Introduced the Quality Watchline, the Coalition sponsored 800 number to
identify quality problems that consumers and workers are encountering with
managed care. Watchline information will be used to promote federal and
state advocacy efforts;
Launched cooperative campaign with SEIU Local 1107 to promote the Quality
Watchline in Las Vegas this fall in a campaign designed to foster community
consensus in a consumer definition of quality health care;
Held May 30th press conference to announce Coalition's agenda and to introduce
new sponsors - AFSME, SEIU and the ANA. AMPRA and AARP also participated
by providing remarks and issuing press statements. Press conference was
covered in the BNA's June 3rd Health Care Policy Report and the National
Journal;
Coalition highlighted in June 22nd National Journal article on SEIU's President
Andy Stern;
Coalition staff has been asked to author a chapter in a 1997 Faulkner &
Gray book on Quality and Managed Care, and will present the consumer perspective
on quality issues in managed care;
Coalition staff have made presentations to the following groups: AFL-CIO
Department of Professional Employees, ANA, AMPRA, Consortium on Citizens
with Disabilities, Jobs with Justice Annual Meeting, the Health Security
Campaign, AFSCME National Convention, AARP, and Administration on Aging;
Highlighted in Action For Universal Health Care article "Fighting Back
Against For-Profiteers in Health Care";
Working with several Coalition members to produce consumer booklets regarding
managed care.
II. FEDERAL ADVOCACY
Medicare/ Medicaid
Opposed Medicare reform bills because of insufficient quality provisions
and consumer protections. Vocal advocate for extension of external independent
review of Medicare HMOs to all private health plans contracting with Medicare;
Advocated as a participant in the Health Security Campaign (consumer coalition
fighting cuts to Medicare and Medicaid) for quality assurance provisions
for all private health plans under contract with Medicare;
Participant in an amicus brief in the Grijalva case against DHHS for failure
to fully implement the grievance and appeals system for enrollees in Medicare
HMOs. Consumer advocates are asking the federal court to compel DHHS to
adequately inform beneficiaries of their grievance and appeals rights;
In Medicaid block grant bills, vocal advocate for the preservation of federal
quality standards and programs;
Worked with the Medicaid Strategy Group (another coalition, led by Families
USA, opposing Medicaid cuts) to oppose Republican Leadership's most recent
Medicaid proposal because it eliminates most federal quality standards.
Issued a Coalition Press Release assailing Republican proposal for eliminating
quality safeguards;
Wrote to Congress calling for hearings on the National Governor's Association
Medicaid proposal because it lacked adequate quality assurance mechanisms;
Met prior to Senate Finance mark-up with Senator Daschle's (D-SD) health
staff, Rema Cohen, and Senator Graham's (D-FL) health staff, Bruce Lesley,
to advocate for retention of federal quality standards in Medicaid reform
bill;
Consumer Coalition has worked with HCFA to provide consumer input for various
beneficiary information projects.
Kennedy-Kassenbaum
Acted as a technical resource to Coalition members opposing the proposal
to establish medical savings accounts because of the potential fragmentation
of insurance risk pools across broad populations. The likely result of
medical savings accounts would be increased premium costs for sicker and
more vulnerable populations.
III. STATE ADVOCACY AND GRASSROOTS ACTIVITIES
Policy Development
In process of completing draft of state model legislation for managed care
consumer protection and quality assurance. The model legislation includes
sections on: consumer information and marketing abuses; consumer participation
on health plan governing boards; mandated data collection; an independent
grievance and appeals system; the establishment of an independent quality
improvement foundation to monitor and facilitate improvements in health
plan performance. Model legislation will be used in Coalition activities
at the state level;
Met with NAIC representatives to discuss NAIC model regulations for managed
care. Have requested application for becoming a designated sponsored consumer
representative to the NAIC;
Consumer Coalition wrote to the NAIC in support of AARP's continued role
as a consumer representative to the NAIC.
Grassroots Activities
Hired a grassroots organizer to direct state campaign and advocacy initiatives;
Organized meeting of advocacy organizations in New York to discuss greater
collaboration on the Medicaid managed care bill and a managed care bill
that were pending in Albany and to discuss ways to strengthen consumer
advocacy efforts in the future. Meeting involved representatives of SEIU,
AARP, the NYC Medicaid Managed Care Task Force, IPRO, Legal Aid and The
New School;
Introduced the Consumer Coalition to 150 AFSCME convention delegates serving
on the Health Committee and members of the United Nurses of America. Discussed
the dangers to patient care under managed care and the need to form local
coalitions;
Organized coalition meeting in Oregon to discuss launching a campaign for
a Patients' Bill of Rights in the next legislative session. Also discussed
launching a statewide campaign around the Consumer Coalition's Quality
Watchline to bank stories of abuses in managed care. Meeting brought together
the AFL-CIO, Oregon Federation of Nurses and Health Professionals, AFSCME,
SEIU, OMPRO, Oregon Advocacy Center, the ARC, AARP, Council of Senior Citizens,
and Oregon Fair Share;
Organized coalition meeting in Washington State to discuss the consumer
protection and quality assurance agenda under managed care. Participants
included the State Labor Council, Washington State Nurses Association,
SEIU, AFSCME, UFCW, Graphic Communications Local 767, Puget Sound Senior
Citizens, Seattle-King County Health Department, Rep. Cody's office, Citizen
Action, AARP;
Provided comments to Oregon Insurance Commission's Consumer Division Director
on draft legislation to regulate managed care and provided Coalition's
model legislation as an alternative. Agreed to assist in development of
legislation throughout the fall;
Met with Washington Insurance Commissioner to discuss rulemaking proceedings
for the regulation of managed care. Commissioner and staff agreed to review
Coalition's model legislation and indicated willingness to include many
provisions that are within their jurisdiction;
Facilitated workshop at the Jobs with Justice Annual meeting in Seattle,
WA. Motivated participants to request a JWJ health committee to share information
on health care issues;
Future state meetings are being planned for Pennsylvania, Missouri, North
Carolina, Tennessee, Mississippi, and New Jersey;
Working closely with Coalition members to identify and catalogue existing
state consumer initiatives vis-a-vis the quality agenda under managed care.
Goal is to establish clearinghouse of information and active network of
state consumer groups that can share experiences and successful strategies;
Established a Consumer Coalition state working group/task force to prioritize
state campaign activity, issues and strategies.
IV. QUALITY MEASUREMENT ACTIVITIES
In process of developing mechanism to assist and staff Coalition member
representatives who sit on the Boards and/or Committees of AMPRA, NCQA,
JCAHO, FACCT;
Will be reviewing recommended performance measures from organizations in
the field, including the latest HEDIS 3.0 version;
Meeting scheduled with Peggy O'Kane to discuss Coalition involvement with
NCQA;
Coalition asked by JCAHO to submit nominations for consumer representatives
on the JCAHO Board of Directors;
Coalition asked by Harvard Medical School to participate in their proposal
to AHCPR for the Q-Span Project (an effort to develop clinical performance
measures);
Coalition staff asked to participate on the Technical Expert Panel in the
proposal submitted by the Harvard School of Public Health for the AHCPR
sponsored QMNET project (an initiative to expand the CONQUEST database
on performance measures);
Met with Jim Lubalin, Research Institute Triangle and Soshanna Sofaer,
George Washington University, principal investigators in the AHCPR sponsored
Consumer Assessments of Health Plan Study to discuss project status and
potential for Coalition involvement;
Coalition staff was a participant in the invitational Institute of Medicine
workshop on Outcomes for the Elderly.
V. ORGANIZATIONAL DEVELOPMENT AND FUND RAISING
Received consultation grant from UNC-CH School of Social Work for consumer
work on managed care;
Requested funding for managed long-term care research proposal;
Coalition has filed incorporation papers as a not-for-profit DC-based corporation
and will file with the IRS for 501 (c)(3) tax status this summer;
Staff has grown to four individuals: Brian Lindberg, Executive Director;
Andy Webber, Senior Associate for Quality Policy; Angela Ledford, State
Campaign Director; Elizabeth Barrett, Public Affairs Director;
Coalition has secured four new endorsers: American Federation of State,
County and Municipal Employees, Service Employees International Union,
American Nurses Association, and the American Federation of Teachers;
The Coalition for Consumer Protection and Quality in Health Care Reform
officially changed its name to the Consumer Coalition for Quality Health
Care, and moved to Suite 602 at 1275 K Street, N.W.
Summary Of Future Activities
I. MEDIA/PUBLIC AWARENESS/CONFERENCES
Launch public information campaign around the 800 number, the Quality Watchline
to give workers and consumers a greater opportunity to report the issues
with manage care that they uncover. The names of the callers will create
a database that will serve as a resource for the press and assist the Coalition's
federal and state advocacy activities;
Complete work on home page on the Internet to introduce consumers to the
Coalition and the quality agenda;
In October of 1996, conduct a retreat, supported by the Helen Bader Foundation,
for consumer leaders to develop consensus on consumer protection and quality
assurance policies under managed care;
Write op-ed pieces and letters to the editor on quality issues from the
consumer perspective;
Help organize an integrated media strategy among coalition members to highlight
quality concerns under managed care;
Provide technical assistance to state based consumer coalitions in their
media activities;
Increase Consumer Coalition staff presentations at managed care and quality
conferences, workshops and meetings;
In 1997, conduct the first annual Consumer Coalition Quality Conference.
II. FEDERAL ADVOCACY
Introduction of managed care consumer protection and quality standards
bill in early 1997;
Continue Coalition work to ensure the preservation and the expansion of
consumer protection and quality assurance policies in the Medicare/Medicaid
programs;
Expand current effort to educate Washington-based consumer groups to the
importance of retaining and strengthening quality assurance and consumer
protections in Medicare/Medicaid.
III. STATE ADVOCACY AND GRASSROOTS ACTIVITY
Distribute model legislation to key state advocates and public officials
around the country, complete with a side-by-side comparison of other leading
proposals to regulate managed care, and with individual fact sheets explaining
the separate sections of the bill;
Critique NAIC models already approved and critique other sections as they
become available to assist state advocates in evaluating proposed state
legislation;
Analyze and comment on proposed state legislation/rules upon request;
Provide or assist in development of testimony for state consumer organizations;
Develop a Quality Health Care Campaign Briefing Book that will include
generic public education materials, fact sheets, opinion /editorials, testimony,
etc;
Launch campaigns in at least 10 states to support passage of managed care
consumer protections and quality assurance legislation or rules. In these
states the Coalition will play a major role in forming the local coalition,
developing the legislative strategy, meeting with public officials and
the press when appropriate and supporting the work of the local coalition;
Host regional conference on managed care in the Northeast;
Identify Consumer Coalition state leaders in each state who will broadly
distribute information to assist consumers in their advocacy for quality
assurance and consumer protection. Develop and maintain an extensive database
of state consumer advocates as sources of information on current trends
in state policy;
Publish monthly newsletter providing highlights of state activity and lists
of available resources;
Facilitate at least 4 national telephone conferences with key state advocates
to brief them on current developments in other states and our national
work;
Attend conferences and workshops around the country to educate state advocates
on consumer protection and quality assurance in managed care;
Establish partnerships with local groups in at least two states to market
the Quality Watchline. Local partners will follow-up with callers to provide
additional assistance and enlist the callers participation in state campaigns.
IV. QUALITY MEASUREMENT ACTIVITIES
Expand Coalition participation with public and private sector organizations
active in the managed care quality assurance and measurement field including
AMPRA, CCQE, NCQA, FACCT, JCAHO, AHCPR, HCFA, IOM, PROPAC/PPRC, NAIC, Business
Coalitions and Academia;
Secure Consumer Coalition representation on Boards, Committees, Panels;
Analyze evolving quality policies and products and provide input and commentary;
Identify and help staff current and future consumer representatives that
are participating with quality assurance and measurement organizations.
Help organize their collective input;
Explore potential of joint ventures with quality assurance and measurement
organizations including conferences, research proposals, policy development
initiatives.
V. ORGANIZATIONAL DEVELOPMENT AND FUND RAISING GOALS
Expansion of Coalition membership;
Successful filing with IRS of the Coalition's 501 (c)(3) tax status;
Continued expansion of list of financial supporters from consumer, union,
and provider organizations;
Submission of grant proposals to private foundations and government entities.
