 is based on objective, quantitative metrics such as operational efficiency, service-level standards, customer satisfaction and employee training.
“Our call center representatives are committed to providing outstanding service to all members and providers calling SCFHP,” noted Elizabeth Darrow, CEO of SCFHP.
More is available from SCFHP here. You can learn more about BenchmarkPortal's Top 100 program here.
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Community Health Plan of Washington's CafeWell Profiled in Information Week
A recent partnership between ACAP-member plan Community Health Plan of Washington and Welltok, a developer of patient engagement software, was highlighted in a recent issue of Information Week.
The program, called Cafe Well, aims to strengthen relationships between the plan and members by providing a platform for members to connect to the plan through educational materials, provide rewards for healthy behaviors such as exercise, and promote conversations with and among its membership.
Cafe Well is a portal for desktop computers, and is also a downloadable app for tablets and smartphones; CHPW has linked it to a rewards program through Wholesome Wave, a nonprofit that delivers locally-grown food to underserved communities.
More than 2,000 CHPW members have already signed up for CafeWell; 60 percent access the program through smartphones. "We were finding they're all getting on CafeWell and they like the sponsored community. They want to start communicating on specific topics," said CHPW senior executive consultant Dennis Cannelis in the interview. "A lot of them are getting in just to talk about their health."
CHPW is considering expanding the program to tailor it specific populations, such as pregnant women, in the near future. More information is available at Information Week.
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Thinking About ACAP's Scholarship Program?
ACAP's 2014 Scholarship program has kicked off; this program awards a $2,000 scholarship to an ACAP plan member (or someone in a member's immediate family) who intends to pursue a career in health services or a related field.
The scholarship is awarded on the basis of three essays written by the applicant as well as a letter of recommendation from a non-family member (such as a teacher, professor, employer or clergy.) Entries are judged by an independent panel of safety net advocacy leaders.
The deadline for entries is June 30. For more information about the Scholarship program, contact Jeff Van Ness or download materials directly here. (ACAP logon required.)
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Join ACAP at the Enroll America State of Enrollment Conference
On June 16 to 18, Enroll America will convene its first national conference at the Renaissance Washington hotel to bring together leaders from all aspects of the outreach and enrollment effort: state and Federal government officials, state-based and national partners, enrollment networks, and other health care stakeholders. The State of Enrollment conference will share lessons learned, new research, and best practices that were most successful in the first open enrollment period. With two-plus days of training, workshops, keynotes and events, the conference offers valuable networking with Enroll America partners from across the country and serves as a premier opportunity to exchange best practices and build momentum for the next open enrollment period.
For more, visit www.stateofenrollment.org.
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A Fond Farewell to Hudson's Jessie Sullivan
At the end of May, Dr. Janet (Jessie) Sullivan, Chief Medical Officer at Hudson Health Plan, will leave the organization to become the Medical Director for the Center for Regional Healthcare Innovation at Westchester Medical Center.
 She has been with Hudson for 17 years, a stalwart presence at ACAP meetings and roundtables, and a respected voice at the national level for Medicaid managed care.
She currently serves on several panels dedicated to quality improvement, including those convened by the National Quality Forum, the AMA's Physician Consortium for Performance Improvement; the National Collaborative for Innovation in Quality Measurement; and the American Academy of Dermatology.
Dr. Sullivan has also served on the Board of Directors of the National Quality Forum. She was a founding member of both the New York Diabetes Coalition and the New York Quality Alliance. She was also recognized for developing “Supporting Excellence,” a Hudson Health Plan program that works with physicians and members to assure top-notch care.
All of us at ACAP will miss her keen insight and her decades-long dedication to assuring that Hudson's members received the very best in health care.
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