5 Things Alaska: 1115 Waiver, legislative update, John Wagner

We hope you enjoyed your three-day weekend. DJ is out this week, so he left us in charge of this edition of 5 Things We’re Watching, which includes an update on the 1115 waiver and DJ’s thoughts on Amazon entering health care.

Thanks for reading our stuff, and DJ will be back next edition!

Kylie Walsh & Emily Boerger
State of Reform

1.  DHSS submits 1115 waiver

The Dept. of Health and Social Services submitted Alaska’s 1115 waiver to CMS last week. The application identifies three target populations who would receive an enhanced set of benefits related to behavioral health and substance use disorders.

The application includes a budget neutrality summary. The projection, conducted by Milliman, shows just over $56 million in savings over the five-year demonstration period.

We’ll be keeping an eye on the public comments, which are open until March 17th. We’ll also keep an eye out for the release of the RFP for the ASO contract.

2.  A few noteworthy bills

Among the health policy bills that have been recently introduced is Rep. Kopp’s HB 356, which would require DHSS to apply for another 1115 waiver to establish a Medicaid work requirement. Eligible adults would be required to work at least 20 hours a week. Exemptions are primarily tied to being a parent or caretaker, or unable to work due to medical reasons.

A bill to require carriers to provide coverage for mental health benefits provided through telehealth is currently in the House HSS Committee. That committee is also hearing HB 268, which requires patients to be advised of the potential addictive dangers of opioids.

HB 54 has been moving through committees. The bill would provide an end-of-life option for terminally ill individuals. It passed out of the HHS Committee 3-2, with two Dems voting “no recommendation.” The bill has been referred to the Judiciary Committee, but has not been scheduled for a hearing yet.


3.  Alaska Resilience Initiative project

The Alaska Resilience Initiative (ARI) is currently in the process of developing a program to train professionals to recognize and respond to trauma and adverse childhood experiences (ACEs). Specifically, the curriculum will be tailored to identify how these experiences manifest themselves in the education and health care sectors.

On average, Alaskans face a higher burden of adversity in their childhoods compared to the rest of the United States. Alaska currently ranks above the national average in terms of the average number of ACEs experienced and ranks high on rates of child abuse and neglect per capita.

According to ARI Director, Laura Norton-Cruz, the purpose of these training programs is to identify individuals impacted by trauma and ACEs and come up with better ways to respond to them. She says the goal is to finalize the first draft of the program by the end of February and run as many pilot presentations as possible in March and April in order to begin preliminary evaluations.


4.  Video: John Wagner, Aetna

John Wagner, Market President at Aetna, is responsible for the delivery system strategy, contracting, and overall relationships for Aetna’s NW markets. He joins us in this edition of “What They’re Watching” to talk about collaboration in healthcare.

“It is a challenge in Alaska. Alaska is very fragmented in terms of the organization of health care. In Washington State roughly 60 percent of physicians are owned by hospitals, and I don’t know what the stat is in Alaska, but it’s probably less than ten percent. And so, how do you develop an ecosystem where there’s a focus on a patient or a group of patients when the organization of physicians and hospitals are very fragmented?”



5.  Amazon shines light on the poor opinion of health care

In September, I outlined a strategy for Amazon to enter the health care space. It starts with leveraging their own employees, which appears to be the focus of their recent news. What has also gained focus is how the Amazon release characterized the health care sector. Warren Buffett called health care a “tapeworm.”  I thought that was a brazen term, but apparently it wasn’t.

Rod Hochman, CEO of Providence Health and Services, agreed with the term.  The former editor of Modern Health care (kind of) defended the sector saying, to paraphrase, ‘no, it’s a cancer not a tapeworm.” A piece in Time called health care “the flabbiest part of the US economy” and “the Gorgon that has stymied politicians for decades.” Kaiser Health News posted a letter saying health care is a “catastrophic failure.” Piers Morgan, one I am generally loathe to quote about anything, said health care was “a sick joke & the envy of no one.”

Put it all together:  there is not another sector in the US economy as openly ridiculed and derided as the one upon which we will all one day depend, and from which we will all receive services that few of us can afford on our own. That’s the stuff of a strong political backlash ahead.