Long live the Basic Health Plan | 3 questions for the Exchange | CMS backing off mental health?

One recent hospital CEO told me “People say to me that we’re on solid ground in our market.  I tell them they’ve mistaken the ground for a canoe – two of them.  And while standing with one foot in each canoe, I’m able to see the white water up ahead.  That doesn’t feel solid to me.”

It doesn’t really feel like that’s going to change anytime soon, does it?  Till then, here are 5 Things We’re Watching for February.

DJ 5 things updated

1. Ending the “bailout” for the insurance industry?

With the federal debt limit set to expire (again) around Feb 27th, Congressional Republicans are “scrambling” to determine what they can demand from Democrats in exchange for a vote to raise the debt ceiling.

One strategy discussed is an end to the “bailout of the insurance industry.”  The “bailout” language refers to the “3 Rs” – or the risk mitigating elements of the ACA – which allow for insurance premiums to be lower than they otherwise would be during this transitional period.

House Republicans have not yet found a pathway to the 218 votes needed to increase the debt limit, though today they announced likely support for a “clean bill.”  But, until the vote is taken, anything is possible.

2. Basic Health Plan is dead; long live the Basic Health Plan!

On Dec. 31st, one of the most successful health care programs in the country came to an end: the Basic Health Plan.  Yet, there was no funeral, no mass procession of mourners.

So we published a story this week taking a look at the program’s past – as well as its future.  Between U.S. Sen. Maria Cantwell and her former staffer, State Rep. Marcus Riccelli, the BHP may yet have a future in Washington state.


3.  PacMed/Providence deal raises questions for Virginia Mason

The PacMed affiliation with Providence seems to make sense for a number of reasons.  Among them, PacMed is looking for partners to help fund and support better care coordination.  Providence is looking to strengthen its central Puget Sound provider network to better manage referrals and  value-based payer contracts.

What will be interesting to watch is the amount of pressure, if any, this puts on independent hospitals like Virginia Mason.  With future referrals from PacMed no longer certain to go to VM, and other regional referral sources consolidating, will VM’s national “Center for Excellence” strategy be enough to maintain VM’s continued independence?

4. CMS appears to back off of mental health demands

Last summer, CMS’s invalidation of Washington state’s mental health system was an earthquake.  It forced a broad discussion about how the state procures mental health, and how the state could integrate those Medicaid services with physical health and chemical dependency.

However, as the state asked more questions of CMS – and CMS failed to provide written responses – it appears CMS is rethinking its position.  With that leeway, even Governor-request legislation initially meant to change the mental health system is, in some key ways, reaffirming the model.

5. Three questions being asked about the Exchange

There is too much political capital tied to the Exchange’s success for it to fail.  But, whether it is a completely successful, sustainable enterprise is a different matter.

And now that we have four months of data and perspective, there are legitimate questions that will be debated regarding the future of the Exchange and whether the online marketplace can become self-sustaining.

We lay them out in this story.