Begich to keynote State of Reform | Defining the “gap” | Exchange sustainability

With our fall conference now just a few months away, we’re getting very excited about the topics and speakers that we’re hearing about from our Convening Panel, sponsors and friends of State of Reform.  Our conference is heavily stakeholder driven, so we are lucky to hear about lots of interesting topics.

The event is Oct 9th, and we’d love to have you with us.  If you have an idea for a topic, panel, or presentation, we’d love to hear that too.  Want to speak?  Tell us what you’re working on, and we’ll see what we can do!

DJ 5 things updated

1. Size of the Medicaid “gap population” still unclear

The number of Alaskan citizens unable to access health insurance of any sort is around 10-12,000, says DHSS, or about 1-2% of all Alaskans. This “gap” cohort was identified back in 2012 as group with no real options for coverage.  In a report to DHSS, The Wilson Agency found the number to be about 17,000.  Anchorage Project Access believes there are about 25,000 in Anchorage alone without access to coverage.

Regardless of the total number, it doesn’t seem like an Alaskan value that households of 4 with an annual income of $115k get government subsidies for health care (on the Exchange) while those with $10,000 get no support for access to coverage.

2. US Senator Mark Begich to speak at our fall conference

Last week, Sen. Begich confirmed his participation as one of our keynote speakers at our October 9th conference.  We’ll invite the winner of the Republican primary as well to be a keynote, and have already started reaching out to the campaigns.

Taken together, their participation makes the State of Reform Health Policy Conference perhaps the most timely opportunity for Alaskans to discuss health care in a non-partisan, policy agnostic setting ahead of the November elections.  Our Convening Panel – some of the sharpest health care folks around – meets this week to put some thought into this fall’s agenda.   We’re getting very excited about things to come…!

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3. “Narrowing the scope” of Medicaid reform

For a state advisory group to be successful, it has to have a clear scope that is proposed by the state and accepted by those advising.  The Medicaid Reform Advisory Group, which met Tuesday, appears to be both narrowing the scope and getting reasonably good ‘buy in’ from stakeholders.

Just to be safe, however, the Tuesday agenda added language at the very bottom to make sure the purpose was clear:  “The goal of this meeting will be to narrow the focus of the Advisory Group into areas that require deeper discussions surrounding reform. What should the Alaska Medicaid Program look like, how can it be changed to meet the Governor’s three key mandates, and how can we get there from here?”

Have you checked out our new job board?

Positions from Alaska, Washington State, and Oregon all at www.stateofreform.com/jobs!

4. Is the Exchange sustainable moving forward?

In some states, like Washington State, where the implementation of the Exchange has been relatively successful, there remain questions about the long term sustainability of the enterprise as it moves away from federal funding.

In states like Alaska, with no local implementation and a small market to support an Exchange, the question is even more acute.  Case in point:  Premera tells us it has only 4 lives on the SHOP small business federally facilitated marketplace.  And, the costs associated with the risk pool of the roughly 5,300 lives on the individual Exchange are higher than expected – in a relatively small group of folks.  On this point, the same is likely true for Moda.

We’ll see what the allowed rate changes are when rates are released later this year, but as assumptions turn to reality around member risk and costs, it could be a bumpy fall.

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5. Cardiologists making “org changes” at AHI

We’ve heard for some time about the challenges amongst the partners at the Alaska Heart & Vascular Institute.  It’s an ongoing story, but not one unique to AHI or healthcare.  What’s different now, however, appears to be how broadly folks outside AHI seem to think that disagreements are deepening.  We’ve seen emails claiming some docs are leaving, or had people tell us the group is splitting into three separate entities.

Not true, says Keli McGhee, CEO of Alaska Heart and Vascular Institute.  “For the record, we are not splitting as a group.  The physicians are constantly talking about the need to make some organizational changes, but as of now they are just internal modifications to improve the practice.”