Issue: September 14, 2017

Published on September 14, 2017

Articles in this issue:

Centene Acquires Fidelis Care

Author: Deanna Stephenson

Politico reported this week that Centene, a major Medicaid national plan purchased Fidelis Care of New York for 3.75 Billion.

By Dan Goldberg

09/12/2017 06:28 PM EDT

Health insurer Centene announced Tuesday evening that it is purchasing Fidelis Care, one of the largest not-for-profit health insurers in New York state.

The $3.75 billion deal gives Centene, a publicly traded company, a foothold in the nation's second-largest Medicaid managed-care market, complementing its position in California, Texas and Florida.

Fidelis, which began in Brooklyn and Queens in 1993, has more than 1.6 million members and nearly $5 billion in revenue. It is the state's leading provider of on-exchange insurance plans sold on the individual market.

Centene intends to fund the purchase price with $2.3 billion of new equity, including share consideration, and $1.6 billion of new long-term debt. The Rev. Patrick Frawley, CEO of Fidelis, said he is confident the insurer will continue Fidelis' charitable mission.

"Good strong business is good mission and that's what I think Centene will help us with," Frawley said during a conference call with investors. "I am confident that this acquisition will only be to the good of our shared mission."

Centene will be the umbrella company for Fidelis, and keep its name and brand throughout the state. The company also promised to keep Fidelis' 4,000 employees.

The proceeds will go back to Fidelis' foundation, run by the Catholic Church. The money, Frawley said, will continue to be used for grants and other programs that serve the poor.

Fidelis' medical loss ratio is 90 percent, according to Centene executives, who insisted this was not a turn-around project. They said it was about bringing scale to a new market as well as a better understanding of risk adjustment, data analytics and value-based contracting.

"We have the platform and manage care expertise to do this right," said Michael Neidorff, president and CEO of Centene. "We are excited about our future as a growth company."

Centene executives said it was "premature" to think about whether they would narrow the size or scope of Fidelis' networks.

Centene is bucking the trend of national insurers and significantly expanding its Obamacare footprint for next year. It's entering the exchange markets in Kansas, Missouri and Nevada in 2018, and expanding its presence in six other states. Centene has stepped in to sell plans in more than 40 counties nationwide that were at risk of not having any coverage options.

The state attorney general must approve the deal, which is expected to close in the first three months of 2018.

Paul Demko contributed to this report.



Deanna L. Stephenson
Director, Managed Programs
518-462-4800, Ext. 16

Readmissions Reduction Webinar Hosted by NYSPFP

Author: Lisa Volk* Published in Clinical & Quality

Do too many of your residents transferred to the hospital emergency department (ED) get admitted as inpatients? Want to clearly identify processes for smoother transitions?

On September 28, the New York State Partnership for Patients (NYSPFP), a joint initiative of the Healthcare Association of New York State (HANYS) and Greater New York Hospital Association (GNYHA) in collaboration with IPRO, will host a readmissions reduction webinar, Improving Transitions of Care between Acute Care Hospitals and Skilled Nursing Facilities, to address high readmission of patients/residents discharged from hospital EDs to post-acute care providers, such as skilled nursing facilities (SNF). Research has shown that one of the best ways to reduce readmissions is to improve the transition from the hospital to the SNF and prevent an avoidable admission following appropriate treatment in the ED.

The webinar will feature Amy Boutwell, MD, MPP, President of Collaborative Healthcare Strategies. Dr. Boutwell will present key processes for reducing readmissions by improving the transfer of patients from the ED to the nursing home, such as: 

NYSPFP encourages hospital, emergency department, and post-acute care teams from SNFs, rehabilitation, and home health staff to attend the webconference.

Topic:  Improving Transitions of Care between Acute Care Hospitals and
           Skilled Nursing Facilities

Date:  Thursday, September 28, 2017

Time:  12:00 p.m.–1:00 p.m.

Webinar details, including log-in information, can be accessed on NYSPFP's website. Attendance is free and does not require pre-registration. Please begin logging into the webinar 15 minutes prior to the start time to enjoy this program.


Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

NYSHFA / NYSCAL Offer Bronze Quality Award Workshop

Author: Rick Patterson

It may be time to apply for the Bronze Quality Award to recognize your facility’s commitment to quality. This one-day workshop will walk you through the application process and help you understand the award criteria and apply it to your organization. At the end of the workshop, participants will have the framework for the Bronze AHCA/NCAL Quality Award application.  The Workshop will be held Thursday, October 26th in Syracuse, NY.  Workshops are being offered at No Cost, thanks to a generous sponsorship from First Quality.  Workshop Flyer & Application attached.

Rick Patterson
Sr. Director, Business Development
518-462-4800 ext. 19

AHCA/NCAL Quality Initiative Recognition Program

Author: Lisa Volk and Nancy Leveille and Carla Erhartic

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is pleased to announce the relaunch of the Quality Initiative Recognition Program to honor skilled nursing and assisted living members for their individual work in achieving the goals of the AHCA/NCAL Quality Initiative.

All achievers will be recognized at the AHCA/NCAL Quality Summit in New Orleans, March 12-14, 2018.


For skilled nursing care centers, members must achieve four or more of the AHCA Quality Initiative goals to be eligible for recognition. The goals are:

  1. Decrease turnover rates among nursing staff by 15% from 2015 or achieve/maintain at or less than 40%
  2. Adopt Core-Q customer satisfaction questionnaire and measure and upload data to LTC Trend Tracker
  3. Reduce the number of unintended health care outcomes
  4. Safely reduce the number of hospital readmissions within 30 days during a skilled nursing center stay by 30% from December 2011 or achieve and maintain a low rate of 10%
  5. Improve discharge back to the community by 10% from December 2014 or achieve and maintain a high rate of at least 70%
  6. Improve functional outcomes by 10% from December 2015 or maintain an average rate of improvement of 75%
  7. Safely reduce the off-label use of antipsychotics in long-stay nursing center residents by a total of 30% from December 2011
  8. Safely reduce hospitalizations among long-stay residents by 15% from December 2014 or achieve/ maintain a low rate of 10% or less

For assisted living communities, members must achieve two or more of the four NCAL Quality Initiative goals. The goals are:

  1. Increase staff stability by maintaining nursing and direct care staff turnover below 40%
  2. Increase customer satisfaction to 90%
  3. Safely reduce hospital readmissions by 15% or achieve a low readmission rate of 5% or less
  4. Safely reduce the off-label use of antipsychotics by 15% or achieve a low off-label usage rate of 5% or less

What to Do Next

By October 13, 2017, nursing centers must submit staffing and customer satisfaction data in LTC Trend Tracker. All other data is automatically uploaded by LTC Trend Tracker.  

For assisted living communities, members must submit data for all NCAL goals in LTC Trend Tracker by October 13, 2017. Customer satisfaction vendors can upload data to LTC Trend Tracker on behalf of members. A list of vendors able to upload can be found here.

AHCA/NCAL also encourage members to:

Notification & Assistance

Later this year, achievers will be notified by the AHCA/NCAL Quality Initiative Recognition Program team using the latest available data.

In the meantime, if you need assistance with LTC Trend Tracker, email and be sure to add the email address to your Safe Sender list. 

Please contact the program team here if you have any questions.


Nancy Leveille, RN, MS
Executive Director
5180462-4800 x20

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Carla Erhartic
Coordinator, NYSCAL Member Support Services
518-462-4800 x13



2nd Annual Emergency Preparedness Conference


NYSHFA/NYSCAL invite you to our 2nd Annual Emergency Preparedness Conference. “Embracing Adversity & Emerging Stronger”, Wednesday, September 27, 2017 at the Albany Marriott on Wolf Road, Albany, NY.  Please click here to view the registration brochure.

Exhibitor Opportunities are also available. Information can be found on the above link!

Scott Jackson
Director, Education & Conference Planning
518-462-4800 x27


Audio Conference - CMS' ROP: New Behavioral Health: Identifying and Treating Residents Who Have Experienced Trauma


On October 3rd NYSHFA/NYSCAL will host an audio conference entitled "CMS' ROP: New Behavioral Health: Identifying and Treating Residents Who Have Experienced Trauma"

CMS requirements of participation related to behavioral health services (483.40) emphasize the need for accurate identification and responses to individuals who present with a history of trauma. The main component of the regulation requires facilities implement a trauma informed approach to care. The introduction of this regulation raises the very basic question of, “What is trauma?”. This session will help foster a better understanding of how a trauma reaction develops and persists, as well as differentiating it from other mental health issues. It will also focus on ways of helping a resident who has experienced trauma through increasing the awareness of staff so they can make the appropriate attributions for the emotional and behavioral difficulties encountered. Since trauma reactions have multiple causal factors, so do helpful clinical responses. Our approach should not only be based on medical management, but also include psychological, interpersonal, and environmental efforts that are well integrated into the daily care routine, and actively promoted by facility leadership and the interdisciplinary team. One thing that is made clear is the importance of early identification of both acute and chronic traumatic events and establishing an environment where the individual’s trauma reactions are not exacerbated, or the person is not re-traumatized.


Click here for additional details.  

Audio Conference - The Changing Landscape of Labor and Employment Law


On October 25th NYSHFA/NYSCAL will host an audio confernece entitled "The Changing Landscape of Labor and Employment Law".  
This year has seen an unprecedented amount of uncertainty in the area of labor and employment law.   This program will examine a number of these changes at the federal, state and local level, which are requiring facilities to re-think employee leave benefits, worker classifications, policy development and enforcement, as well as labor relations and union contract objectives. 

Click here for additional details.  

Audio Conference - 2017 Annual Update: Fraud, Waste & Abuse Enforcement Trends


On November 3rd NYSHFA/NYSCAL will host an audio conference entitled "2017 Annual Update: Fraud, Waste & Abuse Enforcement Trends"....

This annual presentation provides an overview of the fraud, waste, and abuse enforcement landscape and addresses current trends and hot topics. Brian Feldman, is a former Assistant U.S. Attorney who previously directed health care investigations out of Manhattan, and who now represents health care facilities in responding to enforcement actions by actors such as the U.S. Department of Justice and the New York Attorney General’s Medicaid Fraud Control Unit. Ted Townsend, is an associate in the Health and Human Services Group who represents health care facilities in a wide range of operational, compliance and governance matters including counseling those facilities with respect to fraud and abuse matters.


Click here for additional details.  

22nd Annual Fall Conference: Registration Now Open!


NYSHFA/NYSCAL will host the 22nd Annual Fall Education Conference & Tradeshow, November 14-15, 2017 at the Albany Marriott. Registration for attendees is now open!. Click here for additional details.


22nd Annual Fall Conference: Exhibit & Sponsor Opportunities Available


NYSHFA/NYSCAL will host the 22nd Annual Fall Education Conference & Tradeshow, November 14-15, 2017 at the Albany Marriott. The trade show will be held on Tuesday, November 14th.  Exhibit tables and sponsorsphips are now being accepted. Click here for additional details.

Attendee registration will be available early September.