5 Things Oregon: Phil Greenhill, Prov & Ascension, Measure 101

I hope the spirit of these holidays is with you, your family, and your communities! These are literally dark days, with a few days left till solstice. That’s the good news!  The bad news is that there are some key issues on the horizon that could move Oregon health care into a very tough financial space, perhaps more metaphorically “dark” than literal.

We’re watching some of those items this month – but we’re turning our attention to Christmas this weekend!  I hope you are able to turn away from the stress of the work week to enjoy whatever holiday you celebrate this month. This will all be here when you return…

DJ 5 Things Signature





1.  Thoughts on the Providence merger rumor with Ascension

Last week, the WSJ reported that Providence St. Joseph was in merger talks with Ascension to create one of the nation’s largest hospital conglomerates. This has been an open secret since the summer. Over that time, I talked with more than 20 folks about their thoughts on the rumored deal.  We chose not to comment then on the Prov merger discussion, but instead to let that news come out on its own schedule.

From these conversations, I put together this piece with two things I know and two things I think I know about this deal.  One thing I know:  this fits a pattern of Providence CEO Rod Hochman’s leadership, one established while he was at Swedish.

Importantly, one thing I think I know is that Swedish in Seattle may be carved out of this deal. I understand there has been a push within Swedish to review the arrangement with Prov since last year’s Seattle Times coverage of the neurosurgery unit. Ascension may not want the $68m loss that Swedish booked in 2016.  One rumor I hear is that Swedish executives approached Kaiser about solidifying an already strong arrangement where Swedish provides much of Kaiser’s Puget Sound hospital services.  We’ll see if any of this comes to pass.  Five years ago, I also thought Premera and Providence might merge, but that clearly didn’t come to pass, so who knows….

2.  Douglas County Commissioner Tim Freeman on 340B program

Former Republican State Representative and current Douglas County Commissioner Tim Freeman wrote a defense of the 340B Drug Discount Program, which benefits more than 600,000 Oregonians living in rural areas. Commissioner Freeman opposes CMS’s rule change cutting Medicare payments for hospitals enrolled in the 340B program by 28 percent, roughly $1.6 billion for 2018.

Commissioner Freeman argues: “The 340B program merely requires pharmaceutical companies to provide discounts on their drugs.  In exchange, they get access to millions of Medicaid beneficiaries that receive care from rural providers, which act as a crucial safety net.  Bottom line – it’s like we are being taken for granted again, with special interests in DC determining the fate of rural America.”

3.  Implications of Jan 23rd election

Next month’s special election will be a watershed moment for the legislative session.  Recent polling on Measure 101 shows a sizable lead for maintain:  52% for maintain to 20% for repeal. But 28% were undecided, which could make the vote closer. Should the repeal of the health care funding package succeed, the Oregon legislature will have a significant revenue challenge to address, and for which there is no prepared contingency.

This year’s regular legislative session is pegged to only 35 days. So, it’s not the sort of thing that organically allows for new ideas to bubble up.  And, with the primary election dates set for May 15th, legislators are going to want to get home to campaign pretty quickly. All in all, this sets up pretty badly if you’re an incumbent and if Measure 101 is successful. There are no clear paths to getting out of session on time.

Correction: Our email misstated the poll results as 52% repeal and 20% maintain. I regret the error. The correct numbers are above.

4. CHIP, Walden and Wyden

By borrowing $35 million from its Medicaid program, Oregon’s CHIP program has found a way to remain open through April. Without dipping into its own Medicaid resources, Gov. Brown says Oregon would be forced to send letters to families about losing their coverage during the holiday season. While Oregon is looking to short-term fixes on a local level, two state leaders are working at the forefront of CHIP decisions in Washington DC.

Last week, Rep. Greg Walden, Chairman of the House Energy and Commerce Committee which oversees CHIP, said he would insist that CHIP funding be part of the continuing resolution that will keep the government open past December 22. While some leaders say that funding for CHIP can be delayed until a larger funding bill in January, Walden called the delay on CHIP funding “unconscionable.” Sen. Wyden, who in September introduced a bipartisan bill that would extend CHIP funding for 5 years, recently wrote an op-ed in the Statesman Journal imploring Congress to act on CHIP, and quickly. He wrote that Republican leaders have been too distracted with passing the tax bill and appointing nominees in the judicial branch to even make CHIP a priority.

5.  Video: Philip Greenhill on the role of CCOs

Given all the recent news about CCOs and Oregon Health Authority, I wanted to share with you Philip Greenhill’s comments in this edition of “What They’re Watching“. Philip is the CEO of Western Oregon Advanced Health, a CCO which serves members in Oregon’s South Coast region.

“Our challenges were to try to break down the past silos that we all envision breaking down when the CCOs started. The guidance came from our physician group, which had always been a physician managed care organization delivering physical care. And their direction to myself and others on the Steering Committee when we started the CCOs was: “We don’t want to any longer go this alone; we want the CCO to become a community asset.”