5 Things Oregon: Cambia Health Solutions, Medicaid Buy-in, Resa Bradeen, MD

It’s a busy week for Oregon health care with news out this week about Cambia and new legislation coming out of Salem. We feature some of those items, as well as offer some of our original reporting, analysis, and commentary on Oregon health care.

So, here are a few items for your radar screen for health care in Oregon in March, 2019.


DJ 5 Things Signature

With help from Emily Boerger



1. Costs in health care: deck chairs and the Titanic

Cost is increasingly the paramount issue in health care today. That’s not news. But, for as common as this knowledge is, we aren’t always as honest about cost as we could be. We also sometimes try to make it more complicated than we should. In this two part series, I suggest there are really only two kinds of costs: deck chairs and the Titanic.

I spend a fair amount of time with numbers, data, and metaphor in the series. But, after stewing in the national health expenditure data from CMS for a while, in part two we get to the bottom line: Market leverage has more impact on driving cost increases than both utilization and the costs from service delivery combined. Moreover, it appears that this is the first time in American health care history that this is the case.


2. New Medicaid buy-in bill

Representative Andrea Salinas recently filed a bill that aims to establish a Medicaid buy-in optionfor eligible Oregon residents. The bill, HB 2009, would also establish a “shared responsibility penalty,” or an individual mandate for Oregonians.

Prior to introducing the bill, Rep. Salinas gave us a preview of what the bill includes, along with some of her lingering questions, in this Q&A. HB 2009, and two other Medicaid buy-in-related bills (HB 2012 and HB 3185), are scheduled for their public hearings this afternoon.

3. Serendipity, CCOs and the social determinants

The OHA has been very intentional about the CCO 2.0 re-procurement, which is a good sign. However, it’s possible a stroke of serendipity might strike the CCO 2.0 model, which could turn Medicaid on its head – in a good way.

I lay out the details in this piece, but here is the punch line:  if CCOs are required to spend dollars on social determinants – either from their capitation or their surplus – shouldn’t those strategies be put on the Prioritized List and compared to all other medical expenditures?  Housing is a near-term priority for the next CCOs.  If PT is often ranked higher than surgery for lower back pain, I would think getting people into beds and off of concrete would be even better.

4.  Video: Resa Bradeen, MD, Metropolitan Pediatrics

Resa Bradeen, MD, is the Chief Medical Officer at Metropolitan Pediatrics. She joins us in this edition of “What They’re Watching” to discuss transforming financial silos for pediatric care.

“I think the pediatricians are really embracing and seeing the value of having psychologists, social workers, developmental therapists, and other areas within the primary care setting. They’re just really struggling to figure out how to make the nuts-and-bolts work from a financing [standpoint], especially because of the siloed funding streams in the past.”


5. Cambia/Blue Cross Blue Shield announcement

The announcement that Cambia and Blue Cross North Carolina are entering into a new affiliation is big news. It brings Mark Ganz’s career full circle. He scuttled a merger with HCSC when he took the reins of Regence almost 20 years ago. We’ll see if the regulatory pressure that rose in that episode will be recreated this year.

All five states will need to review and approve the deal: NC, ID, UT, WA and OR. It’s possible Washington may become the most challenging regulatory hurdle. The Washington State Insurance Commissioner Mike Kreidler was out immediately with a statement saying he will “carefully assess the potential impact of the proposal on policyholders and the health insurance market, as well as its compliance with state insurance laws.”