5 Things We’re Watching – Alaska, January 2014

With the dawn of another legislative session, it seems some find it an opportune time to raise both big and small policy questions.

Costs in Alaska health care remain at the forefront of many of those questions, with a more active conversation starting to occur in Juneau on the topic.  We’ll see how it develops over the session, but it’s one topic of many we have our eye on in this “5 Things We’re Watching.”

DJ Wilson - Host, State of Reform

1. Dr. Hurlburt connects physician compensation to cuts in teacher pay in testimony to Legislature

Last week’s article in the NYT on physician compensation got some attention.  It pointed to the “deleterious” effects of uncontrolled specialist compensation, citing the diminishment of primary care providers being trained and the elevation of dermatology compensation over even cardiac surgery.

In his remarks last week before the House Finance Committee, Dr. Ward Hurlburt, Chair of the Health Care Commission, opened by citing the NYT story.  He also cited this story on disparities in hospital charges.  He connected the compensation and charges to the projected cuts at the Anchorage school district, concluding “These are real issues and this is the background.”

2. 3,356 Alaskans enroll through exchange    

While only 398 Alaskans were able to enroll in the Exchange at the end of November, that number jumped about 10-fold by the end of December.  There was also the news that about 85% of the 5,360 Premera members who would have lost their coverage actually kept their existing plans.

We can’t yet know the details of who has enrolled on the exchange.  Were they covered somewhere else?  Were they previously uninsured?  However, taken together, these two data points could suggest a rather significant amount of new coverage among the previously uninsured.


3. State of the Union & Republican Response

Let’s be honest:  There has been so much in the way of negative, caustic talk from the right, with defensive, apologies from the left, the two speeches from both parties represented the best of what the parties have to offer when it comes to oratory.

Both were thin on new initiatives or policy, however.  For Obama, implementing the ACA is clearly enough (or more than enough) work.  For Republicans, there still aren’t any new policy ideas that would replace the Obamacare.  But, as the Republican Response offered last night, and on which I think many can agree, “No, we shouldn’t go back to the way things were.”

4. Alaska earns “F” on transparency for consumers

In a recent presentation before the legislature, one of the small footnotes highlighted that Alaska has been give an “F” grade for transparency in health care for consumers and businesses – even after “grading on a curve.”  This was related to the Health Care Commission of an “all payer claims database” for Alaska.

In fact, it’s one of only six states in the country to score absolutely zero points by the non-profit Catalyst for Payment Reform (funded by “large employers and other health care purchasers“) on its review of Alaska transparency for scope of providers, pricing or services.

Without transparency on pricing, it’s awfully hard for a market to function.

5.   25% of Medicaid ER visits come from one neighborhood

In a hearing yesterday before the House Finance Committee, Margaret Brodie, the state’s Medicaid Director, said that the Mountain View neighborhood in northeast Anchorage has the greatest number of ER visits in Medicaid of any part of the state.

These “super-utilizers” in would be a primary target in a managed care model, potentially saving the state taxpayers millions of dollars (based on Alaska ER prices and utilization trends in states with managed care).  With few options for care coordination, it may make a state-run primary care clinic the only alternative.  Given the politics there, Mountain View residents may well continue to rely on the ER for their primary care.