Backlash against Premera on lobbying | Health care leaders get new positions | Obama delays again

The legislative session is set to conclude this Thursday, though today is the day the budget compromise should be agreed to in order to conclude on time.  But, on health care, it’s been a relatively tame session.

That’s given us time to keep an eye on the media, on the rule making process, and on the changing leadership roles in this edition of 5 Things.

DJ 5 things updated

1. Backlash against Premera on all payer claims database

One of the more interesting events in the civic conversation on health care was the recent media firestorm over Premera’s lobbying against the all payer claims database in Olympia.  We’ve followed the matter closely in Olympia but thought it mostly a matter of policy, where good people can disagree.

But, the strength of the backlash in the media – including calling Premera’s explanation “gobbledygook” and implying campaign contributions influenced policy – caused us to take a closer look.  So, we did some digging and some asking around.

What we found is this:  like us all, editorial writers should not be so quick to assign motives in a political process they aren’t following closely.  And, health plans (and providers) must accept the new age in which we live, where the media (and public) have little patience for the standard ways of doing business in health care.

2. ICD-10 anxiety is building among providers 

CMS has announced that it will not extend the October ICD-10 deadline for providers.  With all of the other extensions of federal health care deadlines, the steadfastness on this deadline stands out.  If you’re unsure what it’s all about, this summary gives the details.

If you ask providers – particularly smaller clinics – their anxiety about the infrastructure updates required to meet the ICD-10 deadlines is visceral.  An AMA study points to costs as much as $226,000 for the “typical small practice.”


3.  Obama doing what House Republicans can’t

Last week’s Obama administration delay of the mandate for health plans to meet the ACA requirements is, by one count, the 37th change to the Affordable Care Act since its passage in 2010.  That is a level of (mostly) unilateral executive changes to the law that can make even the law’s supporters shake their heads.

Some suggested this change came about to avoid voters’ ire as they go to the polls this fall.   They might be right.  If so, who at the White House thought it better to protect Democrats in 2014 than two years later – during a presidential election?

Not a good political move – unless you’re a two-term president not running for re-election.

4. New faces in some key health care leadership roles

Here are some recently and newly announced roles for some health care leaders who have been in the business a while.

Peter Adler, formerly SVP at PeaceHealth, has been named the new President at Molina Healthcare of Washington.  J. Michael Marsh, formerly of Providence Health and Services, is the new CEO at Overlake Hospital.  Sarah Cave has started as the new COO at UW School of Public Health.  Karen Lee has been named as the new President and CEO at Columbia United Providers.

5. One state moves to require out-of-network coverage

The issue of network adequacy and narrow provider networks is going to be with us for a while.  Seattle Children’s Hospital is pressing its lawsuit against the OIC, while the OIC is proposing new rules for provider networks.

We’re watching both of those closely, but we were struck by what is happening in New York state, too, where Gov. Cuomo is moving to require plans to include all emergency service providers and specialists in a plan’s network.  That would be good for consumer choice, but arguably remove a plan’s ability to keep downward pressure on provider costs, which have been driving premium increases in the US.