The earnest debate that characterized the Idaho Legislature’s March approval of legislation creating the Idaho Health Insurance Exchange has shifted to intense preparation for meeting a critical deadline in early October.

Since being appointed April 10 to shepherd the process according to the new state law, the Exchange Board’s fast-track mission has been to create an online health insurance marketplace designed, driven and controlled by Idahoans to help our fellow citizens research and obtain affordable coverage that’s right for them.  The ambitious goal is to have the Internet marketplace ready by October for Idaho residents to begin enrolling to determine their eligibility for Medicaid or subsidies on insurance policies they can begin purchasing through the Exchange in January 2014. (more…)

CMS made national news recently in a surprise release of Medicare data for charges and payments for hospitals around the country. Recently, the Everett Herald reposted the rates for Washington and looked at selected hospitals in King, Snohomish and Skagit counties.

While national headlines have been dramatic, for industry insiders it’s not really much of a surprise.  Medicare rates are low.  Billed charges are not real charges in that they don’t affect actual Medicare payments. And generally, the average patient should not expect this to translate to their bill. As Modern HealthCare put it, “Patients are rarely billed or pay a hospital’s nominal charges. Nor do the charges or their variation indicate the rates hospitals negotiate with insurers.”

Time’s Steven Brill, author of “Bitter Pill“, took to the pages of Time to explain how this new data underscores the mystery of hospital billing.

…most hospitals’ chargemaster prices are wildly inconsistent and seem to have no rationale. Thus the release of this fire hose of data—which prints out at 17,511 pages—should become a tip sheet for reporters in every American city and town, who can now ask hospitals to explain their pricing.

Rather than be commonplace, this data actually probably highlights the ongoing disconnect between “life inside the health care bubble” and the real world paying the bills for that bubble.

Nevertheless, just like we did in Alaska and Oregon we wanted to review rates for Washington hospitals.

We charted payments by Medicare diagnosis for COPD, cardiac arrhythmia and conduction disorders, and pneumonia and pleurisy, at Washington State hospitals (based on available data).

As you can see, the disparities are not as far apart as some of the east coast hospitals in the headlines. And while we do see a few things potentially worth noting, we want to open this discussion up and find out what you think. We offer this site as a platform for anyone who would like to use it to communicate to fellow members of the industry. Post your comments below or even send us a guest editorial. We’d be happy to feature it.

Idaho, New Mexico get federal help with exchange technology

The Wall Street Journal is reporting that despite the new exchange board’s best efforts, Idaho will need to enlist federal help for making its exchange fully functional by Oct. 1.

The board’s chairman, Stephen Weeg, said the federal government will run the enrollment and eligibility portions of the state’s exchange because a computer contractor hasn’t been selected. Idaho consumers could still log on to the exchange’s website Oct. 1 to sign up for health insurance, he said. But behind the scenes, federal computers would determine who is eligible for subsidies on insurance.

(more…)

PeaceHealth St. Joseph Medical Center released the following statement today:

​We are pleased to announce that the Washington State Department of Health has approved our Certificate of Need (CON), which will allow our alliance with United General Hospital. (more…)

First published May 15, 2013.

The Office of the Insurance Commissioner released its first decisions regarding plan participation on the exchange.  (more…)

From PeaceHealth:

PRESS RELEASE: UW Medicine and PeaceHealth have signed a groundbreaking Letter of Intent to create a strategic affiliation that will provide patients throughout much of Washington and Alaska with access to the most comprehensive care available in the Pacific Northwest.

(more…)

Last week, our Washington State “Five Things We’re Watching” email newsletter contained the headline “Molina rejected by Exchange.”

This headline is inaccurate and should have stated that Molina’s initial application was disapproved by the OIC.

We regret the error and have extended our apology to the Exchange. We have been in contact with the OIC to discuss the rate filing process further.

The Murky World of Hospital Prices

By The Editorial Board
May 16, 2013

Last week, the federal government made public a vast trove of information on the list prices charged by hospitals for a large array of procedures commonly performed on hospitalized patients. It was a good start toward providing greater transparency in hospital billing, which has long been shrouded in secrecy. But it fell short of providing full information that patients need to make informed decisions about which hospitals to use and which insurance to buy.

The data was compiled from hospital claims submitted to Medicare by more than 3,300 hospitals seeking fee-for-service reimbursements for the 100 most common inpatient treatments in fiscal-year 2011. The prices at issue — sometimes called “chargemaster” prices — are not what most people pay. They are far higher than what Medicare pays, which is close to the real cost of providing the service, and also higher than what private insurers pay because they negotiate for discounts. (more…)

This is part 2 of a two part interview with the president of Regence Insurance Holding Corporation, Jared Short.  You can find the first part of the interview here.

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DJ: Tell me about why Cambia decided to introduce the Bridgespan brand to the marketplace where Regence has been such a successful brand for so long? (more…)

Today, May 15th, the Washington Health Benefit Exchange (HBE) Board voted to move forward in the SHOP (small business) market with only one health insurance carrier, Kaiser Permanente NW.

In February, seven carriers submitted LOI’s for the SHOP Exchange market.

Later, only 3 carriers submitted rates to the OIC.  Both Regence and CHPW later withdrew their plans from the SHOP Exchange leaving only Kaiser Permanente NW with a complete network in Clark and Cowlitz counties and partially covering Lewis, Skamania and Wahkiakum counties.

The HBE staff have learned from carriers and stakeholders that there are concerns about operationalizing the necessary changes within the timeframe for carriers, that the value for SHOP is still unclear for employers, and there may be additional risk for the carriers that carriers are unwilling to assume.

By moving forward with Kaiser Permanante, HBE staff will be able to enhance the value proposition for carriers and small employers, including making changes for system changes which could allow for defined contributions from employers for 2015.

SHOP enrollment targets for 2014 year-end are 17,000.  There are 11 carriers participating in the small business market outside of the Exchange.  The individual markets on and off the Exchange appear to be robust with 9 and 11 carriers submitting rates to the OIC, respectively.