5 Things Texas: Women’s health programs, Medicare changes, future of managed care

This newsletter, 5 Things We’re Watching, tries to deliver you thoughtful market and policy intelligence on Texas health care and health policy once a month.  It’s free, of course. If we are on the right track or if we could do something a little better, I’d appreciate the input.  In exchange, we’ll also send you a few marketing emails as our February conference gets closer.

Our 2019 Texas State of Reform Health Policy Conference is set for February 5th in Austin.  We’d be thrilled to have you with us!


1.  Report on women’s health programs

new HHSC report shows rising enrollment and increased savings for two Texas women’s health programs. The report evaluated enrollment levels, savings and expenditures, service utilization and outreach activities for the Healthy Texas Women(HTW) program and the Family Planning Program (FPP).

According to the report, enrollment in HTW increased by 109 percent in 2017 (from 105,406 enrolled to 220,154) and FPP served 96,990 clients. For both programs, providers served the most clients in the Gulf Coast, Lower South Texas, and Metroplex regions and top procedures utilized include testing for sexually transmitted diseases, blood panels, office visits, and birth control.

By averting unplanned pregnancies, the report estimates that for 2017 HTW saved the state a net $4.3 million and FPP saved approximately $8.5 million.


2.  The four elements of health care’s social contract

I believe you can view our politics and our policy discussions through the lens of our social contract we have with one another, and the social capital we have built together to support it. I’ll talk more about social capital another time, though one of the country’s first efforts to measure social capital was just released in late April. Texas was 44th on the social capital index of states.

Our social contract is the set of responsibilities we owe to one another as Americans. I would argue many, and perhaps most challenges we face in health care today result from a perceived violation of our social contract by one group or another.

I outline the idea of this social contract in a two part series:  connecting the decline of public opinion of health care to our social contract, and the four tenets that make up the contract and which have broad acceptance by a majority of Americans.


3.  Two big moves in Medicare

The Bi-Partisan Budget Act passed by Congress allows for the inclusion of non-health care services to be covered supplemental benefits for MA plans starting in 2020.  I detail some of the background on this here.  This means that strategies related to the social determinants, for example, can be funded in Medicare, if a plan chooses to cover them.

Last week, CMS proposed several updates to Medicare payment policies and rates. Among them is a requirement to have hospitals publish a list of “their standard charges” online in an effort to “empower consumers.” This is an incremental step, but a good one and one we’re likely to get more of from Seema Verma’s shop.


4.  Videos: Rep. Joe Moody, Jay Henderson on opioids

We have two perspectives on addressing the opioid crisis that we wanted to share with you. Rep. Joe Moody is the Vice Chair of the House Select Committee on Opioids and Substance Abuse, which has a hearing scheduled for May 15th. He joins us in this episode of “What They’re Watching” to talk about the need to decriminalize substance abuse. “We’ll be focusing on…understanding there is a criminal justice aspect to this, but more importantly, we need to look at this as a health care issue and treat substance abuse in the correct way.”

Jay Henderson, an attorney at Fibich Leebron Copeland Briggs, has been involved in several lawsuits filed against the pharmaceutical industry. He joins us in this episode of “What They’re Watching” to share his perspective on the legal argument. “We believe they created a market in which these drugs were foreseeably going to be abused and that they created an environment in which addiction, and all the problems that flow from addiction, were inevitable.”


5.  The future of managed care in Texas

The House Human Services Committee continued its Interim Charge of reviewing the Texas managed care model for Medicaid at an almost six hour committee meeting last week.  You can read our summary here.

Anne Rote, President of Molina, featured the success the plan has had with the nursing facility “carve in.” Jaime Dudensing of the Texas Association of Health Plans detailed the Medicaid population: 1 of 2 births is a Medicaid birth, for instance.  HHSC Commissioner Charles Smith talked through the Commission’s work to address recent procurement issues.

On May 9th, the committee will continue the work, focusing on network adequacy, provider satisfaction, and “the future delivery of services under a managed care model to additional populations.” It hopes to complete this by September.