Exchange hikes fees | SGR reform | What is non-profit health care?

For the first time since we moved this newsletter to twice a month, we took an issue off.  Instead of delivering the “5 Things We’re Watching” at the first of the month, my wife was delivering this little gift. Mari Elizabeth joined our family March 5th. Baby and mother are home, happy and healthy!

But after just a bit of time away, we’re back to keeping an eye on things for our loyal readers!

DJ 5 Things Signature

1. SGR reform: Be careful what you ask for

When a government, or any entity, has to pay the bill for health care, it will care about health policy.  So it is with Congress and Medicare, which is why Speaker Boehner himself is leading a vote this week to end the SGR methodology in Medicare.

In its place comes a “Merit-based incentive payment system, due to be implemented in 2019.  The new model will pay providers based on performance against four categories.  Between now and then, Medicare reimbursement will be adjusted annually by 0.5%, far less than even economic growth.

2. Exchange could increase fees 200%

The current assessment on insurance products sold through the exchange is $4.19.  We hear staff will be proposing an increase of an additional $9 for the Board to affirm, a number staff had previously identified as the top end of the potential increases. The increase comes at the same time the Exchange is cutting back on both services to plans and information to consumers.

Few stakeholders appear to be happy with how things are going at the Exchange.  In private conversations, we’ve heard both Board members and staff voice complaints – often about one another.  Legislators and staff from the HCA and OIC have concerns, generally private but sometimes public.  Even plans, who have a lot to gain from the Exchange’s success, are increasingly vocal in their complaints.

3. VIDEO:  “What They’re Watching”:  Rep. Roger Goodman

With the House Democratic budget set to be released any day now, it’s appropriate to have one of the leaders of the caucus featured in this month’s “What They’re Watching.”  Rep. Roger Goodman is the Chair of the House Committee on Public Safety, and one of the legislature’s stronger advocates on issues related to mental health.

4. What is “non-profit” health care?

This year, we are expanding our reach into California, with events in Los Angeles and Sacramento.  We’ve also increased our coverage of health care news there as well.  So, this news that the California Franchise Tax Board revoked the tax exempt status of Blue Shield of California caught our eye.  Now, there is a push to force the insurer to become a for-profit entity, which would spin off approximately $10 bn to a public benefit non-profit organization.

Like many things, this might be an “only in California” phenomena.  Or, it could be the start of a trend catalyzed by the ACA, and which has some precedent in Washington State.  We’ll see.



5. What health care leaders are up to

The always impressive Mark Mantei, formerly COO of The Everett Clinic, has become the new CEO at The Vancouver Clinic.  Southwest Washington Behavioral Health RSN CEO Connie Mom-Chhing has taken the new role of Chief Behavioral Health Officer at Columbia United Providers.  The inimitable Patricia Briggs has announced her retirement this summer from Northwest Physicians Network.

And perhaps the most interesting story:  Jennifer Muhm, King County Public Health’s Director of External and Legislative Affairs, made headlines (on and on) in the launch of a new company, buddingSTEM. It’s a clothing line aimed at empowering girls and nurturing their interest in science and technology, typically marketed only to boys. Check out their Kickstarter campaign. It broke the internet last week.