Ralph Pascualy | Block grants | Andrew Over

I’m a little contrarian in this edition of 5 Things, but I’m channeling my inner Ralph Pascualy from his email to Providence CEO Rod Hochman (read it below): “When truth speaks to power, it’s out of respect and not insolence.”

If you don’t hear from me next month, maybe this newsletter and the commentary at stateofreform.com is what finally did me in…

1.  Block grants: what we’re really talking about

The “block grant” conversation has very little to do with health policy – either by advocates or critics.  It’s all about money. The feds don’t want to keep writing blank checks for states that make policy decisions independent of federal fiscal considerations.  And no one wants to pay the bills resulting from health care inflation rising at 9.7% annually.

That creates a choice for states:  either accept fiscal responsibility for funding cost trends in a system many find too costly, or extend the same fiscal responsibility onto the system itself.  And, with MCO finances already capped, that leaves price caps on hospitals, pharma and specialty providers as perhaps the only reasonable way for states to protect themselves financially in a block grant model.

2.  DC:  Who knew!? Health care is hard

Tonight, President Trump will speak before a joint session of Congress where he will, in part, outline his health care proposal. “Nobody knew that health care could be so complicated,” he said yesterday.

It’s unclear whether a majority is even possible for anything out of the Republican House or Senate given the distance between moderate and more hard-line Republicans. The recent “Policy Brief” from Congressional Republicans was labeled “no longer valid” by the House Republican Whip this morning.

However, local Republicans in the legislature are calling this moment an “opportunity.” They are probably right – but the frame of that opportunity starts with DC Republicans getting a plan on the table.

3.  More questions for Providence from Times

“Nobody believes that Tony (Armada) would allow this kind of situation if you were not in fact supporting” the neurosurgeon at the center of the Times investigation.  This from former Swedish Medical Group CEO Ralph Pascualy in an email to Providence CEO Rod Hochman.  The Seattle Times investigation is cementing questions some have whispered in recent months: is Providence’s strategy of aggressive growth good for Providence or the communities it serves?  A growth strategy was what led Swedish to $250,000 in daily losses and forced a merger.

When I reflect on the critical importance of Providence to our communities, the issues raised in this investigation, and the “let them eat cake” attitude from some senior Providence leaders, I feel like it needs to be said:  Providence, you can do better than this.

4.  Inslee’s national elevation

Gov. Inslee is getting a lot of buzz.  He has been a central figure at this week’s National Governor’s Association meeting, which included a dinner with Pres. Trump at the White House. He was featured on NPR, on Meet the Press, and had the Seattle Times raise the prospect of a candidacy for president. And, he has been selected by his peer governors to lead the Democratic Governors Association.

Gov. Inslee may or may not run for president – who knows.  I think he should have run in 2016 and think he should give 2020 a close look. But I think to know Gov. Inslee is to know that his leadership vis-a-vis the Trump administration is authentic. This is the kind of principled yet scrappy fight that Inslee is made for.

5.  Video:  Andrew Over, Regence

Andrew Over is Regional Market Vice President for Regence Blue Shield of Washington, and was recently promoted to have a similar role for the Oregon market. He is a rising start at Cambia and I expect will continue to have a growing portfolio there.

In this edition of “What They’re Watching,” Andrew talks through the work of reform, Cambia’s role in promoting system reform, and how that becomes a differentiator for Regence in the market with its customers.