SW WA integration launch | Mark Adams | Rise of CAPG

This is our 5th anniversary of writing these newsletters – a milestone I’m surprised we’ve even reached.  It’s been with the support of our sponsors like OneHealthPort, Providence, Premera and Regence – just to name a few.

So, just a note of gratitude to you and colleagues like you for reading our stuff. Thanks for taking an interest in what we are watching.

With that, here are a few things we’ve got on our radar screen now that we’re in April.

DJ 5 Things Signature

1. HCA launches integration in April

April 1 marked the launch of the state’s first Fully Integrated Managed Care pilot in the SW Washington early adopter region. HCA Director MaryAnne Lindeblad shared with us that, at least for most of April, the agency will be on alert for “early indicators” that things aren’t working in the new delivery system.

Meanwhile, HCA has already sent out their next round of letters, inviting counties to respond by next month as July 1, 2017 “mid-adopters.” King and Pierce counties dropped out of the original early adopter group. We will be tracking the success of this historical roll out and how it affects counties’ responses to the call ahead of the 2020 deadline.

2. Call for “march in rights” on pharma prices

In March, members of the US Congress, including presidential candidate Bernie Sanders, sent a letter to Sec. Burwell and NIH Director Francis Collins urging the agencies to exercise theirmarch-in rightson excessive pharma prices. When federal dollars are used to fund private R&D, agencies like NIH and CMS retain certain rights on the patent. In a separate letter, 50 Representatives agreed that now is the time for this authority to be deployed.

The affordability of prescription drugs continues to fuel both political and popular conversations. And, federal intervention may be gaining favor with the public. A recent Kaiser Family Foundation survey reveals that 83% of Americans polled are ok with allowing Medicare to negotiate for lower drug prices while 76% think that there should be caps to prices drug companies can charge for specialty drugs.


foundation for healthy generations event

3. CAPG an advocacy force for providers

The recent Medicare rate finalization concluded a process that highlighted the increasing role of the California-based CAPG as a major player on Medicare advocacy in DC. CAPG represents risk bearing entities that live in the world of “value” rather than “volume.”

CAPG had a breakout year last year with a letter signed by 300 provider groups opposing MA rate cuts, as well as being deeply engaged in the MACRA bill. CAPG has lined up a series of members in Washington State as part of a national expansion strategy with 12 signers on their recent advocacy letter linked above. Based on what we hear when we’re in DC, CAPG’s members are well served by their increasing advocacy role there.

4. Video: Mark Adams, PeaceHealth

Mark Adams, left his position as Chief Medical Officer of CHI Franciscan to join PeaceHealth in January of this year. We’ll be watching to see what innovative clinical strategies the new CMO brings to the health system. In his video, Adams talks about the need for hospital leaders to evolve in their thinking to stay relevant in a reform world.

“It’s important that we be willing to step outside of our hospital-centric world and be willing to understand [the provider’s] world more as a physician-centric business. Then, ultimately, we need to be able to move that to a patient-centric form of care.”

5. “Mid-Adopter” counties and Medicaid

One of the questions shared among county human service leaders, mental health providers, and Medicaid MCOs is which regions will move next to integrate physical and behavioral health?  Letters of intent are due from regions May 1st to the HCA if they are interested.  North Central Washington looks to be ready to innovate next.

We’re going to be exploring this question more in the months ahead but our interview with MaryAnne Lindeblad is worth reading again on this point. Her comments highlight the significant amount of effort the HCA is putting in to bring counties along.