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Four of the Top Five Health Plans in the U.S. are Safety Net Health Plans
ACAP-member Safety Net Health Plans once again garnered top accolades from, the National Committee for Quality Assurance (NCQA), taking four of the top five spots in the organization's recently-released NCQA 2014-2015 Medicaid Health Insurance Plan Rankings. The rankings name the country's top Medicaid health plans based on performance against measures of clinical quality, consumer experience and NCQA Accreditation standards scores.
Among the top performers this year are:
- Network Health (Mass.) - #1 in the U.S.
- Neighborhood Health Plan (Mass.) - #3
- Boston Medical Center HealthNet Plan (Mass.) - #4
- Neighborhood Health Plan of Rhode Island - #5
Other ACAP-member Safety Net Health Plans garnered the top rankings in their states; they include:
- Passport Health Plan
Top-ranked in Kentucky; #19 overall
- MDwise
Top-ranked in Indiana; #28 overall
- CalOptima
Top-ranked in California; #29 overall
- CareSource
Top-ranked in Ohio; #66 overall
“Every day, staff at ACAP-member Safety Net Health Plans work to deliver a better experience for their members, by assuring access to a wide range of physicians and providers, or by providing tools to their providers to help them deliver the best possible care,” said ACAP CEO Margaret A. Murray in a statement. “It’s wonderful to see these efforts validated in such an emphatic, and public, way.”
These rankings reflect untold hours of labor by Safety Net Health Plan staff; our congratulations to all the plans recognized by NCQA in these rankings. The full rankings are available on NCQA's Web site.
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ACAP Seeks a Vice President, Medicare and MLTC Policy
ACAP seeks a Vice President for Medicare and Managed Long-Term Care Policy to succeed Mary Kennedy, who will retire at the end of this year.
This individual will work with ACAP's Board and staff to develop positions on federal policy issues related to Dual Eligibles and long-term care services and vet them with ACAP members, among other duties. The full description is available on ACAP's Jobs page; please forward it to parties who may be interested.
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ACAP Takes to the Hill to Educate Congressional Staff on Churn
On September 19, more than 50 health staffers from House and Senate offices gathered for a staff briefing on churn in the Medicaid program and heard about the benefits of 12-month continuous enrollment.
The briefing, entitled Understanding 'Churn' in Medicaid and CHIP and its Impact on Beneficiaries, Providers, Health Plans and Quality of Care, provided insight on the issue of churn from several perspectives, ranging from the "macro" view of how churn impacts coverage rates in the Medicaid and CHIP programs to the "micro" view, which illustrated how one family's experience with churn disrupted patterns of care and adversely impacted their finances.
ACAP CEO Meg Murray moderated the event, which featured an impressive roster of speakers:
- Benjamin Sommers, M.D., Ph.D.; a professor of health policy at Harvard University and one of the nation's foremost experts on churn in Medicaid and CHIP, who provided an overview of the issue;
- Frank Micciche, V.P., Public Policy and Communications, National Committee for Quality Assurance; who discussed how churn interferes with quality measurement efforts in the Medicaid and CHIP programs;
- Steve Ringel, President, Ohio Market, CareSource Health Plan, who discussed the ways in which churn disrupts efforts to build long-term relationships and care management plans with members; and
- Tamara Pedrojetti, Community Relations Program Coordinator, CareOregon, who works with health plan members on a daily basis and provided specific illustrations of the way that churn disrupts health care -- and, conversely, the way in which continuous coverage can lead to improvements in people's lives. (Tamara was also a nominee for ACAP's Making a Difference award; more on that here.)
At the event's conclusion, Meg reminded the attendees that two bills before Congress -- H.R. 1698 and S. 1980 -- both provide for 12-month continuous enrollment in the Medicaid program. Owing in part to the continuous efforts of ACAP-member plans to move these bills, H.R. 1698 currently boasts 29 sponsors and co-sponsors.
More information about the briefing, including slide decks and handouts, is available here. For more on churn in general, visit www.coverageyoucancounton.org. We'll continue to keep you apprised of ACAP's efforts to lead the charge against churn here in ACAP Community News.
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ACAP's Congressional staff briefing on churn featured (L to R) ACAP CEO Meg Murray, Frank Micciche of NCQA; Tamara Pedrojetti from CareOregon; CareSource's Steve Ringel, and Dr. Ben Sommers from Harvard University.
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ACAP Pharmacy Directors Address Hot-Button Topics at Denver Gathering
Pharmacy--more so than usual--has been top-of-mind for leaders in the managed care space of late. Issues that have garnered significant attention of late include the appropriate management of high-cost specialty drugs, as well as the continuing prescription drug abuse epidemic that has pharmacists and policymakers balancing the need to take measures to combat abuse with the need to maintain access to needed drugs such as opioid painkillers for appropriate pain management. At the end of September, pharmacy directors from ACAP-member Safety Net Health Plans across the country gathered to discuss these and other pressing topics.
Session topics included:
- The use of P4P and incentives to promote medication adherence;
- Pharmacy quality measures;
- Apprioriate management of high-cost drugs;
- Medication Therapy Management and the role of the pharmacist;
- Ways to address prescription drug abuse
- The implications of a single formulary in a state;
- Best practices oversight of pharmacy benefit managers;
- The intersection of pharmacy issues with the Marketplace, and
- Reaching for the STARS: best practices for Medicare Part D.
For those that couldn't make the meeting in Denver, slides and meeting materials are available here. An ACAP logon is required.
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Congressional Leaders Ask ACAP For Insight Into Medicaid Managed Care Best Practices
A September 29 letter from leaders of both parties in both houses of Congress seeks information from ACAP and two other organizations regarding best practices in Medicaid managed care.
The letter was signed by House Energy & Commerce Committee Chairman Fred Upton (R-Mich.) and Ranking Member Henry A. Waxman (D-Calif.); Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Orrin Hatch (R-Utah). It read in part:
"Today, the Medicaid program provides health coverage to more than 67 million people, with over half of those individuals receiving coverage through a private managed care plan that contracts with a state's Medicaid program. As a result, we believe it is important for Congress to better understand the growing and evolving role managed care plays in the Medicaid program. ... [W]e are particularly interested in providing private sector partners the opportunity to benefit from the consideration of an array of successful models for patient care."
The letter seeks information on best practices on a wide range of activities, including network adequacy, quality metrics, drug abuse prevention and more. Fortunately, ACAP is well-positioned to respond, given that the activities of ACAP-member Safety Net Health Plans have provided a good foundation for providing specific examples of best practices.
ACAP is grateful for the opportunity to share with Congress the ways in which Safety Net Health Plans work to improve health care for people with low incomes while at the same time serving as wise stewards of public resources. We will have a response prepared by the November 15 due date and will share it with you here in ACAP Community News.
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ACAP Urges Refinements to Citizenship Data, Cost-Sharing Reconciliation
ACAP recently sent two letters to the Center for Consumer Information and Insurance Oversight (CCIIO) pertaining to two key elements for plans offering coverage through the Marketplaces.
One letter responded to a bulletin issued by CCIIO aimed at resolving eligibility data inconsistencies related to immigration status and citizenship.
In the letter, ACAP recommended that the Federally-facilitated Marketplace (FFM) provide issuers with further information about the types of inconsistencies experienced by those with data-matching problems, such that issuers are in a better position to help enrollees retain coverage; to transmit terminations related to data inconsistencies to issuers in a timely manner (no later than September 15), and to clearly identify individuals whose cases are handled through the Health Insurance Casework System (HICS) such that issuers can take the steps needed to ensure efficient enrollment of these individuals.
The second letter dealt with reporting requirements surrounding the cost-sharing reconciliation process. In this letter, ACAP urged CCIIO to provide data regarding CSR payment amounts at the member level to aid the plans in reconciliation, and to clarify reporting requirements for plans, including a clear delineation of which reporting requirements apply to issuers participating in the FFM versus those in state-based Marketplaces.
For a library of ACAP's comments on the Marketplace and other issues, visit ACAP's Web site.
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What Makes A Duals Plan Great? PRIDE Consortium Spells Out Key Attributes
A recent report from the PRIDE (Promoting Integrated Care for Dual Eligibles) Consortium, an initiative launched by the VNSNY Research Center with Support from the Commonwealth Fund, is an effort to discern common traits among high-performing organizations that support care for persons dually eligible for Medicare and Medicaid.
ACAP Vice President for Medicare and MLTC Policy Mary Kennedy has served on the consortium's National Advisory Board since its inception.
The report emphasized that the single defining trait of effective care for this population is a "dynamic person/family‐centered plan of care built on significant individual/caregiver involvement and comprehensive assessments and reassessments over time to capture changes in people’s circumstances and preferences." Other key elements include:
- A multi‐disciplinary care team with one accountable care coordinator;
- A comprehensive provider network with a strong primary care base and a range of other providers and services that can accommodate diverse needs throughout a lifetime;
- Robust LTSS options, with a bias toward home‐ and community‐based services (HCBS);
- Effective information exchange across organizational silos, multiple providers, and diverse individuals and their caregivers;
- Clear performance metrics with rigorous monitoring and quality improvement; and
- Financial incentives aligned across service providers that reward high performance consistent with the “Triple Aim.”
The conclusions were reached after extensive interviews with high-performing organizations that serve dual eligibles; among the participating plans were ACAP members CareSource, Commonwealth Care Alliance, Health Plan of San Mateo and VNSNY CHOICE Health Plans.
The report in full is available here.
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Dr. Ruben Cowart, One of ACAP's Founders, Announces Retirement
Dr. Ruben Cowart, President and CEO of the Syracuse Community Health Center and instrumental in the founding of ACAP in 2001, recently announced his retirement after a career spanning five decades at the community health center he founded.
ACAP was once known as the Association of Health Center Affiliated Health Plans, or AHCAHP; it was founded in 2001 by a consortium of 14 plans owned by community health centers. Among those was the center Syracuse founded by Dr. Cowart and the health plan it owned, Total Care. Last year, Total Care merged with Universal American.
Dr. Cowart, a practicing dentist, has presided over the Syracuse Community Health Center since its founding in 1978. The center's history, along with a brief sketch of Dr. Cowart's career dedicated to serving people with low incomes, is available here.
All of us at ACAP wish Dr. Cowart all the best in his retirement.
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Making the Most of Data: AHA Webinar Features Ways to Measure Health Equity
As part of its Hospitals in Pursuit of Excellence Webinar series, the American Hospital Association will on Tuesday, October 14 feature a Webinar featuring key lessons learned from the Disparities Solutions Center (DSC) at Massachusetts General Hospital (MGH), the 2014 AHA Equity of Care award winner in regards to dashboards and reports.
This Webinar will provide concrete tips for setting up operational dashboards to measure health equity, collect data and develop reports.
This Webinar will take place Tuesday, October, 14, 2014 at 3:30 p.m. ET; interested parties may find more information and register here; it's free to attend.
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ACAP's Deborah Kilstein Serves on Advisory Panel to Reduce Medicaid Readmissions; Guide Now Available
ACAP Vice President for Quality Management and Operational Support Deborah Kilstein served on an advisory committee to the Agency for Healthcare Research and Quality (AHRQ) that discerned best practices in reducing Medicaid inpatient readmissions. The group's efforts have been distilled in a new guide from AHRQ entitled the “Hospital Guide to Reducing Medicaid Readmissions.”
The only such Federal guide tailored specifically to hospitals serving patients covered through Medicaid, the guide offers suggestions for refining current readmission reduction efforts, an online roadmap to develop new strategies to address readmissions; compliance tips; notes on transitions in care and more.
The guide is available online from AHRQ.
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Making a Difference Spotlight: Tamara Pedrojetti
Tamara Pedrojetti’s work with CareOregon’s member advisory board has made a real difference in the lives of several of the health plan’s members. Her work has catalyzed change in Oregon’s Medicaid program as a whole--and let to her nomination for ACAP's Making a Difference Award.
 In 2011, Ms. Pedrojetti became the full‐time program coordinator for the CareOregon Member Advisory Committee. The committee was formed as a way to enhance CareOregon’s service and member engagement. Many group participants, known as Community Health Engagement Advocates (CHEA), have made dramatic positive changes in their lives after getting involved with CHEA, and were eager to share their stories.
Whether it was improving their mental and physical health, overcoming addiction, overcoming poverty, or becoming a health advocate, CHEA program participants routinely cite the support, friendship, and guidance of Tamara as a factor that helped them overcome their challenges.
The work of Ms. Pedrojetti was in a very real sense a model for others to follow: In 2012, the state of Oregon passed a law mandating that every Medicaid plan in the State have a Community Advisory Council, similar to the one in place at CareOregon. Today, Ms. Pedrojetti works with several of these Advisory Councils as a Member Centricity Program Coordinator, expanding upon the work she did with CHEA.
“Tamara is clearly motivated by a sense of mission, rather than a paycheck,” says Patrick Curran, CEO and President of CareOregon, in nominating her for the Making a Difference award. “The intensity with which Tamara has submerged herself into her work and relationships go beyond any expectation we at CareOregon have as her employer, supervisor or co‐worker. We are proud of her contributions and accomplishments.”
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Sampsel, Chan Named CHCF Leadership Fellows
Chris Chan, PharmD, Senior Director of Pharmaceutical Services at Inland Empire Health Plan and Elizabeth Sampsel, PharmD, MBA, BCPS, Director of Pharmacy at San Francisco Health Plan, were among 32 named as Health Care Leadership Fellows by the California HealthCare Foundation (CHCF).
The program is a part-time fellowship that offers clinically-trained health leaders hands-on opportunities to learn the decisionmaking, strategic planning, and executive skills needed to excel as leaders. Graduates gain insight into the trends and challenges facing health care professionals and leave prepared for new levels of leadership within their organizations.
Our congratulations to Drs. Chan and Sampsel on their recognition!
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Status Update: ACAP Alum Sherry Knowlton
Our profile last year of ACAP alum Sherry Knowlton is in need a bit of an update.
 You see, Ms. Knowlton, a former Senior Vice President of AmeriHealth Mercy and CEO of Sherry Knowlton Health Care Consulting, has a side gig as a suspense novel writer, and her first book was just published.
Dead of Autumn is available on Amazon, and will be soon available at Barnes and Noble and wherever books are sold. You can learn more about the book at www.sherryknowlton.com.
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Vendor Spotlight: How Health Integrated Helped an ACAP Plan Lower MLR, Improve Member Experience
ACAP Strategic Ally Health Integrated, Inc., recently reported impressive outcomes from its work with ACAP-member plan Community Health Plan of Washington (CHPW). The group helped drive an 8% point reduction in Medical Loss Ratio (MLR) for CHPW while at the same time improving member experience.
These results were achieved through Health Integrated's scalable total care management solution, which uniquely leverages psycho-social interventions to impact medical outcomes and coordinates care at unparalleled levels. The solution was deployed for twenty thousand CHPW members of CHPW's Medicare Advantage (MA) and Dual Eligible SNP plans.
CHPW faced a number of challenges: regulatory hurdles, gaps in risk identification and mitigation, underperforming quality metrics, and a medical expense loss ratio exceeding 103%.
Health Integrated responded to CHPW’s needs with a highly integrated total care management solution that includes Medical and Behavioral Case and Utilization Management, a fully compliant SNP Model of Care, Transitions of Care, and their flagship Synergy Targeted Population Management® program.
“As a partner, Health Integrated understood our performance needs and immediately went to work to support them,” said CHPW Chief Executive Officer Lance Hunsinger. “In less than a year, by leveraging Health Integrated’s solutions along with our own improvements in network design and within our quality department, we’ve realized more than $13 million in savings and an 8% point drop in our medical loss ratio. That’s significant... we recently expanded access to their solutions to our 285,000 Medicaid members.”
Specifically, Health Integrated impacted key clinical utilization measures as follows:
- 15% increase in office/home visits
- 54% increase in physical exams
- 7% reduction in overall inpatient utilization
- 19% reduction in surgical utilization
- 9% reduction in outpatient utilization
- 14% reduction in radiology (all settings)
Additionally, Health Integrated helped CHPW decrease overall member and provider complaints.
“We are honored that CHPW chose us to support them with their strategic objectives around costs, quality and member satisfaction,” said Shan Padda, chairman and chief executive officer of Health Integrated. “We firmly believe that individuals deserve to be treated with dignity in their care experience and that the best way to do that is to provide quality care. At the same time, we can improve the health of populations and reduce per capita costs.”
For more information, visit Health Integrated's Web site.
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