5 Things Washington: PEBB, ACH projects, MCO RFP

It’s a very busy time.  We actually had 11 things this issue that we thought were all very much worth your time.  But, we’ve limited it to 5 Things We’re Watching at the state, federal, and local levels of health care and health policy.

As always, thanks for reading our stuff, and supporting our work at State of Reform. I appreciate it.

DJ 5 Things Signature

1.  Why HCA’s award to Regence is a big deal

Last week, the HCA announced it had awarded and contracted with Regence Blue Shield to manage its TPA for the state’s public employees (PEBB). This was one of the biggest awards available in the state for the self-insured line of business.  I outline my initial thoughts on why this is a big deal in this post.

This award includes contract language that requires Regence to offer an ACO product to almost its entire “book-of-business,” which is contractually defined to include “fully-insured and self-insured products within [Regence’s] accounts, including individual products and networks.” Medicare is excluded. The infrastructure and systems Regence will build to meet a demanding HCA PEBB contract will be in place to be leveraged for consumers across the rest of the commercial, association and ERISA markets, potentially driving change with providers and patients beyond the state employees’ contract.

2. What opioid addiction looks like, in photos

If you haven’t seen Time’s recent photojournalism showing what the opioid epidemic looks like in America, it’s worth your time. It’s powerful. “If there was a terrorist that showed up… and shot 50 people or 25 or 10 for that matter, this community would be in an uproar. There would be an army here trying to stop it. That’s exactly where we are with opioids.  But who’s showing up to stop it?”

In Olympia, Rep. Eileen Cody has promoted a package of bills on opioids this session, some of which made it through the process. Notably, while the US has had a 14% increase in overdose deaths, Washington State has seen a decrease of 13.5%.

The US Senate Health, Education, Labor and Pension’s Committee, on which Sen. Patty Murray is the Democrat’s ranking member, held a hearing this morning on “The Opioid Crisis: The Role of Technology and Data in Preventing and Treating Addiction.”

3.  Notes from HCA approved ACH projects

The Health Care Authority has green-lighted ACH projects around the state, releasing $182m in funding under the Healthier Washington initiative and 1115 waiver. Regions submitted project plans to an “independent assessor” for review. King County’s HealthierHere ACH scored the highest on first submission. Olympic, North Sound and Greater Columbia had the most work to do, scoring in the upper 70% range before later winning approval.

According to the Independent Assessor’s report, King County (15%) and Olympic (22%) had the highest level of funding appropriated to “Project management and administration,” while the remaining seven ACHs averaged 6%. Only four of the nine applied some funding to reserves and contingency. Olympia (50%) and Cascade Pacific Action Alliance (43%) used the greatest percentage of their funding for “Provider Performance and Quality Incentive Payments.” The remaining seven ACHs averaged 26% towards performance incentives.

4. Inslee to Trump: less Tweeting, more listening

By now, you’ve probably seen it.  But if not, this interaction between Jay Inslee and Donald Trump during this week’s National Governors Association meeting with the White House likely portends a series of future debates to come.

As early as 2015, I argued Inslee should run for president, an idea some of my friends have pointed at to question my mental health. That said, this interaction is the kind of thing a Democrat will need to take on Trump and win: swagger, policy chops, a “fighter’s” communication style, and an ability to connect with regular folks (“as a grandfather…”).

Moreover, Trump will likely be much harder to beat in 2020. He would beat Clinton again if the election were held today, and some objective observers think “Donald Trump is on track to win reelection to the presidency of the United States.”

5.  Medicaid RFP is out for FIMC

The HCA released its RFP for Medicaid health plans (MCOs) for seven of nine regions that will be moving to financially integrated managed care (FIMC) by January 2020. It includes a few nuggets that suggest the HCA is changing course on its procurement model, which could be in response to political pressure.

Specifically, the RFP says remaining regions will award three to five plans, up from earlier statements that it would ‘award two, or at the most three plans.’ In regions like King County, a county-brokered agreement from September had already effectively locked in all five plans. But the RFP allows five plans in North Sound and Greater Columbia regions as well.  It even re-opens Southwest Washington to add a third plan where CHPW and Molina were previously the only plans awarded that market.