5 Things Alaska: Gov. Walker’s budget, Shawn West, 1115 waivers

Session is now underway, and Gov. Walker is out with his budget proposal for FY 2019.  We’re also tracking a series of other contextual items beyond health care in Alaska, which we have curated for you below.  Here’s what we’ve got our eye on for health care in the state for January, 2018.

1.  Gov. Walker releases his FY 2019 budget

“Due to budget gridlock, Alaska now takes the most time to produce the least legislation at the highest per capita costs of any Legislature in the country.”  Gov. Walker is out with his 2019 budget proposal this morning, which includes a bill to reform to the budgeting process. It moves the state to a two-year process instead of one, and includes penalties for public officials if a budget isn’t done in 90 days. Withholding legislator salaries is probably unconstitutional, but it’s quite a shot across the bow heading into the new session.

Medicaid funding is up only slightly at 4%, though a significant amount of new dollars has flowed in from the federal government as a result of Medicaid expansion.

The mental health budget, which goes primarily through the Trust, is up $13.8m to $231.9m overall. Most of the recommendations from the Trust for operations and capital expenditures are included in Walker’s proposal.


2.  Health care initiatives dropped

Two initiatives meant to codify certain ACA provisions into Alaska state law have been dropped. The Healthcare for Alaskans Act of 2018 would have protected Alaska’s Medicaid expansionThe Quality Health Insurance for Alaskans Act of 2018 would have kept some of the more popular components of the ACA, including no discrimination for pre-existing conditions, letting adult children remain on their parent’s plan, and requiring maternal and pediatric coverage.

I’m told that the initiatives were pulled due to a lack of institutional support among health care players and progressive groups. The money was there, according to my source, but there wasn’t the interest among the health care community to run these policy initiatives.


3.  Video: Shawn West, MD

Dr. Shawn West is the Medical Director for Provider and Customer Engagement at Premera Blue Cross. He collaborates with network clinicians toward improving quality, risk-adjustment and value-based contracting activities, all with the quadruple aim in mind. He joins us in this edition of “What They’re Watching” to discuss the achieving the quadruple aim.

“How can we figure out ways to both share information so that they [providers] can figure out which patients need the most attention? How do we arrange payment so that we’re basically allowing them to do what makes the most sense for their patients? But also, how do we remove the administrative hassles that don’t necessarily add value that the physicians don’t have to do?”


4.  JP Morgan: a window onto ourselves?

JP Morgan’s conference for investors in health care was last week.  There were about 10,000 attendees that were in or “around” the event. It’s one of the biggest events on the bio-pharma and digital medicine calendar. It’s also “a mosh pit of power and insecurity — along with sleeplessness and excessive consumption of alcohol.” Nevertheless, it’s something of a mirror for an industry that continues to generate more money than good sense, sometimes.

Sadly, there were more CEOs named Michael presenting than all of the women presenters combined.

“We are in the middle of a bubble in all health care asset classes. Everyone knows it, but no one knows how it will end.”

The disruptive threat from Amazon is a primary driver of increasing M&A activity, not efficiency.

Shockingly for non-scientists, one “panel on gene therapy acknowledged that reimbursement might just be the trickiest part of these innovative therapies.”


5.  CMS: no more money for new 1115 waivers

On December 15th, CMS issued a letter saying the would not make any more federal funds available to support new 1115 waiver proposals. This does not impact existing FMAP funds, but rather funds for new, innovative Medicaid designs or programs (DSHP funds).

That may pinch the 1115 waiver that DHSS plans to submit. Their draft plan to reform Alaska’s behavioral health system left blank Section 6 where it was to show how to it would use federal funds to improve the system. In other words, whatever the DHSS ask would have been for federal funds, that window now appears to have been closed.