About the Association for

Community Affiliated Plans

September 2014

ACAP’s Mission

To represent and strengthen not-for-profit safety net health plans as they work with providers and caregivers in their communities to improve the health and well-being of vulnerable populations in a cost-effective manner.

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ACAP Represents 58 Safety Net Health Plans

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Arizona

University of Arizona Health Plans

California

Alameda Alliance for Health

CalOptima

CenCal Health

Central California Alliance for Health

Community Health Group

Contra Costa Health Plan

Gold Coast Health Plan

Health Plan of San Joaquin

Health Plan of San Mateo

Inland Empire Health Plan

Kern Family Health Care

L.A. Care Health Plan

Partnership HealthPlan of California

Santa Clara Family Health Plan

San Francisco Health Plan

Colorado

Colorado Access

Denver Health

Connecticut

Community Health Network of Connecticut

District of Columbia

Health Services for Children With Special Needs

Florida

Prestige Health Choice

Hawaii

AlohaCare

Illinois

Family Health Network

Indiana

MDwise

Kentucky

Passport Health Plan

Maryland

Maryland Community Health System

Priority Partners

Massachusetts

Boston Medical Center HealthNet Plan

Commonwealth Care Alliance

Neighborhood Health Plan

Network Health

ACAP Represents 58 Safety Net Health Plans

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Minnesota

Metropolitan Health Plan

New Hampshire

Well Sense Health Plan

New Jersey

Horizon NJ Health

New York

Affinity Health Plan

Amida Care

Elderplan & Homefirst

GuildNet

Hudson Health Plan

Monroe Plan for Medical Care, Inc.

Univera Community Health

VillageCareMAX

VNSNY CHOICE

Ohio

CareSource

Oregon

CareOregon

Pennsylvania

AmeriHealth Caritas Pennsylvania

UPMC for You

Rhode Island

Neighborhood Health Plan of Rhode Island

Texas

Children’s Medical Center Health Plan*

Community Health Choice

Cook Children’s Health Plan

Driscoll Health Plan

El Paso First Health Plans

Sendero Health Plan

Texas Children’s Health Plan

Virginia

Virginia Premier

Washington

Community Health Plan of Washington

Wisconsin

Children’s Community Health Plan

*Incubator plan.

ACAP’s 58 Plans are in 24 States

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23 ACAP Plans Operate SNPs

• Affinity Health Plan (N.Y.)• Alameda Alliance for Health (Calif.)*• AlohaCare (Hawaii)• AmidaCare (N.Y.) • CalOptima (Calif.) • CareOregon (Ore.) • CareSource (Ohio)*• Colorado Access (Colo.) • Commonwealth Care Alliance (Mass.)• Community Care Alliance of Illinois/FHN

(Illinois) • Community Health Group (Calif.)

• Community Health Plan (Wash.)• Denver Health Medical Plan (Colo.) • Elderplan & Homefirst (N.Y.) • GuildNet (N.Y.) • Health Plan of San Mateo (Calif.) • Inland Empire Health Plan (Calif.) • L.A. Care Health Plan (Calif.)• Metropolitan Health Plan (Minn.)*• Partnership HealthPlan of California*• University of Arizona Health Plan**• UPMC for You (Pa.)• VNSNY CHOICE Health Plans (N.Y.)

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* Operating SNP through 2014.** Entering SNP market in 2015.

17 ACAP MLTC Plans

• Affinity Health Plan (N.Y.)• Alameda Alliance for Health (Calif.)• Amida Care (N.Y.)• CalOptima (Calif.)• Commonwealth Care Alliance (Mass.)• Community Health Group (Calif.)• Elderplan & Homefirst (N.Y.)• Guildnet (N.Y.)• Health Plan of San Mateo (Calif.)• Horizon NJ Health

• Inland Empire Health Plan (Calif.)• L.A. Care Health Plan (Calif.)• Metropolitan Health Plan (Minn.)• Neighborhood Health Plan of R.I. • Santa Clara Family Health Plan (Calif.)• VillageCareMAX (N.Y.)• VNSNY CHOICE Health Plans (N.Y.)

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17 ACAP Plans Planning or Participating in Duals Demos

California: Alameda Alliance for Health*; CalOptima*; Community Health Group of San Diego; Health Plan of San Mateo; Inland Empire Health Plan; L.A. Care; Santa Clara Family Health Plan*.

Massachusetts: Commonwealth Care Alliance; Network Health Minnesota (D-SNP Model): Metropolitan Health Plan*** New York: Elderplan/HomeFirst, GuildNet, VillageCareMAX,

VNSNY Choice Health Plans Ohio: CareSource Rhode Island: Neighborhood Health Plan of R.I.** Virginia: Virginia Premier Health Plan

Other ACAP plans are in non-demo duals initiatives

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* Delayed ** LTC services began Nov. 2013; Medicare services included in 2015*** MHP leaving MSHO demo in 1/15 

Contact

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Mary Kennedy | Vice President |Medicare and Managed Long Term Care Association for Community Affiliated Plans1015 15th St. NW Suite 950 | Washington, DC 20005Direct: (202) 701-47491015 15th St. NW, Suite 950Washington, DC 20005

mkennedy@communityplans.net

Web: www.communityplans.net

@safetynetplans

Sue Kvendru

Minnesota Department of Human Services

Minnesota Senior Health Options

Minnesota Experience

Medicaid Managed Care since 1985 Minnesota Senior Health Options since 1997 Initially Medicare Payment Demo D-SNP ( Initial MOU with CMS to transition) MOU with CMS for Alternative Demo signed

September, 2013 – Not a Financial Alignment Demo (FAD)

Minnesota Senior Health Options (MSHO)

Combines Medicare (including Part D) and Medicaid services

Includes Elderly Waiver (MLTSS) Includes 180 days of nursing home care Enrollment is voluntary instead of mandatory

enrollment in Medicaid Managed Care program (MSC+)

70% have chosen to enroll in MSHO Approximately 36,000 enrolled Operating statewide All eight MSC+ (Medicaid managed care) plans

participate

MSHO Features: Overview

Integrated member materials, one enrollment form, aligned enrollment dates, one card for all services

State MLTSS assessment tool integrates Health Risk Assessment (HRA into assessment process

All members are assigned individual care coordinators. The State sets uniform standards, audit protocols and criteria for care plans, face to face assessment and care coordination

Flexible care coordination delivery models High degree of collaboration among SNPs and State on member

materials, PIPs, care coordination, benefit policy, demo decisions, etc. through multiple joint workgroups

Health plans waive Medicaid co-pays for members State level Stakeholders group, each SNP also has local

stakeholders group. Aligned capitated financing supports innovation and payment

reform

Minnesota Demonstration “Demonstration to Align Administrative Systems

for Improvement in Beneficiary Experience” Charts a new demo option path for improving

States’ ability to work with Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs)

Builds on current D-SNPs Current SNP and Medicaid financing and rates

• HEDIS: 98% of MSHO seniors have annual primary care visits

• Dual database: MSHO risk adjusted hospital admits/episode rates lower than FFS Medicare Medicare Advantage (Source: JEN iMMRS-MN)

• S&Ps and STARS: MSHO D-SNPs have been high performing on STARS and SNP S&P measures

• CAHPS: MSHO is highest rated MN Medicaid program; includes care coordination questions

• Disenrollment rates: < 2%

• Encounter data analysis: Increased HCBS access through annual face to face assessment/individualized care coordination

• AARP scorecard: MN has been #1 for HCBS Access. – Minnesota has rebalanced its MLTSS system from 63% NF and 9.5% community

waivers in 1996 to 24% NF and 39% community waivers in 2012. – See Rebalancing Graph (Sources: 1996 Medicaid Forecast, July 2012 Medicaid

enrollment by living arrangement).

Contact Info Sue Kvendru, Managed Care ( Seniors)

• 651-431-2517 • sue.kvendru@state.mn.us

Deborah Maruska, Managed Care (People with Disabilities)• 651-431-2516• deb.maruska@state.mn.us

www.chcs.org

September 18, 2014

Sarah Barth, JDDirector of Integrated Health and Long-Term Services

Key Attributes of Integrated Health Organizations and Person-Centered Innovations

Integrated Care Projects at CHCS

• Implementing New Systems of Integration for Dual Eligibles (INSIDE)► Brings together 16 states for group learning, innovation sharing, and opportunities to work with

federal partners► Supported by The SCAN Foundation and The Commonwealth Fund

• Promoting Integrated Care for Dual Eligibles (PRIDE)► Brings together 7 integrated health organizations to identify and test innovative strategies that

enhance and integrate care for Medicare-Medicaid enrollees► PRIDE consortium membership: CareSource (OH); Commonwealth Care Alliance (MA); Health

Plan of San Mateo (CA); iCare (WI); Together4Health (IL); UCare (MN); VNSNY CHOICE (NY)

► Supported by The Commonwealth Fund

• Integrated Care Resource Center (ICRC)► Established by CMS to help states advance integrated care delivery for Medicare-

Medicaid enrollees► Technical assistance and online resources provided by CHCS and Mathematica Policy Research

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PRIDE Framework for High-Performing Integrated Health Plans Attributes in 5 Domains:

1. Leadership and Organizational Culture2. Infrastructure to “Scale Up” and “Stretch Out” While

Maintaining Quality and Value3. Financial and Nonfinancial Incentives and Related

Mechanisms that Align Plan, Provider, and Member Interests

4. Coordinated Care Provided through Comprehensive, Accessible Networks and Person/Family-Centered Care Planning and Coordination

5. Capacity to Attract and Retain Members, Expand Enrollment, and Increase Retention

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Person-Centered PRIDE Projects

CareSource

360 degree view of individuals’ care needs

Commonwealth Care Alliance

Improving documentation of care plans for fluidity

and person-centeredness

Health Plan of San Mateo

Pilot project providing supplemental residential

supports

iCare

Building independence through person-centered

planning for PCA services

Together4Health

Addressing social determinants of health

from the beginning

UCare

Making assessments more person-centered and culturally sensitive

VNSNY CHOICE

Making care planning more person-centered

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