spring/summer 2013 - michigan association of health plans

Save the Date – Pinnacle Awards Reception September 17, 2013

SPRING/SUMMER 2013

Michigan Association of Health Plans

MORE INSIDE

Page 2Bill Burke’s View from the Capitol

Page 314 Companies Submit Plans for ACA Federal Exchange

Page 4MDCH Updates

Pages 5–9Health Plan Updates

0Delta Dental’s Brighter Futures

Pages 11–13

MAHP’s Legislative Reception

Pages 14–15

MAHP’s Summer Conference

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 Af-fordable 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 na-

tion 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 out-standing and/or work in progress and we will report on them in our next column. I refer-ence 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

Craving Stability While Preparing for the Unexpected

By Rick Murdock, Executive Director, Michigan Association of Health Plans

Blending Good Politics with Good PolicyBy 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. Politi-cal considerations factor heavily into many

mentation, causing many members heart-burn at the thought of endorsing federal law. With the understanding that legisla-tors must account for every vote they take on a myriad of issues, my suggestion to

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 navi-gators 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 sur-rounding the ACA are now focused on preventative care, healthy life styles and personal responsibility. These sound pol-icy discussions will surely result in favor-able political decisions by members of the legislature.

In closing, I will offer the same ad-vice 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.

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 se-vere 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 re-quired to cast votes to facilitate its imple-

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 provid-ers. Give legislators credit for their willingness to discuss this issue while keeping their eye on the costs associ-ated 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 Assess-ment, or HICA, within the last two weeks. It’s hard to imagine any success for ex-pansion or reform if the basic program is not funded adequately.

The implementation of the ACA will rely on decisions of choice relative to es-

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.

2 M A HP SP R ING /SUMMER 2013 insights w w w.ma hp.o r g

Bill Burke’s View from the Capitol

14 Michigan Health Insurance Companies Submit Plans for Federal Exchange

Michigan Qualified Plans Filed for Health Insurance Exchange

Health Insurance Company Type of FilingAlliance Health and Life Insurance Company Individual/Small Group

Blue Care Network of Michigan Individual/Small Group

Blue Cross Blue Shield of Michigan Individual/Multi State Plan/Small Group

Consumers Mutual Insurance of Michigan (CO-OP) Individual/Small Group

Health Alliance Plan Individual/Small Group

Humana Medical Plan of Michigan, Inc. Individual

McLaren Health Plan Individual/Small Group

Meridian Health Plan of Michigan, Inc. Individual

Molina Healthcare of Michigan Individual

Physicians Health Plan Individual/Small Group

Priority Health Individual/Small Group

Priority Health Insurance Company Individual/Small Group

Total Health Care USA Individual/Small Group

United Healthcare Life Insurance Company Small Group

The Michigan Department of Insur-ance and Financial Services (DIFS) has received filing information from 14 health insurance companies seeking inclusion in the federally-run Michigan health in-surance exchange, set to launch on Octo-ber 1, 2013. Nearly all of the companies submitted plans for the individual mar-ket 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 compe-tition and provide many choices for Mich-igan 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

data, including rate information, will be made public on October 1st, after re-views are completed by DIFS and the federal government.

Open enrollment for Michigan’s feder-ally-operated health insurance exchange

will begin October 1, 2013, with coverage effective on January 1, 2014. Information about the health care exchange is avail-able at www.healthcare.gov. Michigan res-idents with health insurance questions can visit www.michigan.gov/hicap.

T H E 2 0 1 3 M A H P

Pinnacle AwardsDeadline 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 man-aged 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

M A HP SP R ING /SUMMER 2013 3517.371.3181

Implementing the Affordable Care Act: Interpreting BRCA Counseling and Testing CoverageSubmitted by the Michigan Department of Community Health Cancer Genomics Program

MDCH Cancer Genomics Program 2013 Awards

The Michigan Department of Community Health (MDCH) Cancer Genomics Program will once again be in atten-dance 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

surgery, and prophylactic oophorec-tomy). 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.

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 devel-opment 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 [email protected].

In 2005, the US Preventive Services Task Force (USPSTF) released a Grade B recommendation state-ment 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 counsel-ing 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 recommenda-tion includes “both referral for genetic counseling and BRCA genetic testing,

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-Ser-vices-for-Women-Closing-the-Gaps.aspx or http://cciio.cms.gov/resources/factsheets/aca_implementation_faqs12.html.


Michigan Department of Community Health Updates

M A HP SP R ING /SUMMER 2013 insights 5517.371.3181

HealthPlus Creates Chief Operating Officer Position–Fills it with a Health Care IT ProfessionalHealth 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 appoint-ment 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-engineer-ing 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 under- stands 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. Respon-sible 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 incen-tives 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 AchieversHealthPlus 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 resi-dents, 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.

Bridget HollingsworthCheryl Wagner

HealthPlus of Michigan Updates

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 Commis-sion 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 commu-nity-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 WinnersDr. 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 opportu-nity 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

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 vulner-able in the nation, Stermer has contrib-uted 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-to-school donation drive to provide 466 free backpacks to children and volun-teering 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 volun-teered more than 4,000 hours of service.

(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

System, Dennis Williams from Detroit Medical Center, and Robert Blehm from Macomb Fresh.

Molina Healthcare of Michigan Recognizes Unsung Heroes at its Seventh Annual Community Champions Awards Ceremony


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 effec-tively 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 Michi-gan 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.

Molina Healthcare “Springs Into Health” with the Children’s Center by Hosting a Free Community Health FairMolina 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.


Molina Healthcare of Michigan Updates


Health Alliance Plan Updates 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 five-year 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 chal-lenging, 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 trans-formed 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, Self-Funded 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 self-funded 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 Associ-ates*, as well as ranking #1 in Michigan in the Consumer Assess-ment 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, multispe-cialty Metro Medical Group, a HAP subsidiary that merged into Henry Ford Medical Group. In addition, Alvin was HAP Admin-istrator 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 signifi-cant growth, profitability and clinical quality outcomes.

Alvin holds a master’s degree in Public Administration with a concentration in Health Care Administration from George Wash-ington 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.

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.

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 engage-ment to help participants go from little or no exercise to running a 5k race (3.1 miles) in just nine weeks.

Other participants with compelling stories include Oakland County Com-missioner Janet Jackson who wants to use the challenge to serve as a healthy role model for her constituents; Dear-

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.

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 prac-tices, training plans and a SparkPeople.com team page where participants can support each other, track their weekly progress and communicate with their coaches.

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 CountyHealth 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 inde-pendent physicians.

PMC and Hurley serve HAP’s PPO, HMO, HAP Preferred, HAP Senior Plus and Alliance Medicare PPO members.

“The HMO agreement with this Level 1 Trauma and Burn Center further strength-ens HAP’s presence in Saginaw, Gen-esee 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.

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.

“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.

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 in-surance rates will be a more exact pro-cess—in that rating cannot address health status (except for smoking), age (in only limited ways), and geogra-phy—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 eligibil-ity 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 insur-ance 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 “uncer-tainty?” We believe there are several.

Shared Communication—Now More Than Ever

The clock is ticking very loudly on the mandatory health coverage de-manded by the Affordable Care Act. The results of polling commissioned by MAHP, and which has been reaf-firmed 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. Fur-ther, many do not know if they may qualify for eligibility for Medicaid un-der the expanded eligibility provisions of the Affordable Care Act—assuming the Michigan Legislature was to en-able this provision.

This begs the question of, “If we build it, will they come?” and the an-swer is “We don’t know.” But if we

Continued on page 16


Health Alliance Plan Updates

Craving Stability While Preparing for the Unexpected, continued from page 1

Michigan Association of Health Plans’ Staff

Cheryl Bupp Medicaid Policy Director

[email protected]

Paul Duguay Deputy Director

[email protected]

Laura Fent Executive Assistant [email protected]

Kirsten Fisk Special Events Manager

[email protected]

Christine Gray Business Manager [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.


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 pre-vented), and students who are absent miss critical instruction time, especially in early grades where reading skills are a focus. Brighter Futures includes an ini-tial 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 Edu-cation 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 Dis-trict’s Reading is Funda-mental program next year.

The company also encour-aged 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 im-prove 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.

MAHP’s Legislative ReceptionMAHP’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.


Representative Mike Callton, Carrie Germain, Rick Germain, Representative Joel Johnson and Representative Bill Rogers

Jim Cavanagh, Warner, Norcross & Judd, and

Representative Marcia Hovey-Wright

Sean Kendall, Meridian Health Plan, Sue Moran and Jon Cotton, Meridian Health Plan

Rick Murdock, MAHP, and Kevin Clinton

Department of Insurance and Financial Service

John Shaski, Physicians Health Plan, and

Representative Sarah Roberts

Bruce Hill, HealthPlus of Michigan, and Kathy

Kendall, McLaren Health Plan



Patricia Graham, Priority Health, and Senator Jim Marleau

Steve Balbierz and Dennis Smith, Upper Peninsula Health Plan, Senator Colman Young and Steve

Mitchell, Mitchell Research and Communications

Dan Champney, Health Alliance Plan, and Karla Ruest, Michigan

Department of Community Health

Ruth Evans, ProCare Health Plan, Representative Phil Potvin, Joyce Poole, ProCare Health Plan, and Senator John Pappageorge

Senator Roger Kahn and Bruce Hill, HealthPlus

of Michigan



Grand Traverse Resort, Acme, 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


28th Annual Summer Conference

Shifting Gears to Meet M ichigan’s Unique Health Care Needs

July 18-20, 2013

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)

Noon Shotgun Golf Tournament: Spruce Course (Boxed lunches for golfers)

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

7:00 a.m. Dental Dash

7:30 a.m. Registration and Continental Breakfast with Silent Auction

8:30 a.m. Opening Keynote: Creating Shared ValueMark Kramer, JD, MBA, Founder and Managing Director, FSG Social Impact Consultants

10:00 a.m. Break in Exhibit Hall with Silent Auction

10:30 a.m. General Session: Medicaid Reform Noon Awards Luncheon

1:30 p.m. Concurrent Workshops:

Session 1: Fraud, Waste and Compliance: The Elephant in the Room

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

Evening Dinner on your own

Optional: Wine Tour and Dinner at Black Star Farms

Saturday, July 20

8:30 a.m. Continental Breakfast

9:00 a.m. General Session: The New Michigan Marketplace for Health Coverage

11:00 a.m. Adjourn

Thank you to our 2013 MAHP Summer Conference Sponsors

Diamond Partner

Novo Nordisk

Gold Partners

American Logistics Company

Area Agencies on Aging of Michigan

AstraZeneca

Behavioral Health Professionals

Boehringer Ingelheim

Catamaran

Cubist Pharmaceuticals, Inc.

Envision Pharmaceuticals

Genentech

Lilly

Medagate

Michigan Dept. of Community Health-Cancer Genomics

Michigan Health Connect

Millenium Laboratories

Newkirk Products, Inc.

Novartis

PerformRx

Sanofi

VARIS, LLC

Confirmed Sponsors

Presenting Partner

Michigan Public Health Institute


28th Annual Summer Conference

Shifting Gears to Meet M ichigan’s Unique Health Care Needs

Grand Traverse Resort, Acme, MI

July 18-20, 2013

Silver PartnersAbbott Diabetes

Active Infusion

Advomas

Allergan

American Specialty Health

Arrow Strategies

Cognizant

Coram Specialty Infusion

Daiichi Sankyo

Delta Dental Plan of Michigan

Emdeon

First Recovery Group

HealthLOGIX

Healthy Living Medical Supply

High Point Solutions

Inovalon

JET Health Solutions

Johnson & Johnson Health Systems

Meridian Rx

Navitus Health Solutions

Pfizer, Inc.

Physicians Review Organization of Michigan

TheraMatrix Physical Therapy

TMS Management Group

URAC

Walgreens

Bronze PartnerIngham Health Plan Corp.Medicaid Health Plans of America National Kidney Foundation of MichiganPlante Moran, PLLCTEVA Neuroscience

Special Event PartnersMichigan 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

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 eligi-bility 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 opportu-nity to more forcibly limit cost shifting due to lack of insurance coverage. This is not the desired outcome for consum-ers, providers or health plans.

It is our expectation that such com-munication 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 commu-nication has been deferred from an ear-lier 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 employer-sponsored health care benefits at companies with 50 or more full-time employees and full-time equiva-lents (FTEs). Otherwise, employ-ers will face a penalty of $2,000

per employee (minus the first 30 employees) if at least one full-time employee receives subsidized cov-erage through an exchange.

• 9.5. The law says employer-of-fered health insurance is not af-fordable if the cost to purchase coverage totals more than 9.5 per-cent of an employee’s wage income per a W-2 statement. This test ap-plies to even the lowest-paid quali-fying employee.

• 45,000. This is the annual in-come level that some major size employers find that separates em-ployees 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 signifi-cantly 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 poli-cies even though they were single.

These figures do not include employ-ees who chose not to buy health insur-ance and thus understate employers’ ex-posure 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 insur-ance 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 employ-ers is going to be, “How do we reach out and engage people who have not pur-chased health insurance before,” and “how do you make that information sim-ple . . .but also precise and complete?”

In addition, lower-income employees will need to know a lot about their house-hold cash flows to determine how to best fulfill their new mandatory insurance require ment. Insurance subsidies are linked to percentages of little-known fed-eral poverty levels that change with fam-ily size.

Unfortunately—but not unexpect-edly, 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.

TransparencyPerhaps this is beginning to be an

overused term; however it is exactly what we need to provide for consumer choice—


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.

16

Continued from page 9


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 re-cent 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 understand-ing 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 poli-cies. 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 docu-ment significant costs to small busi-nesses—$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 com-petition and increase the cost of health insurance. One of the values of the insur-ance 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 con-sumers and business owners to find. Con-sumers, 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

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 in-surance exchanges, the variety of provi-sions that would promote health insur-ance transparency have perhaps been somewhat lost in the shuffle. Implementa-tion of some of these provisions is under way, while others await action.

• Uniform Summary of Cover-age (Section 2715, Public Health Service Act)—Starting this fall as they are offered or renewed, health plans and health insurance poli-cies will have to provide enrollees and applicants with a uniform summary of benefits and coverage (SBC). It will give consumers con-sistent information about what health plans cover and what limits, exclusions, and cost-sharing apply. It must be written in plain lan-guage 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 outpa-tient medical therapies, surgery, and mental health care) will be re-quired at some time in the future.

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.

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 insur-ance 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-grandfa-thered health plans, whether of-fered through exchanges or out-side, must also disclose other information that would help con-sumers understand how reliably the plan reimburses claims for covered services, whether the pro-vider network is adequate to assure access to covered services, and other practical information. The law requires plans to disclose infor-mation, and for exchanges and the federal Department of Health and Human Services (HHS) to then make publicly-available accurate and timely disclosure of the follow-ing information:• Claims payment policies

and practices• Periodic financial disclosures• Data on enrollment• Data on disenrollment• Data on the number of claims

that are deniedContinued on page 18




• Data on rating practices• Information on cost-sharing and

payments with respect to out-of-network coverage

• Information on enrollee and par-ticipant rights under this title

• Other information as determined appropriate by the Secretary

Information disclosed under Section 2715A could also help consumers under-stand aspects of plan coverage that may not be fully described under the SBC. An emerging trend in health plan design in-volves the use of tiered provider networks. Patients who seek care from network pro-

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 pro-viders are not limited to charging the amount the health plan determines reasonable).

This can happen inadvertently when patients are hospitalized or undergo sur-gery in an in-network facility and are cared for by providers (such as anesthesi-ologists) who work in that facility but do not participate in the health plan net-work. Instructions to insurers and health plans for filling out the SBC note that ac-curately capturing how a tiered network plan operates may be difficult to summa-rize in the SBC, so plans and insurers are required to use their “best efforts” to de-scribe rules “as reasonably as possible.” If plans were to report to regulators how

frequently consumers claim care from the most preferred provider tier, less pre-ferred 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, Pub-lic Health Service Act)—The ACA also requires the Secretary of Health and Hu-man Service to develop reporting require-ments for group and individual health plans with respect to covered benefits and provider reimbursement structures that im-

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, in-surers may increasingly have an incentive to compete based on the quality of care enrollees receive. Patients will benefit from information that helps them under-stand and recognize quality of care, and to compare alternative approaches insur-ers may adopt. Quality reporting require-ments will apply to non-grandfathered individual and group health plans and policies, offered both inside and outside of exchanges.

Finally, under the ACA, the Secre-tary of HHS must establish a website to help individuals, families, and small busi-nesses in every state identify affordable health insurance coverage options. This

website, www.Healthcare.gov, was launched in July 2010. It provides information about major medical health insurance policies offered by private insurers in the individ-ual and small group markets.

In the future, the Plan Finder will of-fer 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 disposi-tion of appeals of denied claims. Else-where on the site, consumers can search information about individual and small group market insurers relating to rate re-view 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 de-scriptive standard rate information, re-flecting an aggregate of all cost sharing options offered under a plan and the de-mographics of all small businesses that might purchase a plan. The site does not provide information about how often in-surers surcharge premiums based on a group’s health status. For low-income in-dividuals, 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 pas-sage, and that’s not necessarily surpris-ing. But as a result, so far at least, less attention has been paid to other ACA changes that would promote greater trans-parency in health insurance. These provi-sions may well be less controversial (though surely their implementation has and will engender debate about regulatory bur-dens) and more popular overall to the extent that they help consumers and small businesses understand how coverage works, reduce their search costs in buy-ing insurance and foster competition among insurers.


Issues involving money and ideology have largely dominated the debate about the ACA during and following its passage, and that’s not necessarily sur-prising. 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.




Martin Waymire Advocacy Communications Wins Nation’s Top Award for Public Relations ExcellenceLansing-Based Firm Wins “Silver Anvil” for Public Affairs Excellence

Martin Waymire Advocacy Communications, a Lansing-based full-service public relations and social media marketing firm, won the nation’s top award for public relations excel-lence—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, As-sociations/Nonprofit Organizations. It is the third Silver An-vil 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 ev-ery day,” said Martin Waymire Partner Roger Martin, APR. “Helping bring together the extraordinary coalition of asso-ciations and nonprofits that made up Defend Michigan De-mocracy, developing the strategy and then executing it pre-cisely is extremely satisfying. This award recognizes the efforts of our entire staff, who absolutely killed it to defeat a danger-ous amendment to Michigan’s constitution. Many PR practitio-ners 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 Prosper-ity” special interest group. In the end, Michigan voters de-feated 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 cam-paign to exceed 3 million votes on the Michigan ballot.

• NO on 5 out-performed the next best-performing state-wide ballot campaign by 260,000 votes.

• Every Michigan newspaper in the state that editorial-ized on Proposal 5 said “VOTE NO.”

• One of our “odd couple videos” was named one of Mich-igan’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, ex-plaining 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 na-tionally for that work is particularly sweet.”

Martin Waymire would like to thank the founding mem-bers 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 af-fairs. 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://martin-waymire.com/featured-clients/.

SummaryThis 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

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.

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:

PRESIDENT AND CEO OF HEALTH ALLIANCE PLAN

Publication

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Section

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Price

Ad#

MAHP Newsletter

1/4 pg (3.5”x4.75”) BW

$

13-HFHS30-0007021

• 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

Michigan Association of Health Plans 327 Seymour, Lansing, Michigan 48933

PRESORT STANDARD

US POSTAGE

PAIDLANSING, MI

PERMIT NO. 664

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

M A HP SP R ING /SUMMER 2013 insights517.371.3181 w w w.ma hp.o r g

spring/summer 2013 - michigan association of health plans

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