Institute for International Research

Tuesday, June 20th, 2006

8:30

Co-Chairperson's Welcome and Opening Remarks

G. Kirk Olsen, Chief Executive Officer
CEOMOLINA HEALTH CARE OF UTAH

Vernon K. Smith, PhD, Principal
HEALTH MANAGEMENT ASSOCIATES

Keynote: Federal Regulatory Update – Reform Impacting Medicaid Managed Care

• Status of Federal Medicaid Reform
• Impact of Federal Budget cuts – 2005 Budget Reconciliation Bill
• Harmonization of Medicare and Medicaid
• Federal Medicaid waiver program
• LTC and SSI Population Expanison
• Overview of Medicare Part D implementation
• Hurricane Katrina – what it taught HHS about Disaster Preparedness, Eligibility, and Care Coordination – Will CMS mandate coverage in the event of catastrophic
  situation where people must be relocated

Dennis Smith, Director, Center for Medicaid and State Operations
CENTERS FOR MEDICARE & MEDICAID SERVICES (Invited)

Keynote: Industry Update – Healthcare Industry Trends Impacting Medicaid Managed Care

In an effort to achieve continued growth, the managed care industry is exploring new markets and adding new products. With the implementation of Medicare Part D, the proliferation of Special Needs Plans and increasing interest in expanding Managed Care to LTC and SSI populations continued growth is the marketplace is expected. Other factors impacting Medicaid Managed Care include the erosion of employer sponsored
insurance which shift healthcare cost to the public sector, a changing Medicaid Case Mix as the baby boomers age and the number of elderly disabled increases, as well as cost trends revealing slower rates of increase resulting in States restoring benefits and expanding eligibility are all impacting the industry. In this session keynote speaker discusses:

• Exploring enrollment, rate and healthcare cost trends and the impact of these trends on Medicaid Managed Care in light of the shifting case mix of Medicaid populations
• Assessing the impact and opportunities created by the erosion of employer sponsored insurance
• Meeting consumer demand for accessibility and public expectations of quality
• Proliferation of Special Needs Plans
• Medicare and Medicaid integration – operational, clinical, and social impact of Project Harmonization regulations
• Update on industry consolidation and valuation of Medicaid plans– who has been buying whom
• Potential impact of the Master Patient Index, RHIOs, and other Healthcare technology innovations
• Assessing the impact of Medicare Advantage and SNPs Lock-In on the competitive landscape of Medicaid Managed Care

Grace-Marie Turner, President
GALEN INSTITUTE

Lesson Learned from Katrina - Improving a Healthcare System in the Aftermath of Catastrophe

Hurricane Katrina slammed into the Gulf Coast region on August 29, drastically altering the way of life in the surrounding areas as well as their health care resources. The New Orleans area was home to one third of the state's Medicaid population, and these recipients are now scattered throughout Louisiana and the country. This area also was
home to much of the state's medical infrastructure -- hospitals, clinics, public health units, medical education facilities and public health research institutions. Not many could anticipate a public health disaster of this scale. In this session Dr. Cerise shares his experience and details what he learned that will help others ensure disaster preparedness in the future.

• Implementing population-based strategies to prepare and prevent large scale public health disaster
• Providing primary care services to transitional housing sites
• Launching healthy environment and healthy neighborhoods strategies

Frederick P. Cerise, MD, MPH, Secretary
LOUISIANA DEPARTMENT OF HEALTH
& HOSPITALS

State Medicaid Director Panel – Exploring Effective Strategies to Improve Quality and Control Cost without Limiting Benefits or Eligibility

States are implementing sweeping reform, making significant
budget cuts, and increasing their focus on fraud and abuse
prevention to save money that could be put toward improving
quality of care and access to the neediest beneficiaries. In this
session, State Medicaid Directors discuss other innovative
strategies that control cost while improving quality including
disease management, pay for performance programs, and cost saving
technologies.

• Impact of Medicaid reform and Federal and State budget cuts on quality improvement programs and eligibility
• Innovative technologies that improve quality and control costs
• Measuring the success of Disease Management efforts
• Assessing the impact of Pay for Performance on quality and cost
• Feasibility of Consumer Driven Healthcare and consumer directed accounts

Vernon K. Smith, PhD, Principal
HEALTH MANAGEMENT ASSOCIATES (Moderator)

Tom Arnold, Deputy Secretary for Medicaid
FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

Melissa Rowan, Deputy Director, Managed Care Operations, Medicaid/CHIP
TEXAS HEALTH & HUMAN SERVICES COMMISSION

Jim Hardy, Deputy Secretary, Medical Assistance Programs
PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE

John Young, Associate Director, Division of Health Care Quality
RHODE ISLAND DEPARTMENT OF HUMAN SERVICES

Tuesday, June 20th, 2006

Track A: Operational and Financial Management

Track B: Care Management and Quality Improvement

Special Needs Plan Executive Panel – Implementing Strategies for Ensuring Profitability and Optimal Financial Performance

In 2005, 270 SNPs were approved for operation. In this panel, executives from leading Special Needs Plans from 4 States discuss:

• Issues and challenges with operating a SNP
• Adequacy of current CMS payments and current issues
  with reimbursement
• Actuarial projections for Special Needs Plans

Richard Bringewatt, President
NATIONAL HEALTH POLICY GROUP
Chair, SNP ALLIANCE (Moderator)

Joyce Hagen, President
PASSPORT HEALTHPLAN/UNIVERSITY HEALTHCARE INC (KY) (Dual Eligibles)

John Lovelace, VP, Medicaid Programs
UPMC HEALTH PLAN (PA) (Dual Eligibles)

Barry Volin, CEO
ELDERPLAN, INC (NY) (Institutional)

Implementation of Pay for Performance and Value Based Purchasing Programs to Improve Quality

New York and Texas are among the first of many States to introduce pay for performance and value based  purchasing programs that provide incentive payments to physicians,
hospitals and plans that meet high standards of care. Specifically State representatives tackle how to:

• Get Hospitals, Physicians, and MCOs to Buy-In to Pay for Performance
• Establish an optimal reimbursement structure
• Implement optimal performance monitoring to measure the
  most important healthcare indicators
• Use financial claims data to improve the effectiveness of
  quality improvement projects

Cheryl Bupp, Director, Managed Care Plan Division, MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

Patrick Roohan, Director, Bureau of Quality Management and Outcomes
NEW YORK STATE DEPARTMENT
OF HEALTH

Pamela Coleman, Director of Health Plan Operations
TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Achieving Budget Neutral Program Expansion into SSI and Long Term Care Population / Case Study From
State that has Successfully Expanded Managed Care to SSI and Long Term Care

States continue to struggle with how to design effective Managed Care programs for the elderly and disabled. Today, Long Term Care alone comprises 40% of the national Medicaid budget, and it is growing. Further, it is sometimes assumed that
Managed Care is not the best solution for these populations with complex health conditions. This session discusses:

• National trends and individual state efforts
• Considerations when designing Managed Care for the elderly
  and chronically ill populations
• Strategies for managing care for SSI and dual eligibles

Lisa Chimento, Senior Vice President
THE LEWIN GROUP

Angela Dombrowicki, Director of the Bureau of Managed Health Care Programs
WISCONSIN DEPARTMENT OF HEALTH AND FAMILY
SERVICES

Making the Business Case for Quality in Medicaid Managed Care – Tools that Quantify Improvements in Quality Care

With Medicaid costs escalating on state budgets, the broad
system-wide financial, economic, and social benefits of
improving the quality of Medicaid services must be documented
in order for health care quality to be a priority for states,
health plans, and the federal government. In this session
Mr. Weimer discusses:

• Determining whether or not "quality pays," by testing the costs and benefits of evidence-based quality improvement efforts.
• Identifying where health care payment systems need to be realigned to support quality improvement.
• Promoting further investments by all stakeholders — the
  federal government, states, health plans, providers, and consumers — in quality improvement efforts in Medicaid
  managed care

Elizabeth Cobb, Program Officer
CENTER FOR HEALTH CARE STRATEGIES

Implementing Consumer Directed Care for Medicaid Member to Improve Medicaid Beneficiaries' Access to Quality Care

The Florida Consumer-Directed Care program was designed to provide consumers more flexibility, choice and
independence in determining and arranging their own care and has been in operation since March 1, 2000. In this session participants learn about:

• Steps taken towards implementation and expansion of consumer directed Care in Florida
• Status of the demonstration project
• Concerns about the potential for fraud and abuse in consumer direction

FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

Implementing Disease Management to Improve Care Coordination to those Most in Need

States are looking for plans that provide DM services. They are looking outside standard health plan based programs, linking disease management with PCCM programs.

• Implementing a comprehensive Integrative Care Management Program and Primary Adult Care programs
• Incentivizing healthy behaviors in Medicaid populations

Mary Angela Collins, Managed Care Bureau Chief, Montana Medicaid
MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES

Margaret M. Flaum, Director, Government Programs, MCKESSON HEALTH SOLUTIONS

Determining an Effective Managed Care Strategy for Specialty Benefits to Improve Accessibility, Quality and Cost Trends

Virginia recently transitioned Dental from an integrated FFS/Managed Care system to an all FFS model while other specialty benefits remain integrated. In this session State representatives discuss:

• Different Strategies for each specialty benefit
• Determining the carve in or carve out strategy for specialty benefits including mental health, vision and dental
• Steps to prepare for obstacles in effectively implementing
• Managed Care for specialty benefits

Sandra Brown, Dental Manager
VIRGINIA DEPARTMENT OF MEDICAL
ASSISTANCE SERVICES

Case Study - Implementing a Payer-Based Electronic Health Record to Improve Efficiency, Efficacy and Quality of Care

The Tennessee Medicaid Program (aka: TennCare) is participating in the largest electronic medical exchange
initiative of its kind in the country with over one million members included in the system. The web-based application
enables different providers treating the same patient to view medical histories, medications, lab results and immunization records via a secure web portal. Utilizing a payer-based EHR,
TennCare is connecting medical professionals to a database that
includes patient medical information that goes beyond a particular practice setting. In this session, experts discuss:

• Overcoming barriers of implementation, program details, and program status
• Securing buy-in from physicians, hospitals, and insurers to share patient data to improve care and cut costs
• Measuring results and outcomes from implementation

Bruce Taffel, MD
Chief Medical Officer, Government Business & Emerging Markets
BLUECROSS BLUESHIELD OF TENNESSEE