Medicare Advantage | Mike Rohwer | Middle-aged Caucasians

As 2015 draws to a close, our team at State of Reform would like to say thank you to all of our readers, sponsors, and thought leaders that make our State of Reform community what it is.  More importantly, thanks for what you do to keep the health care system improving for the people of Oregon.

We appreciate very much your engagement with us, and look forward to a constructive and a collaborative 2016!


DJ 5 Things Signature

1. The FamilyCare-OHA matter and the 2016 session

The FamilyCare tussle with OHA has been quite a drama to watch. To catch you up, we have OHA’s letter asking for CCOs which may be interested in taking FamilyCare’s OHP lives, as well as FamilyCare’s response (and OHA’s response to that!). The Lund Report has a story today on the parties entering mediation.

None of the CCO leaders with which I spoke held any angst with one another as a result of the letters of interest. Rather, it’s the public side of this equation where I think things will get interesting. I expect there will be a series of bills in play related to CCO contracting.  This recent event will be contextual to that legislative discussion.  I also think we’ll also see bills attempting to limit in various ways the opportunity of outside health plans to bid on the future CCO procurement.  So, for a short session, OHP contracting might become a significant topic of discussion.


2. VIdeo: Dr. Michael Rohwer, PH Tech

Dr. Michael Rohwer, CEO of PH Tech, has been one of Oregon’s quiet thought leaders for some time.  We’ve been honored to have him speak at a few of our events, and he recently keynoted a conference hosted by CCO Oregon.

We had Dr. Rohwer offer his comments recently in our series “What They’re Watching.”  He says he is concerned by a trend moving towards the centralization of health care. In particular, he says he has close eyes on the Oregon Health Authority (OHA) as it develops programs for statewide implementation. Dr. Rohwer argues that the outcome of centralization is actually higher costs, less quality, and the hindering of innovation at the community level.



3. A startling study and potential implications

It’s not often I see something that shocks me. But this study is one of them. It shows that every age and ethnic group is showing a reduction in morbidity rates and increases in lifespans over the last number of decades in all developed countries.

Except middle-aged white Americans. Increases in deaths of white Americans aged 45-64 is coming primarily from alcohol and substance abuse, suicide, and liver disease. They are effectively killing themselves.

This is the kind of thing that doesn’t happen in the developed world – outside of the vodka-fueled morbidity increase in post-Soviet Russia in the 1990’s. But it’s happening in America, today. And, one can hypothesize, that the the anger, frustration and stress exhibited in our national politics may be symptomatic of this hugely important demographic trend.



4. Increased competition in Medicare Advantage

Humana shared with State of Reform that it will focus the expansion of its Medicare Advantage line of business on the Portland Metro and Central Oregon markets for 2016. Catherine Field, Intermountain Vice President for Senior Products at Humana, explained in an exclusive interview how Humana’s recent accountable care agreement with OHSU is at the center of that strategic move.

Field says that Humana expects to grow into the tens of thousands of MA lives in 2016, up significantly from its 2015 position.  We reviewed the December 2015 Medicare Advantage enrollments where HealthNet, Regence and Kaisercurrently hold strong positions. We’ll watch to see if there is any new market disruption as the current Open Enrollment in Medicare concludes.


5. DCBS exploring new state-based exchange

After the Cover Oregon debacle, it would seem that DCBS would move slowly on considering a state-based exchange again. After all, it took four years of planning from the 2010 passage of the ACA to the anticipated implementation of Cover Oregon.  Not to mention the more than $300 million in funding.

But not only is DCBS reportedly about to release an RFP for options related to a state-based exchange, they appear to be rushing it. The RFP isn’t on their current list of procurement requests, which means that if they want to have this done by mid-January, they risk promoting an imperfect solution that may not have been fully vetted.  With the Oracle lawsuit still pending, this strikes us as too much, too soon.