Sunday, October 13, 2013

ACAP Health Returns to Agenda after 17 Months

This Tuesday's City Council meeting will occur at 5:30 pm, giving interested citizens the opportunity to attend and have their voices heard.  One item I'd like to hear will occur in executive session.  Council will hear the following item outside public purview:

To consult with attorney on pending or contemplated litigation; (b) or a settlement offer to ACAP Health for clinical care engineering services for the City health insurance program.

Oddly, the first item following executive session is a presentation by David Toomey of ACAP Health.

A search of the city's website produced nothing on "ACAP Health" or "clinical care engineering."  While these two subjects are narrow and focused in nature, my recent experience finds City search producing nothing or virtually nothing on subjects that once populated a rich list of historical resources.

However, a search of State of the Division produced a piece on ACAP Health from May 2012.  It stated:

History:  ... Phase II of the ACAP Health services will be to work directly with the providers to attain high value, accountable care for plan participants. This direct relationship will provide the City with a better understanding of the quality performance of the providers and of the cost of the clinical care being rendered. Evidence has shown that higher quality health care actually costs less when the right processes are in place to avoid the unnecessary waste and the complications inherent in a fragmented care continuum.

Financial Impact:  The cost is to be negotiated as part of the contract. The savings will be measured based on actual claims
Last year I wrote:

ACAP will work solely with SACMC providers on Clinical Care Engineering.  I look forward to seeing what comes back to council from such negotiations. 
I didn't reveal my skepticism on this last year, but I was curious as to how ACAP would clinically re-engineer clinical practice at Community while working with but a subsection of the hospital's patients.  Also, when was the contract, with amounts and deliverables, executed and approved?  The May 15, 2012 minutes show:


Human Resources Director Lisa Marley, Holmes Murphy Representative Jared Wills, and ACAP Health Representative David Toomey presented background information. A copy of the presentation is part of the Permanent Supplemental Minute record.

General discussion was held on the plan savings, improvements, and the financial impact based on the amount of savings produced by the company.

Motion, to authorize staff to negotiate an addendum and present at a future meeting, as presented, was made by Councilmember Hirschfeld and seconded by Councilmember Farmer. Motion carried unanimously.
I did not see any negotiated addendum presented in the last seventeen months and City sponsored health insurance is something I watch closely. 
David Toomey's presentation could be an eye-opener.  How many vendors get to talk right after City Council met in executive session to consider suing their company?

My guess is the city purchased ACAP's expertise in some kind of shared savings agreement.  Companies have sold these in health care for decades and they're akin to snake oil.  In good experience years the parties pretend they did something and share the savings.  In bad experience years the parties point fingers at one another and say the other side didn't fulfill their obligations.

I'm not sure how many dice this Council rolled in the last year.  ACAP Health, in my opinion, was one roll.  I can't recall if they increased the limits for their stop loss coverage from $50,000 to $100,000.   If so that was a second toss.

From a historical perspective this issue could reflect two patterns.  The first is Councilman Hirschfeld's desire to wring out every possible health insurance dollar, no matter the impact on employees, retirees and dependents.  The second is Interim City Manager Michael Dane's not bringing important items back to Council for approval.  Dane was in charge during the Furniture Fiasco and city hall renovations.

Was the ACAP deal negotiated before City Manager Daniel Valenzuela became official?  If so, that's another item kept from Council resting on Dane's shoulders.

Update:  I found the 5-15-12 presentation on Slideshare

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