Counties question integration timeline | Bob Crittenden | Innovative or illegal?

Last week, we hosted our first State of Reform event in Los Angeles – and we couldn’t be more excited about how it went!

Looking back, the single most important determining factor in that success was the role our Washington State of Reform community played in connecting us with peers and colleagues across that market.  So, thank you.  We really could not have done it without you.

DJ 5 Things Signature

1. Counties organizing against integration timeline

When HB 2572 and SB 6312 passed in 2014, integration in Medicaid appeared to be set on a firm time horizon.  All parts of the state would have integrated Medicaid purchasing by 2020, though some regions could move sooner than that. These days, however, we’re hearing about some counties and RSNs pushing a stalling tactic, arguing privately that it would be easier to wait out this political issue than try to change it directly.

In a recent set of recommendations, an RSN-led work group formally asked the Adult Behavioral Health Task Force to develop “recommendations for new dates if there are regions that cannot” integrate by 2020.  In response to counties organizing, Gov. Inslee reassigned Bob Crittenden, his Senior Policy Advisor, to focus entirely on integration and keeping counties, RSNs and other stakeholders on board with integration.

2. Walking a fine line in health law

Hall, Render, Killian, Health, & Lyman is a national law firm focused solely on health law, rather than a suite of practice areas.  They recently recruited Stephen Rose, formerly the Chair of Garvey Schubert Barer’s health law practice, to lead the northwest presence.  Rose plans to open an Anchorage location by the close of this year, followed by another in Portland soon after.

Rose talked with us about the fine line between “being innovative and illegal” because of pre-ACA regulatory regimes still governing the post-ACA market. To his point, this week CMS announced a final rule to carve out certain models of payment to providers as exempt under Stark anti-trust regulations.


3. Video: Bob Crittenden, Office of Governor Jay Inslee

Bob Crittenden, Senior Health Policy Advisor to Gov. Jay Inslee joined us in Spokane to talk about what the state is watching in health care reform. Dr. Crittenden commented that a new, expanded definition of health care which includes the housing and mental health sectors is drawing increased attention and support from the state.

Prior to his position in the Governor’s office, Dr. Crittenden was a family physician at Harborview Medical Center and the Executive Director of Herndon Alliance, a nonprofit dedicated to advocacy for patient access to quality and affordable care.

4. CA waiver a bad omen for WA?

California built a waiver request around leveraging past savings, not future.  They were critiqued for not having adequate stakeholder engagement.  And they included things like ACHs and integration of mental health purchasing without a very clear definition of what those look like. They asked for $17bn for their 12.5m Medicaid lives.  Last week, they were awarded $6.2bn.

Like California, Washington built a waiver on past savings, has been scolded about stakeholder engagement, and has lacked clarity around ACHs and statewide integrated purchasing in Medicaid.  If Washington State is awarded a comparable amount of funding on a per member basis, expect Washington’s ask of $3bn over 5 years from CMS to be pared down to about $890m.


Providence HS

5. More spending not leading to more quality

A recent report, pulling data from the World Health Organization and The Economist Intelligence Unit, revealed the efficiency of the U.S. health care system is on par with developing countries such as Kazakhstan, Sierra Leone, and Botswana. We are the number one spender of health care dollars globally but 33rd in quality outcomes.

In the words of Don Berwick, more expensive health care doesn’t mean better care. Myanmar which has the cheapest system in the world, spending about $13 per person, captures one quality outcome point per $0.2 spent while we spend $108 for the same point. All this has health policy analysts scratching their heads and looking for industry lessons in development economics.