FBI says there’s a problem | 75 orgs speak to OIC | Moving child welfare to coordinated care

The May 1 filing deadline for the Exchange is here. The provider network rule from the OIC is out. The 2015 commercial marketplace is taking shape.

So, too, is the sorting of the Medicaid marketplace, with key task force meetings underway, RFPs going to market, and a pending CMS grant response. And, there’s that whole mid-term election which has taken a significant turn. Lots of moving parts, some of which we detail below in this month’s 5 Things.

DJ 5 things updated

1. Will the OIC rule bring greater clarity or confusion?

Last Friday, the OIC finalized its new provider network adequacy rule after taking comments from what seemed like an uncommonly high number of organizations.

Here will be one key initial measure of success of this rule:  does it bring clarity to the regulatory process?  Are there fewer appeals than last year?

With language like “this is a requirement to offer the opportunity to contract, not a mandate that a contract must be entered into by the parties” found in the 95-page “Concise Explanatory Statement,” the question of clarity appears to be a very open one.

2. An RFP for medical coverage for the state’s foster kids

With all of the theoretical discussion around integration of physical and behavioral health services during the last legislative session, it was easy to miss the more direct cross-silo initiative on the horizon:  coordinating medical benefits for the state’s foster children.

An RFP is soon to be released by the HCA for a health plan to coordinate the medical care of foster kids. It’s forcing interested MCOs to build relationships with mental health providers (who currently support the foster kids) and begin to bridge the gap between the silos of medical and mental health.  It’s a small step, and not a highly publicized one.  But, MCOs are tracking it, and the state is watching their approach to inform the 2015 Medicaid procurement. 


3. Bringing care coordination to mental health for kids

With almost 750,000 kids enrolled in Medicaid, the notion of integration of physical and mental health will eventually include the Children’s Administration (CA).  That agency is well down the road towards creating a care coordination infrastructure for child welfare services, particularly in CPS and foster care.  The model is referred to as “performance based contracting” or PBC.

PBC has sometimes appeared to have two steps backwards (one, two) for every few steps forward.  Under new leadership, CA quietly put out a request for information (RFI) targeted to the Spokane area to see what might inform a future statewide RFP.   What they got back from a group of stakeholders, led by the Empire Health Foundation, was ambitious and included the “creation of a single statewide backbone organization that would provide a neutral platform” around which the future care coordination of children’s mental health and other services can be organized.

4. Big shoes to be filled at the Exchange

The leadership of the Exchange Board last August, as it voiced its disappointment with the OIC’s regulatory review, was a watershed moment in Washington State health care.

The deft of that voice was due in significant part to the board leadership of Margaret Stanley, the chair of the Exchange.  Stanley has announced her intention to step away from the board in what is a natural evolution of the board’s membership.

That said, Stanley’s steady hand will be both missed, and likely hard to replace.  Big shoes for whoever steps in to fill them.

5. The FBI says you have a problem

Our newest contributor, David Peters, cites a recent FBI memo saying that not only are attacks on your personal health information stored at plans and providers going to be more common, but that the health care industry is poorly prepared for the hit.

The FBI also says your health info is more valuable on the black market than your credit card info.  As David asks “when will the 2013 Target security breach happen in health care IT? The answer appears to be soon.”

It’s a thought provoking first column from David on a topic we’re likely to hear more about in the weeks ahead.