Michigan Association of Health Plans Craving Stability While

Transcription

Michigan Association of Health Plans
Save the Date – Pinnacle Awards
Reception September 17, 2013
SPRING/SUMMER 2013
MORE INSIDE
Page 2
Bill Burke’s View from the Capitol
Page 3
14 Companies Submit Plans
for ACA Federal Exchange
Page 4
MDCH Updates
Pages 5–9
Health Plan Updates
Page 10
Delta Dental’s Brighter Futures
Pages 11–13
MAHP’s Legislative Reception
Pages 14–15
MAHP’s Summer Conference
Craving Stability
While Preparing
for the Unexpected
By Rick Murdock, Executive Director,
Many pose the question, “What will happen January 1, 2014?” as this is the now
“magical date” that health insurance will be forever transformed due to the federal Affordable Care Act. To answer this question, I have reviewed past columns written in this
space to remind myself of our position on the policy changes necessary (from our point
view) to prepare for 2014. We believed these policies would position Michigan to provide
the best insurance coverage for its citizens, assure greater competition and eliminate
redundant regulatory provisions.
These policy changes can be grouped as the following:
•A decision on the Insurance Exchange (State administered, federal partnership,
of complete federal)
•BCBSM reform (including Insurance Commissioner orders on most favored nation clauses and limiting cost shifting)
• System changes for Medicaid, HIPPA, ICD-10, Exchanges
• Other Insurance Code reform (Alignment with ACA)
• Medicaid reform (Expansion, Duals Initiative, Innovations)
As of today, we can report that decisions/implementation on the first three items
have been made and implementation is under way. The last two items remain as outstanding and/or work in progress and we will report on them in our next column. I reference all of this because the sum total of activity for the insurance industry may create
for us a period of what I would describe as “predicable uncertainty.” It is our job to
minimize this period and to move toward a period of “stability”—however we define that
term in the future.
Just as a reminder, after January 1, 2014 pre-existing conditions will no longer be
a determining factor for insurance eligibility as there will be “guaranteed issue” for
all insurance companies. Comparable benefit plans will be available for consumer
Continued on page 9
Bill Burke’s View from the Capitol
Blending Good Politics with Good Policy
By Bill Burke, Knight Consulting
It has been suggested by many that
there are only two rules in politics: Rule
number one: Get elected. Rule number
two: Never forget rule number one. Political considerations factor heavily into many
mentation, causing many members heartburn at the thought of endorsing federal
law. With the understanding that legislators must account for every vote they take
on a myriad of issues, my suggestion to
The passage of the Affordable Care Act in Washington
was a lightning rod that seemed to polarize both
parties. Whether you love it or hate it, the federal
Affordable Care Act (ACA) is now the law of the land,
requiring that we must do something to prepare for it.
The ACA has survived court challenges at the state
and federal level and it appears clear to me that it will
be implemented as dictated by the statute.
policy decisions by legislators. It’s a simple
fact of life, not intended to shock anyone.
I have always held the belief that if
legislators enact solid policy decisions
based on the best available information,
any political blow back will not be as severe as feared. In many cases, it will be
of a positive nature, as most constituents
say they want their legislators to work
with the “other side of the aisle” to benefit
the citizenry.
The passage of the Affordable Care
Act in Washington was a lightning rod
that seemed to polarize both parties.
Whether you love it or hate it, the federal
Affordable Care Act (ACA) is now the law
of the land, requiring that we must do
something to prepare for it. The ACA has
survived court challenges at the state and
federal level and it appears clear to me
that it will be implemented as dictated by
the statute.
To comply with the many provisions
of the act, state legislators are being required to cast votes to facilitate its imple2
them is this: Good health policy makes
for good electoral politics.
Medicaid reform/expansion allowed
for an open debate on new health care
coverage for over 400,000 Michigan
citizens. It could help bridge the gap for
the “working poor” to provide a sense
of security to their families as it relates
to medical expenses, and go a long way
to mitigate the cost of uncompensated
care to hospitals and medical providers. Give legislators credit for their
willingness to discuss this issue while
keeping their eye on the costs associated with this initiative.
The viability of the basic Medicaid
program has recently been endorsed by
the Legislature by passing an extension
of the Health Insurance Claims Assessment, or HICA, within the last two weeks.
It’s hard to imagine any success for expansion or reform if the basic program is
not funded adequately.
The implementation of the ACA will
rely on decisions of choice relative to esM A H P S P R I N G / S U M M E R 2 0 13
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tablishment of the Exchange, the vehicle
that will be used to provide access to
health insurance options for consumers.
These decisions will necessarily include
the role of insurance agents and/or navigators to assist consumers in the choice of
plans for their consideration. In the past,
most consumers have had limited options
through their employers as to the exact
types of coverage they receive. Often they
were given a small handful of options to
choose from in an employer sponsored
plan. This will change with the advent
of the exchange model, but they will
surely need assistance in this new world
of healthcare.
Discussions on the many issues surrounding the ACA are now focused on
preventative care, healthy life styles and
personal responsibility. These sound policy discussions will surely result in favorable political decisions by members of
the legislature.
In closing, I will offer the same advice to those who love the ACA as to those
who don’t: As long as this is the law of the
land, we have an obligation to do what we
can to make this the best system we can
for the benefit of Michigan’s citizens. If
we can do that, good policy will pave the
way for good politics.
Bill Burke has been
an associate of Knight
Consulting since 1998.
Prior to that, he was
Director of Legislation
and Associate
Executive Director
of the Michigan Dental
Association. His duties
included lobbying healthcare issues at the state
and federal levels for the 14 years that he held
those positions. He has been a registered
lobbyist for 20 years, specializing in health
care, insurance and appropriations issues.
w w w. m a h p . o r g
14 Michigan Health Insurance Companies Submit Plans
for Federal Exchange
The Michigan Department of Insurance and Financial Services (DIFS) has
received filing information from 14 health
insurance companies seeking inclusion in
the federally-run Michigan health insurance exchange, set to launch on October 1, 2013. Nearly all of the companies
submitted plans for the individual market and 11 offered plans for the small
group market.
“I am pleased with the number of
companies that submitted Qualified
Health Plans (QHPs) in Michigan,” said
DIFS Director Kevin Clinton. “The large
amount of participation will foster competition and provide many choices for Michigan families and businesses.”
While Michigan’s health insurance
exchange will be a federally-facilitated
exchange, DIFS will review all plans to
ensure compliance with state and federal
laws. DIFS anticipates that all filing
T he
2 0 1 3
Michigan Qualified Plans Filed for Health Insurance Exchange
Health Insurance Company
Type of Filing
Alliance Health and Life Insurance Company
Individual/Small Group
Blue Care Network of Michigan
Blue Cross Blue Shield of Michigan
Individual/Multi State Plan/Small Group
Consumers Mutual Insurance of Michigan (CO-OP)
Health Alliance Plan
Humana Medical Plan of Michigan, Inc.
Individual
McLaren Health Plan
Meridian Health Plan of Michigan, Inc.
Individual
Molina Healthcare of Michigan
Individual
Physicians Health Plan
Priority Health
Priority Health Insurance Company
Total Health Care USA
United Healthcare Life Insurance Company
Small Group
data, including rate information, will be
made public on October 1st, after reviews are completed by DIFS and the
federal government.
Open enrollment for Michigan’s federally-operated health insurance exchange
will begin October 1, 2013, with coverage
effective on January 1, 2014. Information
about the health care exchange is available at www.healthcare.gov. Michigan residents with health insurance questions can
visit www.michigan.gov/hicap.
M A H P
Pinnacle Awards
Deadline for Submissions: Thursday, August 1
Each year, the MAHP Pinnacle Awards draw attention to the innovative
and rigorous work of Michigan health plans to improve health and
health care in Michigan. While the opportunity to recognize our
Members for their best practices is itself important and gratifying,
the Pinnacle Award process also enables MAHP to share the managed care story with our judges and the constituencies
which they represent, and with the public.
We encourage you to participate and add your work to that story.
Whether or not you submit a program for consideration, we hope
that you will join us when the Pinnacle Awards are presented at a
reception at the Lansing Center on Tuesday, September 17,
2013 from 6:00 to 8:00 p.m.
For more information visit:
www.mahp.org/pinnacleawards.html
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M A H P S P R I N G / S U M M E R 2 0 13
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Michigan Department of Community Health Updates
Implementing the Affordable Care Act: Interpreting BRCA Counseling
and Testing Coverage
Submitted by the Michigan Department of Community Health Cancer Genomics Program
In 2005, the US Preventive Services
Task Force (USPSTF) released a
Grade B recommendation statement for BRCA1 and BRCA2 genetic
counseling recommending that
“women whose family history is
associated with an increased risk
for deleterious mutations in BRCA1
or BRCA2 genes be referred for
genetic counseling and evaluation
for BRCA testing.”
The Affordable Care Act (PHS Act
section 2713) addresses coverage
for evidence-based services with a
USPSTF rating of Grade “A” or “B.”
For patients with a new health
insurance plan or insurance policy
beginning on or after September 23,
2010, these Grade A or B preventive
services must be covered without
them having to pay a copayment,
co-insurance or meet a deductible.
Grandfathered plans are not affected by
this provision until January 1, 2014.
There has been some questions about
whether the 2005 USPSTF Grade B
Recommendation for BRCA only
supports coverage of genetic counseling or also includes coverage of the
test itself as a preventive service. Based
on recently released final guidance
supported by the Departments of Health
and Human Services (HHS), Labor and
the Treasury, the USPSTF recommendation includes “both referral for genetic
counseling and BRCA genetic testing,
MDCH Cancer Genomics Program 2013 Awards
The Michigan Department of Community
Health (MDCH) Cancer Genomics
Program will once again be in attendance at the 2013 MAHP Summer
Conference. MDCH and the MAHP
Foundation are encouraging health
plans to have genetic testing policies for
BRCA1/2 genetic counseling and testing,
as well as written coverage policies for
BRCA-related clinical services (i.e.
mammogram, breast MRI, prophylactic
mastectomy, breast reconstructive
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surgery, and prophylactic oophorectomy). Health plans with appropriate
written policies in place can receive a
2013 MDCH Cancer Genomics Program
award and recognition among their
peers. For more information, please visit
our Cancer Genomics booth at the
summer conference or email Jenna
McLosky at [email protected] to
obtain your personalized health plan
reports and resource guide.
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if appropriate.” This clarification is
supported and further described by
an Institute of Medicine report
released in 2011. That means genetic
counseling and genetic testing for the
BRCA genes must be made available,
if appropriate, as a preventive service
without cost-sharing.
For more information on this IOM
report or the HHS support of including
BRCA testing as covered preventive
service, visit http://www.iom.edu/
Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.
aspx or http://cciio.cms.gov/resources/
factsheets/aca_implementation_
faqs12.html.
2013 Health Plan Key
Informant Interviews
Your opinions are extremely
helpful to us. We are currently
conducting key informant
interviews with health plan staff.
Our goal is to provide better
support and education to health
plans and to assist in the development of new or updated
policies. If you’re interested in
participating in a key informant
interview with MDCH staff, please
contact Jenna McLosky at
517-335-8826 or mcloskyj@
michigan.gov.
HealthPlus of Michigan Updates
HealthPlus Creates Chief Operating Officer
Position–Fills it with a Health Care IT Professional
Health care industry veteran Mac McClurkan helped lead a Kalamazoo, Mich.,
hospital system to Malcolm Baldrige National Quality Award, and will bring
performance-excellence concepts to HealthPlus.
HealthPlus has announced the appointment of Mac McClurkan to the newly
created position of chief operating
officer. McClurkan brings to HealthPlus a
strong history of health care leadership
and innovation in process re-engineering and quality improvement. Bruce Hill,
president and CEO at HealthPlus, made
the announcement.
McClurkan is responsible for strategic
and operational leadership for the
company’s information technology
systems, its customer service activities
and its multiple business locations. He
will be working to incorporate processes
and relationships that best leverage
what makes HealthPlus truly unique,
namely its tradition and commitment to
members, service and the community.
A senior member of the American
Society of Quality, McClurkan understands the value of a lean enterprise and
what it takes to create one. In 2005, as
chief information officer at the Bronson
Healthcare Group in Kalamazoo, Mich.,
he helped to lead the team that earned
Bronson the prestigious Malcolm
Baldrige National Quality Award.
Most recently, McClurkan was executive
vice president at Innovative Consulting
Group, based in Evansville, Ind. Responsible for strategic growth, he expanded
the company’s sales and marketing
teams, launched a new ICD-10 practice
(International Statistical Classification of
Diseases and Related Health Problems)
and, as interim CIO, earned millions of
dollars in federal health care IT incentives for a Minnesota health system.
In addition, McClurkan has served as vice
president and CIO at Genesis Health
System in Davenport, Iowa and director
of information technology at Daughters
of Charity (now Ascension), in St. Louis.
McClurkan earned a master’s degree
in business administration from the
University of Evansville and is a member
of the Healthcare Information and
Management Systems Society.
HealthPlus Now an Option
for Members of the Michigan
Public School Employees
Retirement System
HealthPlus announced that its top-rated
HMO products are now available to the
220,000 members of the Michigan
Public School Employees Retirement
System (MPSERS) residing within any of
the 21 counties HealthPlus HMOs serve.
The HealthPlus HMO network includes
the University of Michigan, Beaumont
Health Systems, Henry Ford Hospitals
and Genesys, among others, including
the Cleveland Clinic and Mayo Clinic.
Planning a trip? No worries. HealthPlus
offers a comprehensive travel benefit, a
vision program, and generous discounts
for fitness club and WeightWatchers®
memberships.
What’s more, HealthPlus HMOs routinely
earn “Excellent” accreditation from the
National Committee for Quality Assurance
(NCQA) and are recognized among the
nation’s top plans. Medicare-eligible
MPSERS members can rest easy:
NCQA rates HealthPlus’ MedicarePlus
Advantage HMO-POS as one of the
best in Michigan. Medicare awarded the
plan 4.5 stars (out of five) again in 2013.
Interested MPSERS members can enroll
now or take advantage of a rolling
enrollment period, which is available
throughout the year.
HealthPlus Recognizes Top Sales Achievers
HealthPlus of Michigan has named account executives Cheryl Wagner
and Bridget Hollingsworth “2012 Sales Achievers of the Year” for achieving
top production in new business sales and enrolled accounts for the
company, respectively. Wagner and Hollingsworth, both Saginaw residents, work out of the HealthPlus Saginaw office and have been employed
by HealthPlus for 24 years and 16 years, respectively.
The recognition reflects the eighth “Sales Achiever of the Year” award
for Wagner. Hollingsworth, who was recently promoted to manager of the
HealthPlus enrolled accounts team, has earned four such awards.
517. 3 7 1. 3 18 1
Cheryl Wagner
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Bridget Hollingsworth
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Molina Healthcare of Michigan Updates
Molina Healthcare of Michigan Recognizes Unsung Heroes at its Seventh
Annual Community Champions Awards Ceremony
Molina Healthcare of Michigan recently
celebrated the good deeds of six
community heroes at its seventh annual
Community Champions Awards. The
ceremony was held at The Rattlesnake
Club and included an invocation by
Pastor Marvin Winans of The Perfecting
Church.
This year’s winners included Dr. Richard
J. Persiani from The Children’s ToothFairy
Foundation, Robert Blehm from Macomb
Fresh, Nancy L. Stermer from Macquarie
Equipment Finance, Dennis Williams
from Detroit Medical Center, Frank
Woods, Jr. from Flint Housing Commission and Dr. Elliott Attisha from Henry
Ford Health System.
The Community Champions program
celebrates the vision of Dr. C. David
Molina, the founder of Molina Healthcare,
as well as community partners who work
together to care for society’s most
vulnerable individuals. Each community
champion was nominated by a community-based organization and also
received a $1,000 grant to give to a
deserving nonprofit organization of his/
her choice.
The 2013 Community
Champions Award Winners
Dr. Richard J. Persiani has dedicated
31 years providing dental care to
children across the globe. He has
traveled on medical/dental missions to
Vietnam, Cambodia, Thailand, China,
Africa, Madagascar, Paraguay and
Haiti providing both surgery and
educational programs. Locally he
works with The Children’s Tooth Fairy
Foundation to provide dental care to
underserved children living in shelters
and foster care in Wayne, Oakland,
Macomb and Washtenaw counties. He
donates his time, resources and
services to treat children who would
have otherwise never had the opportunity for dental care.
Robert Blehm has a passion to change
future generations by changing the way
today’s youth think about food and the
way they eat. He is leading the charge
to put fresh fruit and vegetable gardens
on Macomb County elementary and
middle school properties. The intent of
these gardens is to introduce fresh
produce into school cafeterias and
summer backpack programs for
(left to right): Frank Woods from Flint Housing Commission, Stephen Harris, president of Molina
Healthcare of Michigan, Dr. Richard J. Persiani, from The Children’s ToothFairy Foundation,
Nancy L. Stermer from Macquarie Equipment Finance, Heidi McGlinnen from Molina Healthcare
of Michigan, Mary Syiek from Molina Healthcare, Inc., Dr. Elliott Attisha from Henry Ford Health
children in need. To date, the program
has 15 participating schools in one of
the largest school districts in the state.
The goal is to establish 45 such
gardens in five years and continue to
show students the full spectrum of
nutrition from planting the seeds in the
classroom garden to seeing the produce they were responsible for growing
on their school cafeteria lunch trays.
Nancy L. Stermer is a dedicated
volunteer and steadfast supporter of
The Children’s Center, providing over
15 years of leadership. As Detroit’s
children are some of the most vulnerable in the nation, Stermer has contributed her time and energy to ensure
children receive the care they need;
whether it be health care, mental health
care or assistance for other challenges
faced by families living in poverty. Last
year Stermer’s projects included
beautifying The Children’s Center
garden area, coordinating a back-toschool donation drive to provide 466
free backpacks to children and volunteering her time at The Children’s
Center Holiday Shop wrapping presents
for children in need.
Dennis Williams has been volunteering
in the Coalition on Temporary Shelter’s
(COTS) kitchen for more than 23 years
preparing thousands of meals for the
homeless. While he works at the Detroit
Medical Center and has a family at
home, he volunteers three days a week
and often rides his bike to COTS. He
assists with stock, cleaning, meal
preparation and meal service for the
guests at the emergency shelter. It is
estimated that over the course of his
time with COTS, Williams has volunteered more than 4,000 hours of service.
System, Dennis Williams from Detroit Medical Center, and Robert Blehm from Macomb Fresh.
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Molina Healthcare of Michigan Updates
Frank Woods, Jr. has been a voice
for the homeless in Genesee County
for over five years. As the founder and
director of the One Stop Housing
Resource Center, Woods centralized
key resources that helped to effectively shape the lives of homeless and
near homeless individuals. It is
because of Woods’ leadership that
governmental and community
agencies now work together to help
these individuals’ live more productive
lives. Woods has used his influence to
bridge gaps between community
based organizations and faith based
organizations in order to bring vital
resources to the homeless and
underserved in Genesee County.
Dr. Elliott Attisha works tirelessly as
medical director of the Henry Ford
Health System’s mobile medical
program, which is virtually a doctor’s
office on wheels. With fifty-nine
percent of Detroit’s population living in
medically underserved areas, Dr.
Attisha and his team are able to bring
a variety of health care services to
children where they spend most of
their waking hours—in school and
youth community centers. His
compassion for the youth he sees
means that children who once had no
primary care physician to call their
own, now have a medical provider
who is dedicated to their well-being.
As president-elect of the School
Community Health Alliance of Michigan and an executive committee
member of the Council on School
Health, American Academy of
Pediatrics Dr. Attisha is able to
influence change on a broad scale to
break down barriers to medical care
for Detroit’s children.
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Molina Healthcare “Springs Into Health” with the
Children’s Center by Hosting a Free Community
Health Fair
Molina Healthcare recently partnered with The Children’s Center of Wayne County to
host a free community health and resource fair. More than 500 children and their
families attended the event. Local physicians and nurses provided a range of free
health screenings including vision tests, blood pressure checks, adult physicals and
foot exams, lead testing for children and well-child examinations.
Those in attendance also had a chance to make healthy fruit smoothies using Molina
Healthcare’s Blender Bike, a stationary bike with a blender attached to the front. As
the pedals on the bike are turned, the blades in the blender spin, resulting in a
delicious smoothie. The Blender Bike is a fun and interactive way to demonstrate
healthy eating and exercise simultaneously.
The fair offered other fun activities including raffles, face painting, balloon animals and
fitness demonstrations. Dr. Cleo, Molina Healthcare’s cat doctor mascot, was also in
attendance. Additionally, representatives from community resources including the
Department of Human Services, WIC, Social Security Administration were available to
offer information and answer questions.
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Health Alliance Plan Updates
Henry Ford Health System Announces Retirement of HAP President and CEO
William R. Alvin, President and CEO
of Health Alliance Plan (HAP) and
Executive Vice President of HFHS, has
retired upon the fulfillment of his fiveyear commitment to lead HAP during
the most transformative years in the
company’s history and the period of
greatest change in the health insurance
industry, Nancy Schlichting, chief
executive officer, Henry Ford Health
System (HFHS), announced. Schlichting and the HAP Board of
Directors appointed Alvin as president
and CEO of HAP in February 2009. Alvin
will officially retire from HAP and HFHS
in February 2014.
HFHS and HAP will conduct a national
search for Alvin’s successor. “By sharing
his retirement plans with us early, Bill has
given us ample time to form a search
committee and conduct a thorough
national recruitment process to select
his successor and ensure a smooth
leadership transition,” said Schlichting.
HAP became the second largest health
insurer in Michigan under Bill Alvin’s
leadership, as he managed the challenging, competitive economic climate
and sweeping changes brought about
by federal health care reform. The
company is well-positioned for the
health care reform marketplace.
During the past four years, HAP transformed from a company primarily
serving the insured commercial and
Medicare markets into a full-service
broad-product portfolio health insurance
company that offers six distinct product
lines: Group Insured Commercial,
Individual, Medicare, Medicaid, SelfFunded and Network Lease.
Major HAP Milestones during
Alvin’s Presidency: •HAP is now the second largest health
insurer in Michigan, with 668,000
members—the highest membership
in the company’s history. Dramatic
membership growth resulted from
acquisitions and organic growth,
product diversification, the expansion
of HAP’s individual product line,
Personal Alliance, and broader sales
distribution networks. HAP grew by
202,000 members (43 percent) from
January 2010 to January 2013. •Entry into the Medicaid and selffunded markets through acquisition of
Midwest Health Plan and majority
ownership of ASR Health Benefits.
•Excellent customer satisfaction as
illustrated by HAP’s ranking as the
“highest in member satisfaction
among commercial health plans in the
Michigan region six years in a row,”
according to J.D. Power and Associates*, as well as ranking #1 in
Michigan in the Consumer Assessment of Healthcare Providers and
Systems (CAHPS) survey.
Biography of William R. Alvin
William Alvin has more than 35 years of health care leadership experience, including more than 20 years as the CEO of
Michigan health plans and hospitals.
During his tenure with Trinity Health as the President and CEO of Care Choices Health Plan (from 2001 to 2007), the insurer
was ranked as the #1 health plan in Michigan and the 12th best in the nation by U.S. News & World Report.
Alvin’s ties to HAP and HFHS were forged in 1983 when he became the Administrative Director of the 120-physician, multispecialty Metro Medical Group, a HAP subsidiary that merged into Henry Ford Medical Group. In addition, Alvin was HAP Administrator for Health and Medical Affairs (from 1988 to 1991) before becoming the President of Henry Ford Wyandotte Hospital
(from 1991 to 2001) where he led a team that transformed the hospital’s physical facilities and performance to achieve significant growth, profitability and clinical quality outcomes. Alvin holds a master’s degree in Public Administration with a concentration in Health Care Administration from George Washington University, Washington, D.C. and a bachelor’s degree from Thiel College in Greenville, Pennsylvania.
His extensive experience serving on local, state and national health care boards of directors and advisory boards includes:
America’s Health Insurance Plans, Michigan Association of Health Plans, Health Plan Alliance, New Detroit, Cabrini Clinic,
Friends of Kenyan Orphans and the University of Michigan Dearborn School of Business. Bill is a member of the Detroit
Economic Club and the Detroit Athletic Club.
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Health Alliance Plan Updates
From Couch to 5K in Nine Weeks, HAP Members
Race to the Challenge!
For bride-to-be Clare Shaw and her
fiancé Shaun Marx it was a life-changing
invitation. The 30-year-old nursing
student from Madison Heights had been
overweight most of her life so the invite
to join Health Alliance Plan’s Couch to
5K Challenge was the perfect solution.
born mom Clare Colleran who wants to
show her 18-year-old daughter—joining
her in the program—that it is never too
late to get fit; and Southfield resident
Erica Ballard who is motivated to lose 20
pounds to avoid developing diabetes,
which runs in her family.
The couple joined 400 other Health
Alliance Plan members taking part in the
new HAP Couch to 5K Challenge, a
program designed to motivate, train and
support people shifting from a sedentary
life-style. The program combines
in-person training with online engagement to help participants go from little or
no exercise to running a 5k race (3.1
miles) in just nine weeks.
Participants receive encouragement,
camaraderie and technical support
from fitness experts such as Sherry
McLaughlin, president of the Michigan
Institute for Human Performance
in Troy. Support includes group practices, training plans and a SparkPeople.
com team page where participants
can support each other, track their
weekly progress and communicate with
their coaches.
Other participants with compelling
stories include Oakland County Commissioner Janet Jackson who wants to
use the challenge to serve as a healthy
role model for her constituents; Dear-
Follow Shaw and Marx, Colleran, Ballard
and others on their Couch to 5K journey
and learn more about starting your own
Couch to 5K journey at hap.org.
HAP Signs Agreement with Hurley Medical Center
in Genesee County
Health Alliance Plan (HAP) Commercial
HMO members will have access to
Hurley Medical Center and the highly
respected physicians with Hurley
admitting privileges in the Professional
Medical Corporation network of independent physicians.
HAP also has signed an HMO contract
with Professional Medical Corporation
(PMC), a network of independent
physicians who admit to Hurley Medical
Center, and is in the process of signing
contracts with PMC physicians to serve
HAP HMO members.
PMC and Hurley serve HAP’s PPO,
HMO, HAP Preferred, HAP Senior Plus
and Alliance Medicare PPO members.
“HAP partners with hospitals and
physician organizations to improve the
quality and efficiency of patient care.
Consumers are likely over the next 3 to
10 years to obtain their medical care
from doctors who are part of a clinically
integrated organization like PMC that
focuses on high patient satisfaction and
impressive clinical quality outcomes,”
said Moliterno.
“The HMO agreement with this Level 1
Trauma and Burn Center further strengthens HAP’s presence in Saginaw, Genesee and Lapeer counties. HAP’s statewide provider network includes all three
major health systems in the East Central
region: Hurley Medical Center, McLaren
Healthcare and Genesys Health System,”
said Anita Moliterno, general manager,
East region for HAP.
517. 3 7 1. 3 18 1
Craving Stability While Preparing
for the Unexpected, continued from page 1
selection on the Insurance Exchange.
And while we don’t know yet (as this is
being written), vast new numbers of
eligible Michigan citizens may be able
to participate in the Medicaid program.
While we know that developing insurance rates will be a more exact process—in that rating cannot address
health status (except for smoking), age
(in only limited ways), and geography—but make no mistake, we also
know that rates will likely increase for
many citizens for these very reasons.
How much is offset by subsidies on the
insurance exchange and new eligibility under Medicaid remains to be seen.
Further, we don’t know yet what will be
the dynamic of reduced cost-shifting
by hospitals due to increased insurance coverage on the price of health
insurance—but it is a factor that we
know we can measure.
So are there tools that we can use to
mitigate or limit this period of “uncertainty?” We believe there are several.
Shared Communication—
Now More Than Ever
The clock is ticking very loudly on
the mandatory health coverage demanded by the Affordable Care Act.
The results of polling commissioned
by MAHP, and which has been reaffirmed by many other communication
firms, clearly show that most citizens
are largely unaware of the Insurance
Exchange and the options that they
will have in the future months. Further, many do not know if they may
qualify for eligibility for Medicaid under the expanded eligibility provisions
of the Affordable Care Act—assuming
the Michigan Legislature was to enable this provision.
This begs the question of, “If we
build it, will they come?” and the answer is “We don’t know.” But if we
Continued on page 16
insights
9
Delta Dental Works to Ensure Brighter Futures
for Michigan’s Children
Delta Dental has launched Brighter
Futures, a policy and action initiative that
focuses on improving children’s oral
health and literacy.
Children miss 51 million hours of
school a year due to oral health related
issues (many of which are easily prevented), and students who are absent
miss critical instruction time, especially
in early grades where reading skills are a
focus. Brighter Futures includes an initial commitment of $1 million to ensure
that Michigan’s children show up for
school every day healthy and ready to
learn. As part of that commitment:
•Delta Dental provides weekend
food to nearly 800 undernourished
children at Harms Elementary
School in Detroit and Fairview
School in Lansing.
•Delta Dental employees donated
2,000 new children’s books to
Michigan schools and volunteered
to be classroom readers in area
schools. In addition, the company
is the sponsor of the National Education Association’s Read Across
America program in Michigan and
has provided school media center
grants to be used for the
purchase of new books.
Delta Dental has also
worked with the Capital
Area Library Association
to bring oral health story
hours to area libraries and
committed $48,000 to
ensure the continuation of
the Lansing School District’s Reading is Fundamental program next year.
The company also encouraged state legislators to visit
classrooms during National
Reading Month (March) to talk
about reading and oral health
by providing them with 1,600
Brighter Futures tote bags
filled with oral health books,
toothbrushes, reading/brushing
logs, bookmarks and reading
lists for the students and oral
health lesson plans for teachers.
As part of Brighter Futures, Delta
Dental in the near future will announce a
set of public policy changes that can be
made at the state and local levels to improve oral health for children and adults.
To learn more about Delta Dental’s
Brighter Futures initiative and our other
community involvement and philanthropic
efforts, visit www.deltadentalmi.com.
Michigan Association of Health Plans’ Staff
Cheryl Bupp
Medicaid Policy Director
[email protected]
Kirsten Fisk
Special Events Manager
[email protected]
Paul Duguay
Deputy Director
[email protected]
Christine Gray
Business Manager
[email protected]
Laura Fent
Executive Assistant
[email protected]
Richard B. Murdock
Executive Director
[email protected]
Christine Shearer
Deputy Director,
Office of Legislation and Advocacy
[email protected]
MAHP Insights is a quarterly publication of the Michigan Association of Health Plans. Past issues may be found at the MAHP website: www.mahp.org.
For information regarding advertising or inclusion of news and events, please contact Christine Gray at the MAHP office 517.371.3181.
10
insights
MAHP’s annual legislative reception, held April 23, gave members an opportunity to discuss
key issues facing the industry with a variety of lawmakers, House and Senate, Republican and
Democrat. Held at Troppo’s in downtown Lansing, the event was well attended by key lawmakers
and representatives from the Snyder Administration as well as leaders from health plans across the
state, providing valuable face-to-face communication that will prove useful as the MAHP legislative
agenda moves forward.
Steve Mitchell, Mitchell Research and Communication, Allen Kessler, Midwest Health Plan, Vern Smith, Health Management Associates, Mark Saffer,
Midwest Health Plan and Senator Roger Kahn
Rick Murdock, MAHP, and Lesia Liss, HealthPlus of Michigan
Lisa Farnum, MAHP consultant, and Representative Bill Rogers
Photos provided by TimeFrame Photography.
517. 3 7 1. 3 18 1
insights
11
Sean Kendall, Meridian Health Plan, Sue Moran and Jon Cotton, Meridian Health Plan
Jim Cavanagh, Warner, Norcross & Judd, and
Representative Marcia Hovey-Wright
Bruce Hill, HealthPlus of Michigan, and Kathy
Rick Murdock, MAHP, and Kevin Clinton
John Shaski, Physicians Health Plan, and
Kendall, McLaren Health Plan
Department of Insurance and Financial Service
Representative Sarah Roberts
Representative Mike Callton, Carrie Germain, Rick Germain, Representative Joel Johnson and Representative Bill Rogers
12
insights
Steve Balbierz and Dennis Smith, Upper Peninsula Health Plan, Senator Colman Young and Steve
Senator Roger Kahn and Bruce Hill, HealthPlus
Mitchell, Mitchell Research and Communications
of Michigan
Dan Champney, Health Alliance Plan, and Karla Ruest, Michigan
Patricia Graham, Priority Health, and Senator Jim Marleau
Department of Community Health
Ruth Evans, ProCare Health Plan, Representative Phil Potvin, Joyce Poole, ProCare Health Plan, and Senator John Pappageorge
517. 3 7 1. 3 18 1
insights
13
28th Annual Summer Conference
Shifting Gears to Meet
M ichigan’s Unique
Health Care Needs
July 18-20, 2013
Grand Traverse Resor t, A cme, MI
Don’t miss the opportunity to
join more than 350 health industry
representatives at the 28th Annual
Michigan Association of Health
Plans Summer Conference. The
program features a new, fast-paced
agenda and in-depth discussions
of current issues.
2013 MAHP Summer Conference Working Agenda
Wednesday, July 17
12:15 - 3:45 p.m.
MDCH Lunch and Bi-monthly
Meeting
2:30 p.m.
MAHP Foundation Pre-conference
Education Session
5:00 p.m.
MAHP Medical, Pharmacy and
QI Directors Meeting
7:00 p.m.
Reception and Dinner with Select
Sponsors, Legislators and Health Plan
Executives
Thursday, July 18
7:30 a.m.
Registration and Continental Breakfast
with Exhibitors
8:45 a.m.
Shifting Gears in Michigan
MAHP President’s Report and Strategic
Vision: Bruce Hill, CEO, HealthPlus, Inc.
and President, MAHP Board
A View from the Commissioner’s Office:
Kevin Clinton, MAS, Commissioner,
Department of Insurance and Financial
Services
The View from MDCH:
James K. Haveman, MSW, Director,
Michigan Department of Community Health
10:00 a.m.
Legislative Panel:
Moderator: Tim Skubick, Political
Journalist and Host, Off The Record
11:30 a.m.
Adjourn (light lunch for non-golfers)
1:30 p.m.
Concurrent Workshops:
Noon
Shotgun Golf Tournament: Spruce
Course (Boxed lunches for golfers)
Session 1: Fraud, Waste and Compliance:
The Elephant in the Room
2:00 p.m.
Personal Wellness Option: Zumba
3:00 p.m.
Personal Wellness Option: Yoga
5:30 - 7:30 p.m.
Opening Reception with Sponsors in
Exhibit Hall
7:45 p.m.
Performance in Political Satire:
The Capitol Steps
Friday, July 19
Session 2: Wellness Product Development
and Management
2:45 p.m.
Stretch Break
3:00 p.m.
General Session: Late Breaking News
4:30 p.m.
Closing Reception and Silent Auction
with Sponsors in Exhibit Hall
5:30 p.m.
Close of Silent Auction
6:00 p.m.
Results of bidding
7:00 a.m.
Dental Dash
Evening
Dinner on your own
7:30 a.m.
Registration and Continental Breakfast
with Silent Auction
Optional: Wine Tour and Dinner at Black
Star Farms
8:30 a.m.
Opening Keynote: Creating Shared Value
Mark Kramer, JD, MBA, Founder and
Managing Director, FSG Social Impact
Consultants
8:30 a.m.
Continental Breakfast
10:00 a.m.
Break in Exhibit Hall with Silent Auction
10:30 a.m.
General Session: Medicaid Reform
Noon
Awards Luncheon
Saturday, July 20
9:00 a.m.
General Session: The New Michigan
Marketplace for Health Coverage
11:00 a.m.
Adjourn
28th Annual Summer Conference
Confirmed Sponsors
Shifting Gears to Meet
M ichigan’s Unique
Health Care Needs
Thank you to our
2013 MAHP Summer
Conference Sponsors
Presenting Partner
July 18-20, 2013
Grand Traverse Resor t, A cme, MI
Michigan Public Health
Institute
Diamond Partner
Silver Partners
Bronze Partner
Novo Nordisk
Abbott Diabetes
Gold Partners
Advomas
American Logistics Company
Allergan
Area Agencies on Aging of
Michigan
American Specialty Health
Ingham Health Plan Corp.
Medicaid Health Plans of
America
National Kidney Foundation
of Michigan
Plante Moran, PLLC
TEVA Neuroscience
AstraZeneca
Cognizant
Behavioral Health Professionals
Boehringer Ingelheim
Catamaran
Active Infusion
Arrow Strategies
Coram Specialty Infusion
Daiichi Sankyo
Delta Dental Plan of Michigan
Emdeon
Cubist Pharmaceuticals, Inc.
First Recovery Group
Envision Pharmaceuticals
HealthLOGIX
Genentech
Healthy Living Medical Supply
Lilly
Medagate
Michigan Dept. of Community
Health-Cancer Genomics
Michigan Health Connect
High Point Solutions
Inovalon
JET Health Solutions
Johnson & Johnson Health Systems
Meridian Rx
Navitus Health Solutions
Millenium Laboratories
Pfizer, Inc.
Newkirk Products, Inc.
Physicians Review Organization
of Michigan
Novartis
PerformRx
Sanofi
VARIS, LLC
TheraMatrix Physical Therapy
TMS Management Group
URAC
Walgreens
Special Event Partners
Michigan Health Connect:
The July 19 Wine Tour and Dinner
at Black Star Farms
Human Arc:
Conference Cyber Cafe’
Foster, Swift, Collins & Smith, PC:
Conference Flash Drives
First Recovery Group:
Conference Lanyards
Craving Stability While Preparing for the Unexpected
Continued from page 9
don’t have a series of targeted messaging
regarding options and expectations, then
we surely will not have the expected
“take up” for the insurance exchange.
And if we don’t have a concentrated and
reinforced message on Medicaid eligibility options then we will miss a great
opportunity to not only provide coverage
to hundreds of thousands of Michigan
citizens, we also will miss an opportunity to more forcibly limit cost shifting
due to lack of insurance coverage. This
is not the desired outcome for consumers, providers or health plans.
It is our expectation that such communication will need to begin soon—and
be sustained—and must be reinforced by
messaging from a variety of trusted
sources and use of multiple media.
From an employer’s point of view,
communication is both necessary and
daunting. As we look forward to the 2014
open enrollment season, employers are
expected to communicate clearly what
their employees’ health insurance options
will be and what these options might cost.
They are nowhere close to being able to
do this regarding coverage options under
the Insurance Exchange. The federally
required date set for this crucial communication has been deferred from an earlier March 31 deadline to an unknown
future date.
Amidst the confusion, there are some
key numbers in the law that can help
make sense of the 2014 health insurance
requirements for employers:
• 50. That’s the number of full-time
employees that determines whether
an organization is a small employer
under the law.
• 30/130. Employees with more
than 30 hours of service per week
or 130 hours of service per month
must have access to employersponsored health care benefits at
companies with 50 or more full-time
employees and full-time equivalents (FTEs). Otherwise, employers will face a penalty of $2,000
16
The results of polling...clearly show that most citizens
are largely unaware of the Insurance Exchange and
the options that they will have in the future months.
Further, many do not know if they may qualify for
eligibility for Medicaid under the expanded eligibility
provisions of the Affordable Care Act—assuming the
Michigan Legislature was to enable this provision.
per employee (minus the first 30
employees) if at least one full-time
employee receives subsidized coverage through an exchange.
• 9.5. The law says employer-offered health insurance is not affordable if the cost to purchase
coverage totals more than 9.5 percent of an employee’s wage income
per a W-2 statement. This test applies to even the lowest-paid qualifying employee.
• 45,000. This is the annual income level that some major size
employers find that separates employees who generally buy health
insurance from those who don’t.
The percentage of employees who
buy health insurance is basically
the same at higher income levels
regardless of how much they earn.
The percentage of people who
don’t buy health insurance significantly drops when earnings are
below $45,000.
• 8.6. In research, some employers
found that 8.6 percent of the single
employees in its client companies
had to pay more than 9.5 percent
for health insurance. Nearly all of
them had dependents on their policies even though they were single.
These figures do not include employees who chose not to buy health insurance and thus understate employers’ exposure to affordability problems. Only 37
percent of full-time eligible employees
making $15,000 to $20,000 in base pay
bought health insurance. Among those
earning $20,000 to $25,000, 58 percent
purchase health insurance.
Employee subsidies in state insurance exchanges, for example, will be
based on measures of taxable income that
include more than W-2 statements, and
may require the help of a tax professional
to calculate. A key challenge for employers is going to be, “How do we reach out
and engage people who have not purchased health insurance before,” and
“how do you make that information simple . . . but also precise and complete?”
In addition, lower-income employees
will need to know a lot about their household cash flows to determine how to best
fulfill their new mandatory insurance
require
ment. Insurance subsidies are
linked to percentages of little-known federal poverty levels that change with family size.
Unfortunately—but not unexpectedly, some employers have a fear that
some people just think they’re going to get
health coverage and haven’t thought
about where they’re going to get it or how
they’re going to pay for it.
Transparency
Perhaps this is beginning to be an
overused term; however it is exactly what
we need to provide for consumer choice—
and without consumer choice we cannot
have meaningful competition. The idea of
providing easy-to-understand summaries
of coverage is, in fact, the most popular
provision in the ACA, according to a recent Kaiser tracking poll.
One of the current advantages of
health insurance today is the ability to
prepare coverage that is tailored to the
needs of individuals and employers—
however it is that very flexibility that also
creates consumer frustration. This is due
to both the number of different options
and the complexity of health insurance
and the difficulty people face evaluating
health insurance choices and understanding how coverage works. Indeed, when
asked, people say they would prefer to go
to the gym or work on their taxes than
read through their health insurance policies. Other Kaiser surveys find that too
often, consumers don’t fully understand
how coverage actually works until they
get sick and try to use it, and then are
surprised to learn their plan doesn’t pay
as much, or at all, for care they thought
would be covered.
What is the opportunity cost of not
having a robust transparent system?
According to studies, economists document significant costs to small businesses—$35 billion annually in the
United States—arising from the limited
ability of employers “to compare the price
and quality of the bewildering variety of
complex health insurance policies.” Such
information barriers hinder market competition and increase the cost of health
insurance. One of the values of the insurance exchange is an “apples to apples”
comparison among options and carriers.
We know all too well that measures of a
health plan’s cost and value are neither
routinely available today nor easy for consumers and business owners to find. Consumers, when faced with a myriad of
choices, often make no choice or continue
with their current carrier. Perhaps that is
one reason why Michigan’s insurance
One of the lessons learned over the years is that
“coverage” does not equal access unless there
is an adequate supply of primary care providers.
Regardless of the disposition of the Affordable Care
Act, Michigan (along with other states) is on the
cusp of a provider shortage.
coverage is rated among the worst in
terms of competitiveness.
With so much attention devoted to
the ACA’s controversial requirement that
individuals be insured and debates at the
state level of whether to set up health insurance exchanges, the variety of provisions that would promote health insurance transparency have perhaps been
somewhat lost in the shuffle. Implementation of some of these provisions is under
way, while others await action.
• Uniform Summary of Coverage (Section 2715, Public Health
Service Act)—Starting this fall as
they are offered or renewed, health
plans and health insurance policies will have to provide enrollees
and applicants with a uniform
summary of benefits and coverage
(SBC). It will give consumers consistent information about what
health plans cover and what limits,
exclusions, and cost-sharing apply.
It must be written in plain language and contain no fine print. At
the outset, the final rule requires
two illustrations of typical patient
out-of-pocket costs for common
medical events (routine maternity
care and management of diabetes).
Other care scenarios illustrating how
coverage works for a broader set of
benefits (such as expensive outpatient medical therapies, surgery,
and mental health care) will be required at some time in the future.
This summary begins to provide
consumers with information they
can use to understand the coverage
they have today and to evaluate
health plan choices in new insurance markets that will begin in
2014. The SBC is intended to help
consumers understand how their
health plan works on paper.
• Transparency in Coverage
Disclosures (Section 2715A
Public Health Service Act, Section
1311(e) of ACA)—Non-grandfathered health plans, whether offered through exchanges or outside, must also disclose other
information that would help consumers understand how reliably
the plan reimburses claims for
covered services, whether the provider network is adequate to assure
access to covered services, and
other practical information. The law
requires plans to disclose information, and for exchanges and the
federal Department of Health and
Human Services (HHS) to then
make publicly-available accurate
and timely disclosure of the following information:
• Claims payment policies
and practices
• Periodic financial disclosures
• Data on enrollment
• Data on disenrollment
•Data on the number of claims
that are denied
517. 3 7 1. 3 18 1
insights
17
• Data on rating practices
•Information on cost-sharing and
payments with respect to out-ofnetwork coverage
• Information on enrollee and participant rights under this title
• Other information as determined
appropriate by the Secretary
Information disclosed under Section
2715A could also help consumers understand aspects of plan coverage that may
not be fully described under the SBC. An
emerging trend in health plan design involves the use of tiered provider networks.
Patients who seek care from network pro-
frequently consumers claim care from the
most preferred provider tier, less preferred tiers, and out-of-network tiers (and
what out-of-pocket cost liabilities result),
consumers would have additional tools to
evaluate the accessibility of health plan
provider networks and tiers.
Quality reporting for private
health insurance (Section 2717, Public Health Service Act)—The ACA also
requires the Secretary of Health and Human Service to develop reporting requirements for group and individual health
plans with respect to covered benefits and
provider reimbursement structures that im-
Issues involving money and ideology have largely
dominated the debate about the ACA during and
following its passage, and that’s not necessarily surprising. But as a result, so far at least, less attention
has been paid to other ACA changes that would
promote greater transparency in health insurance.
viders could end up paying more or less
out-of-pocket depending on how their health
plan ranks a particular hospital or doctor.
Patients who seek care out of network
could owe even more if they are subject to
balance billing (which results when providers are not limited to charging the amount
the health plan determines reasonable).
This can happen inadvertently when
patients are hospitalized or undergo surgery in an in-network facility and are
cared for by providers (such as anesthesiologists) who work in that facility but do
not participate in the health plan network. Instructions to insurers and health
plans for filling out the SBC note that accurately capturing how a tiered network
plan operates may be difficult to summarize in the SBC, so plans and insurers are
required to use their “best efforts” to describe rules “as reasonably as possible.”
If plans were to report to regulators how
18
prove health outcomes, prevent hospital
readmissions, improve patient safety and
reduce medical errors, and implement
wellness and health promotion activities.
As the health reform law restricts
competition based on risk selection, insurers may increasingly have an incentive
to compete based on the quality of care
enrollees receive. Patients will benefit
from information that helps them understand and recognize quality of care, and
to compare alternative approaches insurers may adopt. Quality reporting requirements will apply to non-grandfathered
individual and group health plans and
policies, offered both inside and outside
of exchanges.
Finally, under the ACA, the Secretary of HHS must establish a website to
help individuals, families, and small businesses in every state identify affordable
health insurance coverage options. This
insights
website, www.Healthcare.gov, was launched
in July 2010. It provides information about
major medical health insurance policies
offered by private insurers in the individual and small group markets.
In the future, the Plan Finder will offer consumers other types of performance
information about plans and insurers,
based on data collected under Section
2715A authority, including the percent of
individual policies that are rescinded, the
percent of claims that are denied under
each policy and the number and disposition of appeals of denied claims. Elsewhere on the site, consumers can search
information about individual and small
group market insurers relating to rate review actions and medical loss ratios.
For small employers, the Plan Finder
provides similar information about small
group policies offered in each community.
Small employers can see generally descriptive standard rate information, reflecting an aggregate of all cost sharing
options offered under a plan and the demographics of all small businesses that
might purchase a plan. The site does not
provide information about how often insurers surcharge premiums based on a
group’s health status. For low-income individuals, the Plan Finder also provides
information about Medicaid and CHIP.
Issues involving money and ideology
have largely dominated the debate about
the ACA during and following its passage, and that’s not necessarily surprising. But as a result, so far at least, less
attention has been paid to other ACA
changes that would promote greater transparency in health insurance. These provisions may well be less controversial (though
surely their implementation has and will
engender debate about regulatory burdens) and more popular overall to the
extent that they help consumers and small
businesses understand how coverage
works, reduce their search costs in buying insurance and foster competition
among insurers.
Martin Waymire Advocacy Communications Wins
Nation’s Top Award for Public Relations Excellence
Lansing-Based Firm Wins “Silver Anvil” for Public Affairs Excellence
Martin Waymire Advocacy Communications, a Lansingbased full-service public relations and social media marketing
firm, won the nation’s top award for public relations excellence—the Silver Anvil—at a ceremony recently in New York.
The firm was recognized by the Public Relations Society
of America for its work on the campaign to defeat Proposal 5,
the proposed “Super Minority” constitutional amendment on
Michigan’s November 2012 statewide ballot. Proposal 5 would
have required two-thirds of both chambers of the Michigan
Legislature to raise any tax or close any tax loophole.
Considered the “Oscar” of the public relations profession,
the Silver Anvil is the oldest and most prestigious award given
in the nation for outstanding achievement in PR. Martin
Waymire’s award came in the category of Public Affairs, Associations/Nonprofit Organizations. It is the third Silver Anvil won by Martin Waymire staffers in the past 20 years, all for
managing ballot campaigns.
“We are thrilled to be recognized in the public affairs
category, since that is the arena Martin Waymire excels in every day,” said Martin Waymire Partner Roger Martin, APR.
“Helping bring together the extraordinary coalition of associations and nonprofits that made up Defend Michigan Democracy, developing the strategy and then executing it precisely is extremely satisfying. This award recognizes the efforts
of our entire staff, who absolutely killed it to defeat a dangerous amendment to Michigan’s constitution. Many PR practitioners can do excellent work for an entire career and not win a
Silver Anvil, so we are so very grateful.”
Defend Michigan Democracy came together after the ballot
proposal was certified for the November 2012 election. Before
we launched the NO on 5 campaign, polls showed the proposal
winning with 70 percent of the vote. It was supported by Tea
Party organizations and the so-called “Americans for Prosperity” special interest group. In the end, Michigan voters defeated Proposal 5 by 69 percent to 31 percent, the largest margin
of any of the questions or candidates on the statewide ballot.
Here are some other metrics from the successful NO on
Prop 5 campaign:
•NO on 5 got the most votes—by far—of any candidate
or question on Michigan’s ballot (including President
Obama, who won the state by a landslide for the second
time).
• NO on 5 was the only ballot question or candidate campaign to exceed 3 million votes on the Michigan ballot.
•NO on 5 out-performed the next best-performing statewide ballot campaign by 260,000 votes.
•Every Michigan newspaper in the state that editorialized on Proposal 5 said “VOTE NO.”
• One of our “odd couple videos” was named one of Michigan’s political videos of the year for 2012.
“While Roger and I have both won Silver Anvils in the past
for managing ballot proposal campaigns, this is our first working
together at Martin Waymire,” said David Waymire, a partner at
the firm who this year received the Central Michigan Public
Relations Society of America’s PACE Maker of the Year Award.
“Our entire team was immersed in this campaign, implementing
an extensive social media campaign and developing viral videos
that featured ‘odd couples’ such as Gov. Rick Snyder and his
2010 Democratic opponent, Lansing Mayor Virg Bernero, explaining why all of Michigan was coming together to reject the
extremist proposal. Beating this extremist measure was good for
Michigan, and being recognized for our work by our peers nationally for that work is particularly sweet.”
Martin Waymire would like to thank the founding members of Defend Michigan Democracy for retaining our firm to
run the NO on 5 campaign, including the Michigan Health &
Hospital Association, the Michigan Municipal League, AARP
Michigan, and the Michigan Education Association.
The campaign also won first place in the Mid Michigan
Public Relations Society of American contest for public affairs. Martin Waymire was one of only two Michigan-based
firms to even be nominated for a Silver Anvil.
For more information on Martin Waymire and our services
visit www.martinwaymire.com. For more information on the
Defend Michigan Democracy campaign, visit http://martinwaymire.com/featured-clients/.
Summary
This is the start of major transformation. Early success will
depend largely on how well we communicate (at all levels) and
how transparent the services, coverages, pricing, and overall
quality are reported. Our next edition of this column will focus
on the implementation in Michigan of both the Exchange and
Medicaid eligibility.
19
PRESORT STANDARD
US POSTAGE
PAID
327 Seymour, Lansing, Michigan 48933
LANSING, MI
PERMIT NO. 664
PRESIDENT AND CEO OF
HEALTH ALLIANCE PLAN
Health Alliance Plan (HAP) is a nonprofit, regional health plan based in Detroit, MI and is a subsidiary of
the Henry Ford Health System, one of the nation’s leading health care systems and proud recipient of the
2011 Malcolm Baldrige National Quality Award for Performance Excellence and Innovation. HAP provides
health coverage to individuals and companies, and is a leader in personalized customer service, disease
management and wellness programs as we partner with physicians, employers and community organizations
to improve the health and well-being of the communities we serve.
Reporting to the President and CEO of HFHS, Nancy Schlichting, as well as to the HAP Board of Directors,
you’ll be responsible for providing visionary leadership toward the achievement of HAP’s strategic business
objectives within HFHS’s and HAP’s aligned missions and visions. You’ll also be responsible and accountable
for Health Alliance Plan’s annual profitability and strategic contributions to HFHS.
This position, which is open due to the planned retirement of the incumbent, requires at least 15 years’ relevant
experience, with a strong, progressive track record in leadership positions. This preferably includes currently
serving as a COO or a CEO of a major managed care business or as a senior executive with significant P&L
responsibilities in a large national insurance company, ideally with excellent provider knowledge before moving
into managed care and insurance roles. You’ll also have a solid track record of working closely and effectively
with physicians, hospitals, and other healthcare providers, particularly in an integrated delivery system setting,
as well as experience in leading or participating at the senior level in mergers, acquisitions and joint ventures.
MAHP 2013
Upcoming Events:
Thursday, July 18 through
Saturday, July 20, 2013
Summer Conference*
Tuesday, September 17, 2013
Pinnacle Awards*
*For more information on this event,
please call 517.371.3181 or visit our website:
http://www.mahp.org/events.html
517. 3 7 1. 3 18 1
Additional requirements include a minimum of a Bachelor’s degree with a relevant advanced degree preferred,
and preferably progressive experience in marketing, sales and product development before assuming broader
management roles. Other key critical leadership and management behavioral competencies include the
following attributes:
• Strategic thinker; ability to engage and guide the leadership team to develop a strategic plan,
scenario planning, identify opportunities and exploit them fully (e.g. HFHS/Beaumont merger, other
providers in the market); focus on execution;
• Strong leader who has employees best interest at heart; provides feedback; results driven; will be
firm and hold the team accountable;
• Bridge Builder; strong ability to build relationships with the Medical Group, consumers, government,
the union, and other providers/employers);
• Trustworthiness, transparency, integrity, personal will and humility;
• Inspirational; the ability to build a vision of Service and Cost (Value Creativity), then articulate that
vision to all groups in a way that builds enthusiasm, trust, honesty and accountability;
• A system thinker with the ability to integrate and leverage the advantages of being part of a larger
system and navigate the challenges. Needs to understand each Business Units’ unique needs.
Looks at the success of the broader organization versus simply HAP;
• Sophisticated understanding of the healthcare industry including solid knowledge of Medicare,
Medicaid and healthcare reform; accountable care act;
• Experience managing Health insurance operations (provider owned preferred);
• Experience working within a large integrated healthcare system;
• Track-record of leading an organization through radical change;
• Strong leadership experience with good track record with people, financials and physician relations;
• Experience building and developing boards;
• An understanding of the history of the market place, HAP and unions (respectful of Unions);
• Financial background helpful; good financial sense;
• Experience with government programs;
• Network development; proven track record of plan growth.
Compensation is generous and is accompanied by a complete executive benefit package and bonus
program. For confidential consideration, please forward your resume to: [email protected], HAP and
HFHS are AA/EEO Employers. Please, no agencies or 3rd party inquiries.
* This is a paid advertisement
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