5 Things We’re Watching – Washington, October 2013

What an amazing time in health care.  Given that we are all working so hard in health care, we may not be able to appreciate how truly dynamic – and, I think, meaningful – the work we’re all doing is.

But, it’s important to step back and look at the bigger picture.  Ending the mental health carve out, historic pent up demand, and “Accountable Communities of Health” – here are 5 Things We’re Watching this month.

DJ Wilson - Host, State of Reform


1. Exchange:  Pent up demand and the site itself 

It’s worth saying clearly:  it looks like the Washington insurance exchange is performing at the very top of its class. 

With the federal exchange continuing to be a debacle, (not a single registrant in Alaska?) the relative performance by Washington Health Plan Finder – 363,000 unique visits, 40,000 completed applications – gives us an opportunity to step back and look at the big picture.

There may not be, in the history of the world, as much pent up demand for a single service or good as has been unleashed with exchanges in October.  Think about what that means for the work we’re all doing.

2. January 8th

This is what State of Reform looks like.

And, with our Convening Panel set for our SeaTac conference on January 8th, we’re very excited about how the event is coming together in about 10 weeks from now.

However, rather than host 600 folks as we did last January, in 2014 we are thinking about limiting the attendance a little, capping it at around 525 for space.  So, while the early bird rate is still good (a few more weeks), you might register with us early this year to be sure you’ve got a seat with us in January!


3.  What ending the mental health carve out might look like

The CMS letter invalidating the RSN procurement model continues to be driving what I think will be significant system change, over time.  A legislative hearing in October highlighted the likely policy response:  putting mental health dollars up for an open procurement along side a separate RFP for the medical Medicaid dollars – or even potentially integrated with it.

That could mean all medical health, mental health, chemical dependency dollars in the state – and maybe others – could flow through a few contracted entities, like CHPW or United/Optum, which have experience on both sides of the medical and mental health divide.  For medical and mental health providers, that would mean needing to understand one another in way they probably haven’t their entire career.

4. Reading the details of the OIC-Coordinated Care case

We’ve heard more whispering over the last 4 months about the OIC than perhaps anything else, on topics ranging from staffing to politics.  It’s not a topic many feel comfortable talking about publicly because of the regulatory power of the office.

So, it’s no wonder that the final judicial order in the matter between Coordinated Care and the OIC has been generating so much buzz.  The documents lay out in some stark detail just how difficult one plan felt they had it when dealing with the Office of the Insurance Commissioner.  The OIC has appealed that order.

It’s noteworthy that the administrative law judge in the case – herself an OIC employee – ruled in the plan’s favor in the only instance where questions on the recent exchange regulatory review process were not otherwise settled out of court.


5. “Accountable Communities of Health”

The HCA’s current effort to leverage stakeholder input with CMS dollars to innovate the health care system has placed “Accountable Communities of Health” (ACOH) at the center of it’s innovation plan.

The draft Executive Summary, out just a few days ago, calls these “locally governed public-private partnership organizations.”  Our understanding is ACOHs will be paid by the state, or MCO, to direct savings from improved Medicaid case management back into the local system where the ACOH best thinks they should flow.

I expect that those MCOs taking risk will have an opinion about outside organizations providing “direction” about where the MCO savings should go.  Something we’ll keep an eye on.