Wehby v. Conger | Sovaldi at $85,000 per qtr | Convening Panel meets to set agenda

Welcome to Primary Election Day – don’t forget to vote!

With our conference coming up in a few months – Sept 24th – our Convening Panel met last week to talk through the most pressing topics in Oregon health care, both in the market and in policy circles. Expect a great conference in September! Until then, here are some of the thoughts taken from last week’s discussion.

DJ 5 things updated

1. Wehby vs. Conger

The Republican primary for the US Senate going on today has tremendous national implications.  Wehby looks likely to win based on independent polling.  We’ll know in a few hours.

If she wins, the manner in which she is talking about health care has tremendous opportunity to change the conversation about what we want out of our health care system.  For instance, messaging like this ad is very, very good.  It’s on my list of some of the best ads of all time, with this and this.  If she talks about health care this way, however, it comes off to us as shrill and more in line with Washington DC-speak than how Oregonians talk about health care.

2. OID framing rule making on network adequacy

The State of Oregon is taking up the question of “adequate provider networks” in new rules getting framed up this summer.  Like other states, Oregon is looking to Washington State’s recently written rules for guidance.  Those rules were viewed as disruptive by providers and onerous by carriers.  They appear to have drawn more comments than any other rule in that agency’s history.

Initial draft legislation is already drawing comments from groups like Salem Health and the Oregon Chiropractic Association.  The Advisory Committee tasked with this issue meets next on May 28th.


3. Oregon Convening Panel formed and meeting

At each of our conferences, we are proud to organize a Convening Panel of some of the leading voices in Oregon health care.  This year’s list of participants is as strong as any, and we’re thrilled to be working with them.

Our conference will be held this year on Sept 24th at the Hilton Portland and Executive Tower.  Expect our draft Topical Agenda out 60 days before the event, with our list of over 60 speakers released 30 days before!

If you have an idea for a panel presentation, send it to us!  Now is the time to share your ideas on the topics we ought to be discussing come September.  Drop me a note if you have an idea.  I’d love to hear from you.

4. What the CoverOregon transition will entail

Now that the decision to move to the federal exchange has been made, we’ll see what that implementation looks like and how much of the infrastructure from Cover Oregon can be kept.  A legislative hearing late in May will be interesting as it will put the question before a Joint Legislative Audit Committee.

Likewise, based on Sylvia Burwell’s testimony at her HHS confirmation hearing, it’s likely the feds will be asking Cover Oregon for repayment of some of the funds it had provided for the exchange, though both gubernatorial candidates disagree with that assessment.  It’s in both governments’ interests to get this issue put to bed.  We’ll see how long it takes them to agree on a grand compromise to do that.


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5. “This could bankrupt us all.”

CCOs are struggling with covering a newly approved regimen for Hep C, which runs about $84,000 per treatment at $1,000 per day for 13 weeks.  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, CCOs don’t have the same flexibility.  Put it all together and this issue is one of the greatest concerns facing CCOs and other Medicaid plans nationally.