Commercial plan losses | Relationships and leadership | King v Burwell

Some interesting items in this month’s edition include a review of commercial health plans’ financial performance and the questions those raise. A few items of national interest are also holding our attention this week.

It’s what we’re watching in Oregon health care for June, 2015.

DJ 5 Things Signature

1.  How sustainable is the commercial market?

The Oregon Insurance Division serves as the watchdog of financial solvency for commercial health plans in the state. While the DCBS surplus report through 2014 does not raise any red flags for health plans, a breakdown of health plans’ annual statements by net income and underwriting losses reveals some interesting trends.

As a whole, health plans have been on a 5-year downward trend fall in net income, losing $19m in 2014 compared to a gain of $208m in 2010. In 2014, 9 of 16 plans reported losses. Oregon’s Health Co-Op’s net underwriting loss was 163% of total commercial revenue.  Health Republic’s net underwriting loss was 51% of total commercial revenue.  Those don’t strike me as sustainable numbers.

2.  King v Burwell

With only a few days before a decision comes down from the Supreme Court, one can be allowed to spend some time thinking about “What ifs…”  We asked a series of attorneys, and some political folks, what they thought would happen.  You can read the lawyers’ take here.

We are expecting the unexpected. And, while Oregon has been clear their model is a state-based exchange, that may be subject to some interpretation.  If the court decides to define what is or is not exactly a state-based model, it could throw Oregon’s administrative approach to the exchange into tumult.


3.  Video:  Robert Anda, co-founder ACE Study

Our series, “What They’re Watching,” is about letting health care leaders talk about the things that challenge them most. In that regard, this week’s interview with Robert Anda, MD, MS, co-founder of the Adverse Childhood Experiences (ACE) Study, fits right in.

Anda thinks that health care communities need to overcome the taboos of talking about childhood abuse. He says that when practices wrap their minds around “trauma-informed” care, they will uncover the funding strategies and best clinical practices they need for their community.  Anda is a consultant and researcher based in Georgia and a regular attendee and speaker at our State of Reform conferences. For more thought-provoking interviews, check out our entire video series.

4.  Waste in health care

Very rarely do we feel so strongly about an article that we feel compelled to feature it here. But you can’t read Atul Gawande’s recent New Yorker article “Overkill,” without wanting to pass it on. The Boston surgeon talks about the huge portion of health care dollars doled out to unnecessary or inappropriate care.  But at the recent CCO Oregon conference, we couldn’t help but notice that the spirit of “less medicine, more health” is not only alive and well but poised to spread in the state.

Lynnea Lindsey-Pengelly, lead on the Trillium Integration Incubator Program, says that alternative payment method models, tools, and team-based care practices the group has been developing for the last year are almost ready to be unveiled to the public. We’ll see how those roll out.

Sponsor: Providence Health & Services - Oreogn and Southwest Washington

5.  Relationships and leadership in APM

One of the things that struck me most about the CCO Oregon APM conference two weeks ago came from the OHSU Center from Evidence-based Policy.  Their research into alternative payment methodologies turned up some key findings that are often overlooked.

“It’s all about relationships.”  So true.  And, “Establish Strong Leadership.”  These are two central ingredients in health system transformation, but there is too often such little thoughtful facilitation within organizations in the development of these two areas.  Turns out, according to OHSU, it’s hard to drive transformation without them.