5 Things Hawaii: 1115 Waiver, Tulsi Gabbard, Laura Esslinger

A big mahalo to the inimitable Emily Boerger for holding down this newsletter while I was away on vacation with my family.

We visited Bosnia, Croatia and Montenegro, where the beaches were great but so was the history lesson. The siege of Sarajevo is a story everyone should know. The massacre at Srebenica has not been forgotten there. And, the nationalist, ethno-centric rhetoric that started the war is worth reflecting upon.


DJ 5 Things Signature

With help from Emily Boerger

1. Another extension for the 1115 waiver

Just days before Hawaii’s 1115 waiver demonstration was set to expire, CMS sent a letter to Medicaid Director Judy Mohr Peterson granting a one-month temporary extension. This followed a previous extension of six months through June, 2019. The one-month extension means CMS has until July 31 to approve the state’s application to extend the “QUEST Integration” demonstration.

A range of stakeholders are anxious to get this put to bed. While the state can move ahead with new RFPs while making them subject to CMS’s approval, it’s always something of a tenuous time as negotiations like this move to conclusion. Expect that folks are ready to get this stage of the process behind them.


2. Oahu Healthcare Partnership pilot program

A new pilot program through the Oahu Healthcare Partnership is finding success in its first year. The project aims to reduce the number of avoidable emergency room visits by identifying frequent users of the ER and targeting them with interventions. So far, the program has achieved a 62% reduction in ER visits in two cohorts of high ER utilizers.

The program was created in partnership with health care leaders at the Queen’s Medical Center and Kalihi-Palama Health Center. “One of the weaknesses in the health care sector is the fragmentation of the system,” says Dr. Emmanuel Kintu, CEO of Kalihi-Palama Health Center. “What we were trying to do is to see if there is a way in which, through our actions, we could ease or reduce the fragmentation.”

3. Dem candidates all in on health care

Sam Baker at Axios says “Health care may be the most defining substantive policy disagreement among the 2020 field.” This week saw a flurry of new health care proposals from 2020 Democratic presidential candidates. Joe Biden made headlines when he released a health plan that builds on the ACA and preserves key portions of it. Sen. Bernie Sanders was quick to criticize the plan ahead of his speech on Medicare for All on Wednesday.

Also this week, Sen. Kamala Harris introduced a drug pricing plan and the Domestic Workers Bill of Rights Act to protect home care workers, among others. Sen. Cory Booker introduced a long-term care plan and Gov. Jay Inslee announced his “Putting Families First” plan which includes plans for long-term care, universal coverage, and paid family leave.

4. Video: Laura Esslinger, AlohaCare

Laura Esslinger is the CEO of AlohaCare. She joins us in this edition of “What They’re Watching” to discuss preventative medicine.

“We recently did a community reinvestment program called Waiwai Ola. And the purpose of that was to focus on some of these key areas where we want to get upstream and be more proactive, and look at simultaneously how do we save some money and improve quality and outcomes in the near term on high cost, high need members? And then, also, how do we think proactively about the future and work on things like social determinants of health?”


5. Rep. Tulsi Gabbard campaign update

Rep. Tulsi Gabbard had a standout performance on night one of the first Democratic candidate debates. She saw a bump in google search volume, and had a breakout moment when she sparred with Congressman Tim Ryan about pulling out of Afghanistan. And this week, CNN officially announced Gabbard as one of the 20 candidates participating in the next debate in two weeks.

Gabbard’s second quarter fundraising tells a different story. For Q2, she raised about $1.6 million – less than half the amount she raised in Q1. Gabbard also spent more in the second quarter ($1.9 million) than she brought in. On the positive side, Gabbard ranked in the top 5 for percentage of donations $200 or less (69%), and this week her campaign celebrated receiving over 100,000 donations from unique donors.