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Medical Directors CouncilFall 2013 Meeting
September 30 – October 2, 2013Portland, Oregon
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ACHP Mission
ACHP and its members improve the health of the communities we serve
and actively lead the transformation of health care to promote high-quality,
affordable care and superior consumer experience.
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ACHP Members
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Capital District Physicians’ Health Plan Albany, NY
Capital Health Plan Tallahassee, FL
CareOregon Portland, OR
Dean Health Plan Madison, WI
Fallon Community Health Plan Worcester, MA
Geisinger Health Plan Danville, PA
Group Health Seattle, WA
Group Health Cooperative of Madison, WI
South Central Wisconsin
HealthPartners Minneapolis, MN
Independent Health Buffalo, NY
Kaiser Foundation Health Plans Oakland, CA
and the Permanente Federation
Martin’s Point Health Care Portland, ME
New West Health Services Helena, MT
Presbyterian Health Plan Albuquerque, NM
Priority Health Grand Rapids, MI
Rocky Mountain Health Plans Grand Junction, CO
Scott & White Health Plan Temple, TX
Security Health Plan Marshfield, WI
SelectHealth Murray, UT
Tufts Health Plan Waltham, MA
UCare Minnesota Minneapolis, MN
UPMC Health Plan Pittsburgh, PA
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ACHP’s Mixed Delivery Models
CDPHP
Capital
CareOregon
Fallon
Geisinger
Group Health
GHCSCW
HealthPartners
Independent
Kaiser
Martin's Point
New West
Presbyterian
Priority
Rocky Mountain
Scott & White
SelectHealth
Security
Tufts
UCare
UPMC
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Plan Enrollees Cared for by Contracted Physicians Percent of Plan Enrollees Cared for by Plan-Employed/Associated Physicians
* Source: Based on self-reported estimates from ACHP plans reflecting 2012 data. * This chart shows the percent of enrollees cared for by employed versus contracted physicians. The information reflects physician care only and not hospital care.
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ACHP Distribution of Enrollment
CDPHP
Capital
CareOregon
Fallon
Geisinger
Group Health
GHCSCW
HealthPartners
Independent
Kaiser
Martin's Point
New West
Presbyterian
Priority
Rocky Mountain
Scott & White
SelectHealth
Security
Tufts
UCare
UPMC
ACHP Total
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Commercial Fully-Insured HMOCommercial Fully-Insured PPOSelf-Insured HMOSelf-Insured PPOMedicareMedicaidFEHBPOther
* Source: Based on self-reported estimates from ACHP plans reflecting 2012 data.
2012Total Enrollment Distribution Among ACHP Member Plans
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NCQA’s Health Plan Rankings – Proven Quality
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On the 2013 NCQA Health Plan rankings, ACHP plans were:
•17 of the top 25 commercial plans
•16 of the top 25 Medicare plans
•8 of the top 25 Medicaid plans
ACHP Member Plan Commercial Medicare MedicaidCDPHP 18 & 19 9 9
CDPHP PPO 26
Capital Health Plan 15 6
Fallon Community Health Plan 34 15 1
Geisinger Health Plan 22 7
Group Health 52 12
GHCSCW 21
HealthPartners 30 14
Independent Health 31 28 20
Kaiser Permanente
CO 13 4
Southern CA 17 1
Northern CA 7 2
Northwest 2 3
Hawaii 25 5 2
Mid-Atlantic 16 8
Ohio 10 11
Priority Health 41 12 5
Security Health Plan 45 18 12
Tufts Health Plan 6
Tufts Health Plan PPO 8
Network Health (Tufts Health Plan) 3
UPMC Health Plan 11 & 12 48 15
UPMC Health Plan PPO 48 40
ACHP’s 2013 GoalsACHP members: • Lead improvements and innovation in accountable
community systems of care• Demonstrate distinctive value and performance;
provide leadership toward greater affordability of coverage & care
• Successfully compete in their markets• Influence public policy outcomes on issues that are
central to business and mission success
ACHP:• Effectively communicates our leadership role as an
organization of the nation’s highest performing health plans
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Implementing the ACHP Agenda
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Accelerated Learning
ImprovementTools
Public Policy Development & Advocacy
Communicating Distinctiveness,
Leadership
ACHP Work Groups
Behavioral Health Directors
Compliance Officers Communications
Leaders Legal Counsel Marketplace Leaders Medical Directors
Medicaid/Dual Eligibles Focus
Pharmacy Directors Policy and Legislative
Leaders Quality Leaders Medicare Star Rating
Leaders
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ACHP has various work groups that meet periodically throughout the year:
Medical Directors’ Agenda: Affordability
Aligning our work to drive more attention to total cost of care without compromising quality
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Lower cost, improved
health and care
Primary care
Payment reform
Greater transparenc
y
Focus on high cost areas and
populationsPopulation
health
Pharmacy Directors -
Primary Focus Areas
Best practice sharing
Telling our story
Multi-year, multi-lever work
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Levers for Influence
Quantitative proof of differen-tiation
Best practice sharing Bi-annual meetings Innovation webinars
Focused working groups- Pharmacy Directors
- Specialty Drug- Opiates
- Behavioral Health Directors- Medicaid/Duals
Telling our story Primary Care Transformation Curbing Opioid Overuse in
Communities Payment roundtable and
testimonies - Innovations in MD payment
Quantitative proof of differentiation Specialty drug and opiate data
collection and analysis
Pharmacy Directors’ Collaborative: Work Summary• Launched the Specialty Drug Management workgroup – Fall 2011
– Created a utilization and drug spend benchmarking tool– Data collection and analysis – Convened at bi-annual meeting to discuss key topics and share
best practices
• Launched second workgroup on Opiate Management – Spring 2012– Developed utilization tool for frequently prescribed narcotics– Highlighted existing and planned initiatives around narcotic
use
• Continuous information exchange– Member inquiries– Bi-weekly workgroup planning calls– Pharmacy Directors’ Collaborative workgroup calls– Online learning sessions on focused topic areas– Surveys (e.g. Specialty Drug Benefit Design Survey) 17
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ACHP is the collective voice for mission-driven organizations focused on
providing high-quality health care and improving the health of their
communities with greater affordability.
Appendix
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ACHP.org
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Opioid Issue Brief
Ensuring Safe and Appropriate Prescription Painkiller Use: The Important Role of Community Health Plans
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• Outlines the issue• Highlights the initiatives in place at
ACHP member plans that appear to reduce doses of opioids used to safer levels, improve coordination of care and patient-physician communication, and lower costs
• Stresses the key role health plans play in ensuring safe and appropriate use of opioids
Medicaid/Dual Eligibles Workgroup
• Created by ACHP Medical Directors in 2012 as a learning group, due to Medicaid expansion under the ACA, growth of Medicaid Managed Care products among our plans, and challenges in caring for Medicaid and dually-eligible patients.
• Will meet every other month for discussion-based learning sessions.– These will be led by a member plan but focused on
sharing experiences, ideas and challenges among all participants on the call
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Health Plan Innovations in Patient-Centered Care: Primary Care Transformation• A report by ACHP, found that health plans can strengthen organized
systems of care through primary care transformation, and can ensure that such transformation is successful, sustainable and scalable by focusing on three core elements:
1. collaboration;2. sharing of tools and resources with practices;3. building on the existing cultures and characteristics of the health plan, providers, patients and community.
• Outcome: All 17 member organizations profiled increased quality care, improved patient and/or provider experience and/or lowered costs and/or improved patient or provider experience. Many did all three, demonstrating that health plans and provider groups do not have to sacrifice quality and patient experience for cost.
• Release date: March 7, 2013
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ACHP Contacts- Jennifer Phillips, Manager, Innovation Programs
([email protected]) - Lynne Cuppernull, Director, Clinical Learning & Innovation (
[email protected]) - Stephen Cox, Senior Business Analyst
([email protected]) - Lindsay Arrington, Administrative Coordinator, Learning & Innovation
A full list of staff members can be found at http://www.achp.org/about/staff. Phone: 202-785-2247 Fax: 202-785-4060 Web: www.achp.org
@_ACHP
Address: 1825 Eye Street, NW Suite 401 Washington, DC 20006
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