5 Things Alaska: Providence Family Medicine Center, Breakfast with Candidates, Michael Humphrey

Big thanks to Kylie and the team who held down the fort for me while I was out, but I’m back in the saddle here at State of Reform. We’ve got details for you this month about the future of coordinated care in Alaska Medicaid, about the pending Alaska gubernatorial election, and a few matters that are more technical but interesting to watch.

1.  Providence’s Coordinated Care proposal

Last month, DHSS posted its Notice of Intent to award the Provider-Based Reform contract to Providence Family Medicine Center (PFMC) under the Medicaid Coordinated Care Demonstration Project. We have a summary of PFMC’s proposal for you here, or you can read the 68-page document here.

PFMC plans to make its Integrated Direct Care Team services available to all Medicaid enrollees seen in the clinic based on the level of need. PFMC proposed a blended payment model that continues fee-for-service payments for physician services and introduces a per-member-per-month fee of $5 for each Medicaid enrollee who receives primary care at the clinic.

2.  Comments on 80th percentile rule show industry divide

The comment period for feedback on a renewed discussion about the 80th percentile rule has closed. We read through the 33 submitted comments and found a divide by industry: medical providers support the rule while insurers and brokers would like it replaced.

The majority of comments from insurers and brokers recommended replacing the 80th percentile rule with 250% of Medicare. Most lower 48 states use 125% for non-contracted services. Medical providers pushed back on this recommendation, because Medicare doesn’t “represent the fair market value of healthcare services” according to the Alaska College of Emergency Physicians.

For what it’s worth, we started covering the topic in 2012 in a chapter from Lon Wilson in our book “Dear Governor: About The State of Reform.”  We also highlighted it here in 2013 as an issue. It’s a thorny political issue, but one that’s been in the mix for some time.

3.  Breakfast with the Candidates: Treadwell & Dunleavy

The most important thing happening in Alaska health care this fall is likely the gubernatorial election.  We hope to have all of the general election candidates with us in October at our 2018 Alaska State of Reform Health Policy Conference.  But, with the Republican Primary coming up in August, we thought we’d host a conversation on health policy with each of the candidates:  Mead Treadwell and Mike Dunleavy.

So, we’ve got two breakfast events teed up for you in two weeks: Treadwell on July 31st and Dunleavy on August 1st.  You can get registered here, if you’d like to join us.  We’d love to have you with us.

4.  Video: Michael Humphrey, Alaska Railroad

Michael Humphrey has over 20 years of experience in human resource management.  He’s the Benefits & Records Manager at Alaska Railroad, and was a Senior Benefits Advisor at The Wilson Agency. He joins us in this episode of “What They’re Watching” to discuss the challenges of influencing health care in Alaska.

“It’s hard to influence health care in Nome [as an employer] when you’ve got 15 people there. It’s hard to influence health care in Fairbanks when you’ve got 100 people there. Anchorage is a little bit more of a competitive market but it’s still hard to influence health care [as an employer].”

5.  Ombudsman investigation into DPA

There is a significant backlog of applications for new enrollees into Medicaid. The Alaska Ombudsman released its findings into complaints against the Division of Public Assistance at DHSS, which administers Medicaid. The investigation found all three allegations were justified: DPA isn’t meeting mandated timelines for processing applications, doesn’t consistently respond to communication from the public, and the processing model for managing long-term care cases is inefficient and ineffective.

This Ombudsman recommends increasing staff capacities, but DPA has a high vacancy and turnover rate. DPA also needs improved document management practices given the “incredible amount” of documentation received from applicants.