5 Things Texas: HHSC, Drew Peterson, California elections

In our 5 Things We’re Watching newsletters, we work to elevate the topics we think are worth your attention across the health care industry, regardless of where those ideas or coverage come from.

So in addition to the five topics below, we’re also watching and reading The Dallas Morning News investigative series Pain & Profit on the Medicaid managed care system in Texas. It’s well worth your time.

1.  Oversight Committee blisters HHSC

Following recent claims of procurement and contract mismanagement, the HHS Transition Legislative Oversight Committee received an update from HHSC on how the agency will improve the current procurement and contract process. In the presentation to legislators, HHSC revealed a strengthened checklist, a new standardized scoring tool, and a new Quality Control team.

From Committee Chair Senator Jane Nelson’s opening comments:  “We made it crystal clear that HHSC has become to some extent a contracting agency… And in my opinion, these recent problems have nothing to do with the size of this agency or boxes on an organizational chart, but rather a failure to elevate the importance of contracting at an agency that contracts out a very high percentage of its services. This has to change.”

A series of audits and investigations into HHSC are ongoing.

2.  BCBS new ER policy, in context

Last week, Blue Cross Blue Shield delayed its new ER policy wherein it would not cover non-life threatening services at an out of network ER.  The 60-day delay came, in part, from the work from the Texas Medical Association, which raised questions in a letter to the Texas Division of Insurance.  TDI responded with questions of their own to BCBS.

To understand this policy shift, one has to understand the issue of free standing ERs. From the view of those ERs, they are offering patient choice and access. From the view of payers, these free-standing ERs are popping up rapidly, are often not in network, and create out of pocket costs to consumers that cause significant hardship.

As this continues to spill into the public sphere, expect action to build on a legislative solution for out of network free standing ERs in 2019.

3.  Texas’s poor health system performance

The Commonwealth Fund released its 2018 Scorecard on State Health System Performance. Texas was ranked 44th overall in the nation.

The state ranks last for access and affordability. While its rank did improve for avoidable hospital use and cost and health lives, health disparities’ ranking worsened. This was not a glowing report of the approach Texas has taken over the last eight years since the passage of the ACA. You can explore the data here.

4.  Video: Andrew Peterson, UnitedHealth Group

Andrew Peterson is the Vice President of Business Development at UnitedHealth Group. In his role at UnitedHealth Group, Peterson develops, finds, and leads growth opportunities in the Medicaid market. He joins us in this edition of “What They’re Watching” to discuss new technologies in healthcare.

“I think in the crossover between the legislature and the insurance industry, they should look at things that can be paid for or should be paid for. And some of these new technologies are very slow to be adopted by state insurance industries or state insurance commissions, and so I would ask them to kind of push the envelope.”

5.  California’s election and implications for 2020

I’m increasingly of the opinion, and yesterday’s election in California reinforced this belief, that to win a competitive Democratic nomination for President in 2020, a candidate will need to have some proposal for a single payer-like health care system. That could be Medicare for all, or a buy-in option for Medicaid, or a full embrace of single payer like Gavin Newsom has made. He won yesterday’s gubernatorial primary there.  This idea about single payer is one of the three key implications for national elections I think come out of the state.

That said, I’m just as sure that a single payer model is a poison pill for a general election electorate. In other words, to get through a Democratic primary, a candidate may need to embrace a policy that will sink him/her later in the fall. We’ll see.

Notably, also, is this:  if a blue wave is going to form in 2018, a place like California is where it should swell the highest. Instead, only 19% of the electorate has return a counted ballot, so far. That number will increase as provisional and absentee ballots are counted, but it’s still likely to be well below the average primary turnout of 37% since 2006.  Sure, it’s a primary and there is a long way to go until the general.  But, that doesn’t look like a wave, particularly in a blue state with a competitive gubernatorial contest.