Inside CMS

March 8, 2013

America’s Health Insurance Plans’ (AHIP) unveiled Tuesday (March 5) a 40-page report detailing wide-ranging efforts by Medicaid managed care plans to implement innovative programs that aim to improve care and reduce health care spending. The report, which industry notes comes at a time when lawmakers are looking at ways to improve care and save money, highlights plan efforts and achievements in three categories: working with community partners, addressing obesity, and caring for people with complex needs.

AHIP President and CEO Karen Ignagni says the report, Innovations in Medicaid Managed Care, could demonstrate to members of Congress that Medicaid health plans offer a compelling solution for states and federal governments who are looking at ways to reduce spending, and improve health outcomes. The report says it is industry’s hope that a review of best practices will be “especially productive” during this transition period for Medicaid, which could result in as many as 7 million more people enrolled in the program, even taking into account the Supreme Court decision that made the expansion optional.

She says the report shows that Medicaid plans have been providing “game changing” services and supports to vulnerable populations. It also shows that plans are already accomplishing the number one goal that the policy community has been talking about for low-income, disabled beneficiaries: Providing the supports and services to beneficiaries who want to be at a home, rather than in an institutional setting.

The amount of activity in that areas is “striking,” she says.

Care coordination, which the Medicaid plans pioneered, Ignagni says, is the best way of providing health care for vulnerable populations. “The consequences of not doing this are simply far too high to not have everyone in a health plan,” she says.

AHIP notes that more and more states have been relying on Medicaid managed care plans and as of 2011 about 50 percent of beneficiaries were in such plans. From 2010 to 2011, enrollment in Medicaid plans was nearly double traditional Medicaid enrollment ( 9 percent compared to 4.6 percent), according to the report.

The report also arrives as AHIP and other groups — including Medicaid Health Plans of America (MHPA) — are working to repeal the health law’s premium tax, which a Milliman report suggests could result in $38.4 billion more in federal and state health spending. Many states are looking to Medicaid managed care as they seek to align payments for beneficiaries eligible for both Medicare and Medicaid services, either via the demonstration or in other ways.

One plan, Medica, has been working with nurses and social workers who serve as care coordinators to help seniors enrolled in Minnesota’s Senior Health Options program for dual eligibles live independently at home, according to the report. The coordinators help seniors with a range of activities, including transportation, meals, adult day care, and “even services to mow the lawn and shovel the driveway.”

The coordinators sometime join members on doctors and other medical visits to help explain any medication instructions and ensure that all questions are answered.

Results show that from 2006 to 2012 the portion of members who lived in their own community grew from 39.4 percent to 71 percent. Other plans included in the “caring for people with complex needs” category focus on transitioning patients from care settings — including an Affinity Health Plan — that helps move people from in-patient psychiatric hospitals to home settings, and provides patients with more care choices, including a plan in Tennessee that allows patients or other representatives to hire personal care aides.

Passport Health Plan in Kentucky partnered with Louisville’s EMS services in a public-private partnership that came to being after EMS realized that many people called 911 services for non-emergency situations, which overwhelmed the system and threatened its ability to respond to true life-threatening needs. EMS applied for, and received, a grant from Passport to create a new Priority Solutions Integrated Access Management (PSIAM) intuitive that helps triage callers. People that do not have immediate need for an ambulance or fire services are transferred to a PSIAM nurse who asks questions based on “nationally recognized clinical standards” that determine the best way to respond.

“Our triage nurses are not only medical professionals but they’re care navigators, patient advocates, negotiators, transportation coordinators, salespeople — it’s a unique combination of skills,” Kristen Miller, chief of staff of Louisville EMS, says in the report. “With a little guidance and confidence on our end of the line, most patients realize that it’s a tool that’s there to help them, not simply remove them from the 911 system.”

The report says that since 2011 the program has served more than 1,200 callers with non-emergency conditions, and saved patients an estimated 30 percent in transportation costs from 21010 to 2011. The city made the program permanent, and this year Louisville was one of five cities to get funding from Bloomberg Foundation to help improve customer services. The city plans to expand the program by adding weekend hours, hiring another nurse, adding a direct phone line and offering case management services for chronic care patients who frequently call EMS.

Health Partners in Philadelphia is one of the plans highlighted for its work to address obesity for it’s “Biggest Winner” nutrition program launched in 2009.

For the program, the health plan offers a 13-week session during which beneficiaries are counseled on ways to improve nutrition and pay attention to calories. The program is small — 46 people completed the sessions in 2011- but the report notes that most of the people who finished it lost weight or reduced triglyceride or blood sugar levels. Other programs touted in the report offer community and family fitness classes, nutrition educations and other tools that have helped people to lose weight and control diabetes and other medical issues.

Ignagni says that AHIP decided to put the report together last summer as part of an innovation series, which has previously focused on plan innovations in health information technology, Medicare Advantage and other subjects but had not probed Medicaid plans for a while. She says she was not surprised by the number of innovative programs offered by the plans, but that reading the report with all of them put together tells an important story. — Amy Lotven

Copyright © 2013 Inside Washington Publishers. All Rights Reserved.

Charity Spotlight: Passport Health Plan CEO, Mark Carter

Charity Spotlight: Passport Health Plan CEO, Mark Carter

Debra Childers
pg. 45, March 2013

Mark Carter came to Passport Health Plan as interim CEO in the wake of a critical state audit revealing the plan was in jeopardy. He put in place internal controls and made some fixes he terms “easy.” The reason he stayed, however, was the story of one person’s need and one employee’s generous response. The Courier-Journal ran a story of a woman with unmet health-care needs. She was one of the many vulnerable members of our society who lacks access to healthcare and whose needs are most often neither seen nor heard by the more fortunate.

But not this time. A Passport employee read the story and tracked down the woman in need. Although she was not eligible for Medicaid and Passport, her guardian angel was able to connect her to other social services agencies. Carter discovered that this “above-and-beyond” effort was the essence of the Passport culture. That began his “attraction to Passport,” and four months later, despite the comple-tion of his goals during an interim role at Passport, he decided to stay.

“I feel a compelling personal desire to do something meaningful in our com-munity. My best opportunity to serve is right here, right now.” Though many are aware of Passport in our community, few understand the one-of-a-kind health care network that serves over 100,000 children, and Medicaid-dependent adults in Kentucky.

Carter’s confidence in the vision and mission of Passport is supported by a unique business model. Sponsored by a group of compassionate physicians that assumes 51% of the financial risk, Passport has provided a consistent, provider-sponsored, community-based Medicaid health plan for more than 15 years. The plan employs over 230 individuals and offers a large provider network, including approximately 914 primary care physicians, 3,977 special-ist physicians, and all hospitals in the 16-county region it serves—all of whom are dedicated to improving the health and quality of life of Passport members. In addition to working closely with local providers, Passport also works with area health departments and social service agencies to promote events that support healthy living such as Healthy Hoops Kentucky, a program for children living with asthma, and the 2013 March of Dimes’ Walk for Babies. 

Carter’s work day begins at 5:00 with a vigorous encounter on his treadmill, and with the demands of Passport and his many philanthropic commitments, it doesn’t conclude until around 8 pm. Yet he says that his enduring marriage to wife Kellie keeps him centered and balanced. Mental and emotional renewal come from his family retreat on Lake Cumberland, enjoying his three children and four grandchildren, piloting his sin-gle-engine Beach Bonanza, and listening to old style country music.

Volunteering his time on behalf of the American Heart Association, Carter served as President of the 2013 Heart Ball Gala, which raised over $515,000! His philanthropic energies line up with his professional choices. The Heart Association has a “Big Goal of reduc-ing heart disease by 20% in 2020,” and Carter says that “gets his motor running.”

“When I leave here, ten years from now, I want to point to real improvements in the health status of Kentuckians. Obesity and diabetes threaten our population. Many of them are children, whose lives are just start-ing out. The implications are daunting. If we want a vibrant economy, we must have a very productive workforce. The choices we make now affect our health status as these young people grow up to live and work in their 40s and 50s. We are small and nimble with close con-nections to our providers. Together we make a difference.”  

—Debra Childers