ROI on Medicaid dollars | Transparency on agenda | Comparing 1954 to 2014

With our conference now about 7 weeks away (we released our Topical Agenda yesterday), things are starting to move quickly!  So quickly, in fact, that we had the wrong link to register in yesterday’s email!  Here’s the correct one.

While the second time may be the charm when it comes to registration links, we’ve got 5 Things We’re Watching in Alaskan healthcare for you below.

DJ 5 things updated

1. Medicaid:  $147m (state) would return $2.1b (federal)

Mark Trahant is a long time political observer and writer in the Lower 48.  He’s now in his 2nd year as the Chair of the Journalism Dept at UAA.  He has written a thoughtful piece on the implications of expanding (or not expanding) Medicaid in various states in the US, with particular attention to the native health system.

Drawing on a recent Urban Institute study, Trahant says that “In Alaska, an investment of $147 million would return $1.5 billion in Medicaid funding and another $.6 billion in hospital reimbursements.”  On a related note, this month’s Medicaid Reform Advisory Group has cancelled its Aug 21st meeting, leaving only two scheduled meetings left for this year.


2. Transparency on the agenda at State of Reform

Last month, we featured the question of transparency and an all payer claims database.  I linked to a policy brief getting shopped by the Health Care Commission, and mentioned both plans and provider voices — which is why I’m so excited to preview for you one of our panels on transparency at our October 9th health policy conference.

The panel will include Dr. Bruce Kiessling from Primary Care Associates (and self-identified provocateur), Eric Earling from Premera (one of the sharpest communicators in health care today) and Deb Erickson of the Health Care Commission (one of Alaska health care’s long-time insiders).

3. Primary: $100 per voter in outside spending

Dan Sullivan won the Republican Senate Primary on Tuesday, setting him up to face Mark Begich in the general election this fall.  Because this race is likely to impact control of the US Senate, it’s likely to continue to draw waves of outside money.  Much of that money is likely to be focused on health care and health policy.

The ADN reported $15m in outside spending from groups trying to influence the primary (just the primary!) – reportedly the greatest level of spending ever in Alaska.  With about 150,000 total votes cast in the primary, that equals about $100 spent per voter by outside groups trying to influence the election.

4. Moving backwards on tele-health?

HB 281 on Gov. Parnell’s desk may have the unintended consequence of limiting access to providers via tele-health services.  The bill implicitly excludes out of state providers from protection from sanctions by prescribing drugs for patients – protections afforded to providers in Alaska. Because so much behavioral health care is provided by tele-medicine, the Alaska Behavioral Health Association is sounding the alarm.

From a recent email from their Executive Director, Tom Chard:  “Out of state medical providers, concerned that they may face being sanctioned, have already started questioning their continued involvement in partnering to provide care for Alaskans.”  This would seem to be a potential burden to the larger health care systems, too – Providence, PeaceHealth, Alaska Regional – which can draw upon out of state provider resources for patient care.

5. Health problems: “political, administrative, fiscal”

The Health Care Commission is engaging in a unique research project comparing the state of health care in Alaska in 2014 to that of 1954 and 1984.  It draws upon a recently re-discovered Parran Report (1954) and the 1984 State Health Plan for Alaska, as well as new data to be released next month.

While much is different in 2014, I’m particularly struck by what is the same.  The 1954 report (pg 14) claimed “The health problems here are essentially political, administrative and fiscal.”  That politics and money – both private and public – influence health care today is commonly accepted, but it is a surprise to see it called out this way in 1954.

Likewise, the 1984 document (pg 17) says the “priorities for the State Health Plan are:  mental health problems, alcohol abuse.”  There are five other priorities on the list, but these are at the top – like a recent Mat-Su Community Health Needs Assessment found in 2013.  It seems the more things change…