5 Things OR: Two trends, Ralph Prows, CBO score

I’m trying to find a distraction from health policy in the Italian hills of Umbria with my family, so I am 9 hours ahead of Oregon at the moment.

With the session (hopefully) ending soon, and Congress about to go on break, hopefully we’ll all be without the distraction of politics soon – at least for a little bit…

Until then, here are 5 Things We’re Watching for Oregon health care executives for June.

1.  Senate version of the AHCA

The CBO score of the Senate health care plan is relatively straight forward:  22m will lose coverage, of which 15m will fall off of Medicaid. The federal government will save $321 bn over ten years, more than the savings from the House-passed version of $119 bn.

Four conservative Republicans are withholding their votes until changes are made. Senate Republicans can lose only two votes. Sen. Bob Casey (D-PA) has a simple run down of the major elements of the bill, though from a critical view. Sen. Murray (D-WA) highlights that Sen. Cornyn (R-TX) stated that bill isn’t a bill, but just a “discussion draft.” No surprise then that Republicans are sending another bill to the CBO for scoring by Friday.

The Senate version is so different from the House bill that a conference committee (assuming this passes) may come back with something altogether different, forcing members of Congress to vote on yet a third bill before it’s done. That’s a tough ask, one even conservative voices are saying is a mess.

2.  What these folks have in common

Alan Yordy, Jeremy Vandehey, and Greg Van Pelt. Diane Lund-Muzikant, Eric Hunter, and Bud Pierce. I’m extraordinarily pleased to tell you that these esteemed Oregon health care leaders are all a part of our Convening Panel ahead of our 2017 Oregon State of Reform Health Policy Conference!  They are a great group of thoughtful folks.  We met together in late May, and are finalizing input for our draft Topical Agenda for our fall conference.  We’ll release it here in a few weeks to get your feedback – along with anyone else that would like to share their thoughts.

We start lining up speakers and sponsors from there.  With more than 70 speakers expected for this year’s one-day conference, it’s going to take some work!  So, we’re excited to get started.  You can take a look at the highlight video from last year’s event here.  Early bird registration ends next week.

3.  Trends in conflict: single payer & integration

California’s single payer legislation builds on Bernie Sander’s advocacy in 2016. It also builds on a Colorado initiative on the issue, lots of energy in Vermont, and a study funded by the legislature in Oregon.  There is energy there, and even if it hasn’t yet come to pass, it appears increasingly clear that something like a single payer is becoming the most likely political response from the left to the AHCA.

That said, I think the momentum there is in conflict with a second policy trend, that of integrating care across physical and behavioral health.  Or, perhaps more specifically, rather than in conflict, they operate at cross purposes.  I view one as moving horizontally and one moving vertically within the system.  This post lays out my thinking more clearly, but it concludes with this timeless challenge in a world of finite resources:  advocates probably can’t have both.  Political capital is in too short of supply these days.

4. Video: Ralph Prows

Ralph Prows is the Chief Medical Officer at Adventist Health Medical Group and the former CEO of the Oregon Health Co-Op. He’s been on the cutting edge of system innovation – and has some of the scars to prove it.

In this edition of “What They’re Watching,” Prows talks through the challenges of population healthcare, and specifically the importance of cultural competency in the Oregon Medicaid population.

5.  FamilyCare, OHA rates, and Health Share

An interesting policy question has arisen through FamilyCare’s long-running conflict on rates with the OHA. Does the CMS requirement of actuarial soundness of Medicaid rates apply to specific CCOs, or just to a region where rates may be determined? This is essentially FamilyCare’s legal argument: that regional soundness of rates isn’t acceptable where more than one CCO exists, and FamilyCare rates aren’t sound. OHA has argued that CMS has approved rates for all CCOs, not just at the regional level but at the CCO level, as well.

Interestingly, if a judge finds FamilyCare’s rates are lower than “actuarially sound” in the Portland Metro area, that means Health Share’s rates are higher than “actuarially sound.”  In other words, it’s reasonable that if FamilyCare’s lawsuit is successful in raising its rates, and assuming the regional rates remain at a level of “actuarially sound,” then Health Share’s rates could get cut substantially to average out the regional rate.