5 Things Alaska: Harsh comments on waiver, Legislation moving, Wilson Agency sells

It feels like the momentum of success that has been a hallmark of the last few years in Alaska health care is coming to an end. I may be wrong – hopefully I am.

But with the 1115 waiver request running into severe and harsh criticism, with The Wilson Agency selling to a national brokerage, and with the politics of the 2018 gubernatorial election gaining steam, it seems like the energy in Alaska’s health care system is slowing.  It’s some of what we’re watching this month in Alaska’s health care system.


DJ 5 Things Signature

1.  1115 waiver comments: “incredibly damaging incentives and outcomes”

The federal public comment period for the 1115 Waiver application closed over the weekend. Kylie Walsh on our team writes that the comments reveal concerns over a general “lack of detail” in the application, the administrative services organization model, eligibility requirements for beneficiaries, and treatment options.

Providence argues the eligibility criteria will encourage inappropriate use of intensive and emergency settings while impeding access to care (“incredibly damaging incentives and outcomes)”. The Alaska Behavioral Health Association wrote “The application begins to fall short at the more detailed level. As was mentioned in our previous comment, the plan itself focuses largely on what it is that is hoped to be achieved and lacks critical details on how it might be achieved. Questions to this effect that have been put to the Department have been met with responses such as ‘This level of detail will be addressed through the waiver implementation plan.'”

DHSS told me they had no comment on the waiver feedback as they are “focused on the legislative session.”

2.  Health policy bills in this session

The Legislature has less than a month left in the regular session so we have an update on some of the key health policy bills that have progressed and stalled in Juneau. Notably, both Chambers have introduced Medicaid work requirement bills (HB 356 and SB 139) but only the Senate’s version has been heard in committee. Alaska is one of the few Medicaid expansion states that are also considering work requirements.

Other bills scheduled for hearings include a telehealth coverage bill and an end-of-life option for terminally ill adults bill. Opioids continue to remain in focus, with a bill requiring patients to be informed of potential addictive dangers scheduled for a hearing later today.


3.  Gov. Walker on improving the health care system

Governor Walker joined four governors to unveil a bipartisan framework to improve the health care system. The four guiding principles are improving affordability, restoring stability to insurance markets, providing state flexibility for innovation, and improving the regulatory environment.

Walker addressed Alaska’s unique health care environment and the politicization of health care: “The solution to health care is not a partisan issue. Health care is a human issue, it’s an American issue that we need to embrace. The pendulum is swinging back and forth between the administrations on health care. That’s what’s got to stop because the ones that get hurt in that swing of the pendulum are those that need health care and need coverage.”


4.  Video: David Frain, Christian Health Associates

David Frain is the Practice Manager at Christian Health Associates, a non-profit corporation that operates under the Cornerstone Clinic Medical and Counseling Center umbrella. Frain joins us in this edition of “What They’re Watching” to talk about the opioid crisis.

“Maybe we can look at treatment modalities that don’t require opioid use. There’s a few physicians in Anchorage that are providing OMT (osteopathic manipulative treatment) and they’re getting referrals from everybody. They’re managing people with chronic pain that are not served by opioid use, that are not getting success, that are not getting pain alleviation.”


5.  The Wilson Agency sells to national brokerage

The Wilson Agency (TWA) is Alaska’s largest brokerage and a cornerstone of the commercial health insurance sector. A few years ago, it acquired Washington State-based brokers Albers & Co, growing its book of business to a second state.  As an Alaskan-owned business, it has been a relative standout among independent, privately-held companies in Alaska.

The Wilson Agency recently announced it had been acquired by Alera, a national brokerage based in Illinois. Alera says they are talking with 40 other brokerages, building a national model at a “furious” rate.

Lon Wilson tells me he has a significant equity position in Alera, which will keep him vested in the success of TWA under the new ownership model. I’m sure that’s right. But this seems like the end of an era in Alaska health care nonetheless.