Plans submit intent for exchange | Voter initiatives to cap exec pay | What Amazon can teach healthcare

The purpose of “5 Things We’re Watching” is to provide a snapshot of things we think are important for senior health care leaders to be aware of.  We don’t argue it’s an exhaustive list, or even that there aren’t more important things to track (there is that Senate budget out yesterday, after all).

But if navigating health care today is sort of like sailing the Atlantic in the dark  500 years ago, we hope to provide a few reference points in the sky to help you find your way.  We all know we’re moving.  Where we finally make landfall, however, might still be undetermined.

1. Plans on 2015 exchange to be announced

Thursday’s Exchange Board meeting will have two key bits of information to keep an eye on.  First, it’s expected that staff will announce the list of plans which have submitted letters of intent to appear on the 2015 Exchange.  We’ve heard both United and Moda intend to have offerings statewide on the small group exchange (SHOP).  Only Kaiser is on the SHOP in 2014, and only in Clark and Cowlitz Counties.

Second, there is an overview of the OIC’s work at clarifying rules that plan filers will need to follow regarding provider networks and carrier applications.  The OIC rules are pretty arcane, even in an open process.  Comment periods lasting all of one week don’t help.  Nevertheless, the overview presented this Thursday will likely be as good of a summary as any you’ll find.

2. Multiple investigations, reviews launched on Cover Oregon

We track policy and market activity closely in four states:  WA, AK, OR and ID.  Last year, we often looked at Oregon somewhat wistfully given how smoothly and comprehensively reform seemed to be moving forward there.

As Cover Oregon looks for a new “half full” CEO, that seems foolish in hindsight, where today the failure of the insurance exchange appears to be the first and (so far) only major threat to Gov. Kitzhaber’s historic re-election to a fourth term.  KATU is doing great work on this, and the Oregonian has been in the weeds, too.

We’ve got a “crib sheet” on all of the investigations (so far), including a call from Congress calling for a federal investigations.  It was our most read story of the last week.

3.  What Amazon’s Kindle can do to improve health care

Jeff Bezos’s Amazon is a disruptive force – no question about it.  As the company matures, its talent diaspora is spreading, bringing the lessons from Amazon’s disruption to other industries.  Ask the team at the Washington Post, the daily recently purchased by Jeff Bezos, about how that’s going.

Which is why Providence’s recent hire of Aaron Martin as SVP of Strategy and Innovation is so interesting to watch.  From his bio:  “Prior to joining Providence, he worked at Amazon and led the team that transitioned traditional publishers from a physical books business to Kindle.”

What will that kind of disruptive thinking mean to the transformation of care at the state’s largest provider organization?

4. Medicare Advantage cuts coming (maybe)

On Friday, the Obama administration announced cuts to Medicare Advantage (MA) plans of 3.55% to health plans.  This number is down from an initially rumored cut of about 7%.   These cuts are driven by the ACA, which offset half of its 10-year, $1 trillion price tag with projected cuts to Medicare Advantage plans.

The idea was to end the subsidy to private MA plans and force Medicare Advantage to operate on the same per member level of funding as traditional Medicare.  It was argued that plans could better administer and coordinate the care of beneficiaries than could the federal government.

All of which makes for a great political weapon against ACA supporters in the 2014 election.  In a letter last week to the president, Speaker John Boehner outlined what could well be messaging for the mid-term elections.  Majority Leader Eric Cantor included MA cuts in a memo outlining the Republicans legislative (and election) strategy for the year ahead.

5. Initiatives cap hospital compensation, prices in Oregon

Oregon’s SEIU 49 filed two initiatives last week that were rather earth shaking in their scope.  One would have capped hospital executive compensation to 15 times that of the lowest paid employee.  The other would have capped a hospital’s prices to no more than 30% of its per patient reasonable costs for service.

The union later withdrew the initiatives, citing an effort by the governor to broker a deal.  Insiders suggested the initiatives were just a tool for leverage at the bargaining table.

Nevertheless, in Washington State, where income inequality and a $15 minimum wage are central elements of the policy ecosystem, such initiatives could be very well received by an increasingly ‘activist’ electorate.  Is it only a matter of time before we see such initiatives here?