Excellence and Accountability
Two ACAP Plan CEOs Make a Public Pitch For
Medicaid Expansion in Texas
In light of recent expansions of Medicaid in several states, the debate
around reforming and expanding the program in Texas has
picked up steam. Two ACAP plan CEOs have weighed in
publicly in recent weeks: Ken Janda, CEO of Community
Health Choice in Houston, and Dr. Mary Dale Peterson,
CEO of Driscoll Children’s Health Plan in Corpus
Christi, published separate op-ed pieces in major media
outlets making the case for Texas to expand its Medicaid
program. Select quotes from each opinion piece follow:
[R]efusing to participate in the federal program that guarantees a 100
percent federal match for Medicaid, the provider of
services for Texans' poorest, for the next three
years, is unthinkable. So is presenting a state plan
that lawmakers know full well will be turned down by
the federal authorities. The health of our most
vulnerable Texans and the big dollars involved make
getting this right imperative. We think there's a
middle way… The problem of the uninsured in Texas is
numerically daunting. More than 6 million of our
fellow Texans go without insurance, including nearly
2.7 million whose incomes are between zero and 133
percent of the federal poverty level. About 800,000
are undocumented workers, but 5 million are
citizens. Community Health Choice is calling for
what it describes as a "unique Texas solution" that
would acknowledge the political reality in this
state where federally administered registries are
unacceptable.
--Ken Janda:
A health care blueprint made in Texas, acceptable to
Washington? Houston Chronicle, February 21.
I think there is an opportunity for the State of Texas to reduce by at
least half its number of uninsured residents. We
have to convince our elected officials that we
should expand Medicaid or a similar program to
low-income adults… This would include adults under
the 138 percent of poverty — $15,401 for single
adults and $31,809 for a family of four. This
represents more than 9,000 adults in Nueces County
who currently are excluded from the Medicaid
program… We are at a crossroads — send more of our
hard earned money to neighboring states and continue
to be No. 1 in the nation with uninsured, or say yes
to this expansion that will save lives and money.
Contact your elected officials today.
--Dr. Mary Dale Peterson:
Why Texas needs to expand Medicaid. Corpus
Christi Caller, February 24.
Deborah Kilstein Joins PCORI Workgroup on
Treatment of Uterine Fibroids
Earlier this
week, ACAP Vice President for Quality and Operational
Support Deborah Kilstein joined a workgroup of the
Patient-Centered Outcomes Research Institute (PCORI) to
help develop funding announcements for research into
uterine fibroid treatment.
PCORI was established under the Affordable Care Act; its purpose is to
assist patients, clinicians, purchasers, and
policy-makers in making informed health decisions by
advancing the quality and relevance of evidence
surrounding the diagnosis, treatment and prevention of
diseases, disorders and other health conditions.
The workgroup discussed proposed research questions regarding treatment
of uterine fibroids, and their context given the current
state of evidence surrounding such treatment. The
overall aim of this workgroup is to identify gaps in the
evidence base for uterine fibroid treatment for which
studies could reduce uncertainty, improve
decision-making and lead to better health outcomes; the
ultimate product of the group will be specific, targeted
funding announcements for uterine fibroid research. We
will keep you apprised of further developments.
UPMC for You Payment Reform Initiative
Highlighted in Pittsburgh Tribune-Review
Readers of ACAP Community News with long memories know that the
substantial coverage has been devoted to the efforts of
ACAP-member plan UPMC for You to pilot an
initiative that would significantly reform Medicaid
payment systems for children with complex medical
conditions.
But it’s worth noting again, as the Pittsburgh Tribune-Review
recently profiled the plan’s efforts to overhaul the
payment system for these children with complex
conditions.
The UPMC for You proposal combines global payments with medical
accounts for families through which they could direct
part of their Medicaid funds to services they need. For
instance, a family could use payments to install a
wheelchair ramp, or take a taxi instead of an ambulance.
It is a program that generates significant interest
because if successful it could serve as a model for
overhauling the Medicaid program.
The entire profile is available at the
Pittsburgh Tribune-Review.
Safety Net
Health Plan News
Inland Empire Recognized for Connecting Children
with Coverage
Earlier this
week, ACAP-member plan Inland Empire Health Plan was
recognized by the California Children’s Health
Initiative with the Champion for Children Award for its
commitment in helping children get health coverage.
“This award is a great honor because it is
a testament to our team’s hard work in helping families
get health coverage for their children,” said Dr.
Bradley Gilbert, IEHP chief executive officer, in a
statement.
Since 2002, IEHP has helped over 150,000
uninsured children apply for Medi-Cal, Healthy Families
and Healthy Kids programs. Among its initiatives to
connect children with coverage are promotion of
public-sponsored health programs, connection with
community-based organizations participation in community
events where families can learn about their options.
For more, see IEHP’s
press release.
Family Health Network of Chicago On the Move to
New Offices
The three
readers of ACAP Community News who still use a
Rolodex will need a new card for their friends at Family
Health Network of Chicago, which recently moved into new
offices. The rest of us can update our Outlook contacts
with a brand-new address:
Family Health Network,
Inc.
322 S. Green St., Suite 400
Chicago, IL 60607
FHN was kind enough to grant ACAP staff
the opportunity to preview the new location in October;
it’s a space with a modern loft feel and a view of the
Sears Willis Tower. Photos of the new
space are below:
  
Photos courtesy Family
Health Network/Sarah Mahisekar.
Affinity Health Plan Names Lisa Keehn Executive
Director for MLTC, Medicare
Affinity Health
Plan recently named Lisa Keehn Executive Director,
Managed Long Term Care (MLTC) and Medicare. In this
capacity, a new role at Affinity, Ms. Keehn will oversee
operational and financial management of the MLTC
product, a new line of business to be launched in the
second half of the year. Ms. Keehn previously
Affinity’s Director of Medicare Compliance. “Ms. Keehn
has done an outstanding job in leading our Medicare
initiatives,” said Glenn MacFarlane, Affinity Vice
President of Strategy, Business and Product Development,
in a
release. “I’m confident she will bring comparable
diligence and expertise to the management of our MLTC
product.”
Partnership HealthPlan of California Hires New
Chief Information Officer
 Partnership
HealthPlan of California recently introduced Kirt Kemp
as the plan’s new Chief Information Officer. Mr. Kemp
has an extensive healthcare and I.T. background. "We're
thrilled to have someone as experienced and
knowledgeable as Kirt on board with PHC," said PHC Chief
Executive Officer Jack Horn. "Healthcare reform,
expansion of Medicaid and other initiatives have given
us many opportunities as well as challenges. Kirt Kemp
is the perfect fit to help us grow and change our
infrastructure to accommodate all of this activity."
ACAP Meetings and Events
Save the Dates for ACAP’s Expansion Support
Meetings, April 23-25
Following on
the heels of the wildly successful Marketing and Network
Development meetings in San Jose, ACAP has set aside the
dates of April 23-25 for two expansion support meetings
as follows:
April 23-24: Human
Resources Officers
April 24-25: Compliance Officers
These meetings will be
held at the Westin National Harbor just outside
Washington D.C., just across the Potomac from Reagan
National Airport (DCA).
You can reserve your
hotel room now! ACAP has reserved a block of rooms
at the Westin National Harbor for the discounted rate of
$224 per night. Hotel details are below:
Westin National Harbor
171 Waterfront Street
National Harbor, MD 20745
Phone: (888) 627-8104
Hotel Web site |
ACAP group reservations page
To reserve under the
block, call the hotel at (888) 627-8104 and ask for the
“ACAP Rate” or visit our
meeting reservation page. The discount is available
until Friday, March 29, 2013. Please note that ACAP
cannot guarantee hotel and group rate availability.
Don’t miss this great
networking opportunity! Watch your inboxes for more
information on registration. Contact
Robin Perry
with any questions.
ACAP Roundtable Round-Up
Following are
quick summaries of recent ACAP roundtables. As always,
you can see archived roundtable summaries on ACAP’s
Roundtable page, and there’s a comprehensive list of
upcoming calls on ACAP’s
Member Calendar.
You need an ACAP logon to
see either page. ACAP plan staff encountering logon
difficulty should contact
Jeff Van
Ness.
February 13: CMS Quality Update with Karen Llanos
Karen Llanos, Technical Director at the CMS Division
of Quality, Evaluation, and Health Outcomes within the
Children and Adult Health Program Group, joined ACAP to
provide a CMS quality update including a discussion of
their goals for 2013. With the development of the
Medicaid Quality Strategy, CMS continues to advance
quality as the key driver of Medicaid program
improvement.
February 15: ACA ACTION Call: Discussion of New ACA
Regulations
ACAP held a roundtable call to discuss a new rule
published by CCIIO with a very long title: Medicaid,
CHIP, and Exchanges: Essential Health Benefits in
Alternative Benefit Plans, Eligibility Notices, Fair
Hearing and Appeal Processes for Medicaid and Exchange
Eligibility Appeals and Other Provisions Related to
Eligibility and Enrollment for Exchanges, Medicaid and
CHIP, and Medicaid Premiums and Cost Sharing; Proposed
Rule. The purpose of the call was to explain the rules
and discuss ACAP's proposed response. Additional
guidances recently released by HHS related to the
Affordable Care Act were discussed as time permitted.
The link includes a slide
deck and links to the many-splendored guidances.
February 20: Medicare Plan Rates, MLR Rule and Risk
Adjustment Issues
This call covered the CMS draft Call Letter and 2014
Advance Notice, and ACAP’s response thereto. CMS is
implementing various ACA changes to MA rates. Per their
notice, preliminary estimate of the combined effect of
the Medicare Advantage growth percentage and the
fee-for-service growth percentage is estimated to be
-2.2 percent. CMS also announced a proposed rule
implementing the Affordable Care Act’s medical loss
ratio (MLR) requirements for Medicare Advantage and
prescription drug (Part C and Part D) plans. The
proposed rule limits plans to an 85% MLR.
The link includes slides
and links to various documents from CMS.
February 20: ACA Action Biweekly Expansion/Exchange
Calls
ACAP has instituted biweekly Medicaid Expansion &
Exchange calls to review any new regulations and
guidances issued in the prior two weeks, and for member
plans to network on issues related to both expansions.
This call discussed new guidance and regulations,
focusing on the single streamlined application and
developments in states. The link includes slides.
February 22: Engaging Children with Dental Services
Brian J. Bastecki, D.M.D., Dental Clinical Services
Lead at Horizon Blue Cross Blue Shield of New Jersey,
spoke about the efforts at Horizon NJ Health to improve
access to dental care and to ensure children are
receiving appropriate dental care; 2011 CAHPS survey
data show that only 2% of children had not visited the
dentist in the past six months. Jenny Babcock shared
information related to required dental benefits and
dental plans from the Affordable Care Act statute and
regulations. The link includes slides from the call.
February 28: Networking Call on Dual Integration/MLTC
Initiatives
This is part of ACAP's regular networking call
series to discuss development in integration for dual
eligibles and managed long-term care. The link includes
slides from the call.
March 1: Networking Call on ICD-10 Implementation and
CORE Operating Rules
ACAP hosted a networking session on ICD-10
implementation and the mandated CORE operating rules
including the upcoming certification requirements that
take effect 12/31/13.
March 7: ACA Action Biweekly Expansion/Exchange Calls
ACAP has instituted biweekly Medicaid Expansion &
Exchange calls to review any new regulations and
guidances issued in the prior two weeks, and for member
plans to network on issues related to both expansions.
This call focused on potential ACAP responses to a CMS
request for information on Medicaid and CHIP business
processes and the annual QHP letter, as well as an
update on the varying approaches to the Medicaid
expansion, including enrolling member in the Exchange,
being proposed by some states. The link includes slides
from the call.
CCIIO Engagement and
Training Call Series
Not listed here in detail is a series of calls held
by CCIIO to educate health plans and others on specifics
of the process for certification of qualified health
plans, Federally-facilitated exchanges, enrollment,
compliance and more. These calls have been occurring
with regularity over the last eight weeks. Recent calls
include:
February 28: Issuer
Engagement Call on FFE
February 27: Understanding the Rules of Enrollment
Effective Dates
February 21: Developing Effective Compliance Plans
February 14: Overview of QHP Certification Process (Part
II)
February 13: Enrollment Transaction and Companion Guide
February 7: Issuer Engagement Call
These calls are ongoing.
Visit regtap.info
for registration information; for a schedule, ACAP
members can refer to the Member Calendar or contact
Jenny
Babcock.
Join ACAP at the Medicaid Managed Care
Congress in Baltimore
The 21st annual Medicaid Managed Care Congress
will take place this year May 20-22, 2013 at the Baltimore Marriott Inner Harbor
in Baltimore, Md. Over 300 state officials and leading health plan executives
will be in attendance. ACAP's Kathy Kuhmerker serves on the event's planning
committee and will provide opening remarks on the
conference's second day.
Highlights of the Congress include:
-
More than 30 presentations from Medicaid
Managed Care thought leaders.
-
Preconference summit options focused on
health insurance exchanges, predictive modeling, Medicaid managed care for
pharmaceutical executives and the ever-popular Medicaid Managed Care 101.
-
Three newly aligned tracks bringing
everything from financial and administrative considerations to sales and
marketing excellence to best practices for complex care management.
Many members of the ACAP family will be noted speakers at the event. Among them:
-
Drew Berenato, Director, Office of
Exchanges, AmeriHealth Mercy
-
Eric Berman, DO, MS, Regional Chief
Medical Officer, Northern Division, AmeriHealth Mercy
-
Steven Bohner, Chief Financial Officer
and Senior Vice President of Finance, AmeriHealth Mercy Family of Companies
-
Philip Bonaparte, MD, Vice President of
Clinical Affairs, Chief Medical Officer, Horizon NJ Health
-
Jamie Bruce, MBA, CHC, Chief Development
and Marketing Officer, MDwise
-
Caroline Carney Doebbeling, MD, MSc,
FAPM, Chief Medical Officer, MDwise, Inc.
-
Harry Castleman, Senior Director of
Marketing and Communications, BMC HealthNet Plan
-
Jacqueline Dowdy, Member Advocate,
Neighborhood Health Plan of Rhode Island
-
Kristin Gericke, PharmD, Director,
Clinical Pharmacy Management, CalOptima
-
Ken Janda, President and CEO, Community
Health Choice, Inc.
-
Kathy Kuhmerker, Vice President,
Medicaid Policy, ACAP
-
Margaret (Peggy) Leonard, MS, RN-BC, FNP,
Sr. Vice President for Clinical Services, Hudson Health Plan
-
John Lovelace, President, UPMC for You;
President of Government Programs and Individual Advantage Products, UPMC Health
Plan
-
Meg Murray, Chief Executive Officer,
Association for Community Affiliated Plans
-
Ken Pariseau, Manager of Government
Affairs, Neighborhood Health Plan of Rhode Island
-
Paul Rothman, President, Prestige Health
Choice
-
Christina Severin, Chief Executive
Officer, Network Health
Register as a Guest of ACAP
and save 25%
off the
standard registration rate – use code XP1826ACAP.
Visit the website, call (888) 670-8200 or email
register@iirusa.com.
ACAP will also host a dinner during the
conference the evening of Tuesday, May 21. It was a highlight of last year – if you’re going to the
conference, you really don’t want to miss it. Details on the dinner will be forthcoming.
We hope to see you in Baltimore this coming May!
Vendor
News
Join ACAP and Verisk Health March 26 to Discuss
Data-Driven Strategies for Improvement
On March 26,
ACAP and Preferred Vendor Verisk Health will team up to
present a Webinar on how Medicaid state agencies and
MCOs can balance the dual objectives of cost containment
and quality improvement through managed care
initiatives. Through data-driven strategies, payers and
providers can improve financial sustainability through
risk assessment of the enrolled population, stratify
disease groups to inform care strategies and direct
outreach efforts, and evaluate network provider
efficiency. The Webinar will cover help attendees:
-
Build a strong foundation for Accountable
Care initiatives;
-
Improve financial forecasts for short span
eligible members;
-
Achieve quality standards and improvement
in population health and well-being; and
-
Evaluate Provider network performance and
drive down associated costs.
The Webinar will take place on Tuesday,
March 26 at 2 p.m. Eastern. For more
information, visit ACAP’s
Preferred Vendor Education Series Web page.
ACAP Welcomes HTMS as a Preferred Vendor for
Management Consulting Services
HTMS, an Emdeon
company, recently became a new ACAP Preferred Vendor for
management consulting services.
HTMS is a management consulting
organization focused exclusively on the healthcare
market, with particular emphasis on regional Medicaid
and provider affiliated health plans. Several ACAP
member plans are HTMS clients. HTMS helps clients adapt
and lead in an ever-changing environment by providing
executive-level consulting services with a special focus
on technology and operations. HTMS has an excellent
track record of delivering projects on time and within
budget, focusing on actionable outcomes with measurable
results.
“Working with ACAP plans has been special
for our company,” said Mike Weiher, President of HTMS.
“These plans play an essential role in the healthcare
landscape, and they are poised to become even more
important as the Accountable Care Act takes effect.
Although each is unique, ACAP plans face many common
limitations and obstacles. We are able to leverage our
experience among like plans to ensure our consulting
work is relevant and productive.”
HTMS services include:
-
Strategic Analysis and Market Intelligence
-
System Assessment, Selection & Procurement
-
System Implementation and Upgrades
-
Process Optimization
-
Program and Project Management
-
Strategic Staffing
-
Health Plan Start-up Assistance
HTMS expertise covers a number of service
areas, including:
-
Core Administrative Systems
-
Health Insurance Exchanges (HIX)
-
Quote-to-Card
-
Care Management
-
Patient-Centered Medical Home
-
Health Information Exchange (HIE)
-
Accountable Care Organizations
-
ICD-10
-
Government Programs (Medicaid, Medicare)
HTMS brings clients a consortium of
specialists with decades of experience in hundreds of
healthcare organizations and multiple markets.
HTMS team members average more than 20
years of direct experience working in the health
industry before serving in a consulting role. They know
what it means to optimize performance despite limited
resources, organizational obstacles and competitive
pressures. As a talent-rich, infrastructure-light
organization, they are equipped to provide consulting
services that can reduce costs, increase efficiencies,
and improve service.
ACAP STRATEGIC
ALLY
Health
Integrated |
about the Strategic Alliance
ACAP PREFERRED VENDORS
340(b) Drug Pricing:
PerformRx
Actuarial and Data Services:
Cirdan Health Systems
Analytics, Business Intelligence and Performance Management:
MedeAnalytics
Behavioral Health:
Beacon
Health Strategies, PerformCare
Business Process and IT Services:
TriZetto
Business Process Outsourcing:
TMG Health
Business Strategy and Development:
OptumInsight
Business Technology and Compliance Consulting:
HTMS, an Emdeon company
Care For High Risk Members:
INSPIRIS
Compliance Software:
Compliance 360
Disease Management:
Accordant Health Services,
a CVS Caremark company
Executive Search and Recruitment:
Morgan Consulting Resources
Group Purchasing:
CommonWealth Purchasing
Group, LLC
Health Management Solutions:
Health Integrated
HEDIS Compliance and Reporting:
Univita Health,
Verisk
Health
IT Consulting Services:
InfoArch Consulting,
Inc.
Legal Services: Epstein Becker Green
Member Assessments:
INSPIRIS,
MedXM,
Univita Health
Member/Provider Communications Consulting and Software:
Cody Consulting Services
Network Development:
Creative Health Concepts/WeiserMazars
Non-Emergency Medical Transport Management:
Coordinated Transportation
Solutions
Patient Communication Services:
CommonWealth Purchasing Group, LLC
PBM Solutions:
Excelsior
Solutions, The Pharmacy Group,
Solid Benefit Guidance
Pharmacy Benefit Managers:
Catamaran,
MedImpact,
Navitus Health Solutions
Radiology Benefits Management:
Care to Care
Reinsurance Services: RBS Re,
Summit Re,
U.S. Advisors, Inc.
Risk Adjustment:
Altegra Health,
PopHealthMan,
Univita Health
Special Needs Consulting:
Special Needs
Consulting Services
Specialty Pharmacy:
Accordant Health Services,
a CVS Caremark company; Amber Pharmacy,
Welldyne,
Inc.
Strategic Consultants: DeltaSigma, LLC
Strategic Government Business Solutions:
ClearStone Solutions
Subrogation:
First Recovery Group
TPL Subcontractors: HMS
Vision: Block Vision
Web Portals/SaaS: Health X
|
Mary
Kennedy became a proud grandmother on February 26 as
her grandson Magnus was born in Chicago. The baby,
his parents and proud grandparents are all doing
well. Join us in congratulating Mary on the new
arrival!