Rate changes for the Exchange | Ron Sims and Alison White | Quick turnaround on HCA grant

May is a month of deadlines, where the work talked about in board rooms or caucus chambers gets done.  This month, we’re seeing some of that work start coming out into the public view:  insurance filings, grant opportunities, new hires.

It’s what we’re watching this month.

DJ 5 things updated

1. Hepatitis C: “It could bankrupt us all”

Medicaid plans are struggling with covering a newly approved regimen for Hep C, which runs about $85,000 per treatment.  While the treatment is covered, the benefit is not yet included in the actuarial data that goes into the Medicaid premium.  In other words, the state isn’t yet providing any money to pay for it.

While commercial plans can negotiate a discount for the drug, Medicaid plans don’t have the same flexibility.  Put it all together and this issue is one of the areas of greatest financial concern to Medicaid plans today.

2. Exchange plan rate increases:  -6.8% to 11.2%

It is hard to determine a rate for insurance products on the Exchange.  Plans don’t really know the health of the risk pool yet, nor do they know what utilization for those consumers will look like.  Filings for 2015 were built on only a few months of data, which followed a year that was very mostly stab in the dark.

Reviewing the 2015 filings for insurance carriers entering the Exchange tells this tale pretty clearly.  Molina is requesting an average drop in rates of 6.8%.  At the high end, Coordinated Care has asked for a 11.2% increase, as has Group Health (though Group Health also requested a 14.2% increase for products off the Exchange).  Drawing specific conclusions about rate drivers is tricky, but it’s still clear that pricing these products is as much art as it is science.


3. A narrow window for Innovation Plan grant responses

One of the areas of the HCA’s State Innovation Bill included the creation of “Communities of Health:”  a collection of voices set around a regional table at which the top health priorities of the health care system would be set.  It’s a simple and worthy concept in the legislation, but one fraught with significant cultural impediments in the practical implementation.

Early this month, the HCA released a grant to help support the creation of these organizations.  Good news:  the $50,000 can provide significant seed money to help get local voices organized.  Bad news:  there was only a week to respond, essentially limiting the number of voices that might get organized to respond.

4. Expect Ron Sims to be a catalyst

The Exchange has new leadership:  Ron Sims, former King County Executive is now the board chair.  Sims is a worthy replacement of Margaret Stanley, who left big shoes to fill.  You can read his long form bio here, which is still posted at King County’s website.

Insiders will remember that Sims was the initial driving force behind the Washington Health Alliance, which at the time of its launch, was driving more discussion around reforming health care in WA than any other initiative.  He also gets credit for pushing the change in employee benefits which have improved quality and reduced costs.

5. Better Health Together in Spokane hires out of King Co.

Better Health Together (BHT) is an organization to watch.  You won’t learn much about it from Google, but if you hang out in Spokane health care circles, you know of its tremendous potential both as a “convener” and a “doer” when it comes to health reform.  You might learn the most about it from its recent job posting for a new Exec. Director.

Alison Carl White, Executive Director of WithinReach, has taken the new BHT position and will start in Spokane in June.  Like BHT, you may not know Alison, either.  In short, Alison is one of these people who makes things happen at the consumer level of health reform, where putting strategy into practice is most complicated.

Both names are names you’ll want to keep an eye on over time.  Mark my words:  this Spokane initiative will develop statewide relevance.