5 Things Washington: Premera & MultiCare, Alex Rule, California’s primary election

We are in our eighth year of bringing you these newsletters, which we do now twice a month thanks to the support from Rick Rubin at OneHealthPort. Adding a second newsletter per month required a significant shift in our shop, and it was with Rick’s encouragement and support that we’ve been successful with this.

So, if you like our stuff, thank Rick – and have your friends sign up for the newsletter!  If you don’t like our stuff, reply to this email and tell me why.  I’m always interested in the feedback.


1.  Premera, Multicare announce alliance

This morning, Premera and MultiCare are announcing a new alliance taking shape in Pierce County.  It will manifest in a product for the small group market that will save employers “up to 15%” on their 2019 premiums.

I sat down with MultiCare CEO Bill Robertson and Premera EVP John Espinola to talk through the alliance, what it means for consumers, and how it all came about.  You can listen to the interview on our podcast here for the long version, or check out the two minute video highlights here.

After taking it all in, the most important story – I think – out of this is the work the two organizations have put in to build trust and a deep sense of cultural alignment. That stands out among four key takeaways I highlight from the deal here.


2.  Rate filings for individual market

Eleven carriers have submitted proposed rates for the 2019 individual market with an average rate increase of 19%. BridgeSpan has the lowest rate change request at 0.89%, Kaiser Washington has the highest at 29.78%. But it’s worth looking at past years’ increases to see the trends at each plan.

The federal government continues to bring instability to the market through AG Sessions’ decision not to defend the constitutionally of the ACA in Texas v. United States. AG Ferguson and 16 other AGs have been granted a motion to intervene. But this lawsuit will have long-term implications for the future of the commercial, Medicaid and Medicare markets.


3.  Leadership challenges at Western State Hospital

After a two week survey, CMS has concluded its review of Western State Hospital to determine if the hospital will retain its federal certification and $65m in federal funding. During the review, surveyors issued a citation, which was rescinded following a mitigation plan, because fire detectors posed a hanging risk. CMS has not yet released its final report.

Meanwhile, interim CEO Dr. Marylouise Jones announced she is leaving for the private sector. Her last day is July 6th. DSHS will name a new interim CEO while continuing the search for a permanent CEO. Without steady leadership at Western State, it’s hard to see how reforms will be implemented effectively there.


4. Video: Alex Rule, Arthur J. Gallagher

Alex Rule, Vice President of Northwest Regional Sales at Arthur J. Gallagher, says he is working to ease the administrative burden for employers. He joins us in this edition of “What They’re Watching” to talk about navigation support in the health care system.

“Our preference would be to have that service [navigation support] come through the health systems… But the existing reimbursement model doesn’t really pay for that. So until health systems get paid, until the reimbursement model makes it worthwhile for the health systems to provide that kind of support, until the payment reform moves far enough along the spectrum to actually make it beneficial for health systems to provide that kind of support, it’s got to come from someplace else.”


5.  California’s election and implications for 2020

I’m increasingly of the opinion, and last week’s primary 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 California’s gubernatorial primary there on the back of a vision for single payer.  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 almost 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 that 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. Insteadonly 27% of the electorate has return a counted ballot, so far, 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 turnout, particularly in a blue state with a competitive gubernatorial contest.