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T h e M e d i c a i d B i g P i c t u r e Y o u N e e d . I n U n d e r 5 M i n u t e s.

M o s t ly M e d i c a i d

HEALTH REFORM

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4th Annual

Medicaid Medicaid Medicaid Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Medicare Medicare Medicare Marketing Marketing Marketing

Medicare Toolkit Receive Key Updates on Healthcare Reform and its

Impact on Marketing to Increase Plan Compliance

Integrate Marketing Across Di erent Media Channels to Grow Age-In and Current Enrollee Market Share

Create Compliant Customer Service Approaches to Identify and Respond to Todays Senior Population

Understand the Evolving Medicare Sales Strategy to Prepare for a Post-Reform Environment

Explore Innovative Marketing and Retention Strategies for Medicare SNP Plan Growth

Leverage Best Practices to Maintain Quality and Boost Enrollment During Peak Periods

Medicaid Toolkit Drive Creative Partnerships with Advocacy Groups to

Expand Outreach Dollars under Limited Budgets

Maximize ROI on Marketing Initiatives in Tight Budgets

Master Meeting EPSDT Well Visit Goals Th rough Innovative Checkup Outreach Programs

Improve Member Retention and Quality Outcomes For Better Regulatory and Financial Outcomes

Grow Maternal Post-Partum Visit Rates through Overcoming Barriers to Improve HEDIS Scores

Understand the changing demographics of your plan and community to provide culturally competent services and give providers to the tools to make necessary changes

Advanced strategies to optimize enrollment, maximize retention and ensure compliance in an era of change

&

Enrollment Congress&

March 22-23, 2010 Hilton Baltimore Baltimore, MDMention priority code XP1514MMad when registering

www.iirusa.com/mmo

Actionable Insights from the Plans & Thought Leaders You Admire MostAetna Amerigroup Amerihealth Mercy Blue Cross Blue Shield of AL Blue Cross Blue Shield of MN Blue Cross Blue Shield of SC Boston Medical Center Healthnet Health Plan CareSource Community Partners Louisiana Dept of Health & Hospitals Medica Health Plans Molina Healthcare of Ohio Neighborhood Health Plan Oklahoma Healthcare Authority/SoonerCare OmniCare Passport Health Plan Priority Health State of Maryland UCare UC Berkeley UPMC Health Plan

3

QUALITYANDINNOVATIONNEWS VeryfewdoctorsseeenoughMedicarepatientstoreportreliablequalitymetrics CMSreleasesmeaningfuluseregsforEHRs

KristinPattersonandMMStaff

Samplesizedoesnotcompute

The whole world may be abuzz with using

quality metrics to reform payment there's

just one big problem. According to a study

published in JAMA inDecember 2009,most

primary care physicians don't even see

enough Medicare patients to calculate the

current Medicare quality measures with

statisticalvalidity.Put simply, theirMedicare

patient traffic is too low to tell if they are

improvingqualityorcost.The lowestsamplesizeneeded is328patients (formammography)andthe

highestneededismorethan19,000patients(forhospitalprevention).Mostphysiciansseelessthan180

Medicarepatientseachyear.IfMedicarequalityandcostmeasurementaretobethestandardsmoving

forward,thisain'tlookinggood.1

RegulationsDefiningMeaningfulUseofElectronicHealthRecordsReleased

When theAmericanRecoveryandReinvestmentActof2009wassigned, the law included theHealth

InformationTechnologyforEconomicandClinicalHealthAct(HITECH).HITECHgivesCMStheauthority

to establish criteria for the utilization of EHR technology within the healthcare system. Under the

proposedregulation,meaningfuluseisdefinedbyCMSandONCasaneligibleprofessionaloreligible

Calculating Medicare Quality Metrics - Not Enough Patients Seen to be Accurate

180

328

Average Seen by Physicians Mammography Sample Size Needed

4

hospital that, during the specified reporting period, demonstratesmeaningful use of certified EHR

technology inamannerthat improvesquality,safety,andefficiencyofhealthcaredelivery,reduces

health care disparities, engages patients and families, improves care coordination, improves

population and public health, and ensures adequate privacy and security protections for personal

healthinformation.2

During the first year of participation in

the program both eligible professionals

and hospitals must demonstrate they

have performed one or all of the

following criteria: 1) acquired and

installedanEHRsystem2)trainedstaff,

deployedtoolsandexchangeddataor3)

upgraded a certified EHR system by

expanding its functionality and

interoperability.3

Furthermore, participants must also

satisfy additional annual requirements

suchas30percentMedicaidpatientvolume (forprofessionals),average lengthof stayof25daysor

fewerand10percentMedicaidpatientvolume(forhospitals).4

At first glance, the initial costof implementing anEHR systemmightbe tooexpensive foroperating

budgets;however,eligibleprofessionalscanreceiveupto$63,750overasixyearperiodwhilehospital

paymentsaredeterminedbyaformulathatbenefitsthosewithahighMedicaidpatientvolume.Ifthe

proposed regulation is passed, providers should consider this an opportunity to implement an EHR

systemata lowercost.Moreover, incentivepaymentscouldbeginasearlyasOctober2010toeligible

hospitalsand January2011 tootherproviderswhichwouldhelpease the immediate costburdenof

implementingorupgradingasystem.5

Theproposed regulation containsmany incentives toaccelerateand facilitate theadoptionofhealth

information technology by individual providers and organizations throughout the healthcare system.

MorenewsoverattheMostlyMedicaidBlogs

blog.mostlymedicaid.comwherethebestMedicaidmindsmingle.

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Participantswillseethatthecostsof implementationwillbeoffsetby improvementstopatientsafety

andquality,reductionofmedicalerrorsandacquisitionofaloyalpatientbase.

HEALTHREFORMNEWS Updatesonthemadness States that have already broadened health care coverage say that the Senate overhaul bill

unfairlypenalizesthem

Lookingatmanagedcarefirmsandincentivesforreform MedicaidexpansionbyhavingMedicarepickupthefulltabforduallies

BrendanStern,ClayFarris,andKristinPatterson

Giventhedirectionofcurrentpoliticalwinds,theGreatHealthReformDebatemaybeoversoonsowethoughtwedtalkaboutitonemoretime.

Updatesonthemadness

Ithastrulybeenheadspinningtotrytokeepupwiththehealthreformchanges/ideasproposedeach

day.InDecember,somesenatorsweretryingtolowertheMedicareeligibleageto55aswellasextend

mandatoryMedicaid coverage to familieswith incomes up to $33,075. Thosewacky politicians also

proposed requiring insurance companies to spend 90%ofpremiumson services,building in aprofit

limit.Sortoflikeonlygivingtocharitieswhohaveloweradmincosts?

Oh,beforeweforgetHarryReid(who'sadmittedlyon

ournaughtylistforhisshamefulporkslingingseelast"Weare, ina sense,beingpunished for our owncharity."

6

issue)comparedopposition topassinghishealth

reformopustooppositiontoabolition.Weknow

thatall'sfair in love,warandUSpoliticsbutthat

lowblowisjustdownrightdisgusting.