WA: Interview with MaryAnne Lindeblad, HCA Director of Medicaid – Part 2

MA Lindeblad

MaryAnne Lindeblad is the Director of Medicaid at the Washington State Health Care Authority, and is at the center of system reform in Washington State.

Part 1 of this interview can be found here.


Q:  You mentioned the MCO contracts that are moving into place for 2014.  It’s my sense that, at least among some of the plans, there may be some real financial challenges in Medicaid, particularly with the HOBD lives, and that some plans have struggled in the new model financially, given enrollments, the complexity of those patients.  That’s just my own sense.  I haven’t seen any data that speaks to that or looked at financial statements but…

A:   That’s just not what we’re seeing.  It is a new population.  Things need to settle out as you bring new populations on.  But I haven’t seen any of the plans in what I would say wasfinancial difficulty, and we monitor them very closely in terms of operational performance and financial performance.

There is a small rate reduction this year.  Rates are built on a number of components,including utilization factors, and in some areas the utilization didn’t bear out like we had expected.  Health homes are a good example of that.  That was a new service, and you expect a ramp-up there.

But in terms of the normal course of adding a new benefit, we used the best information we had from a rate-setting perspective, and we’ll have to see how that plays itself out.  But, I’m not anticipating that any of our plans are in any financial straits.

Q:  And I should make clear, I’m not suggesting any of the plans don’t have the financial reserves, or can’t weather any transition.  Raising financial sustainability issues related to Medicaid is always a tricky subject for a host of reasons.

A:  We do recognize that to stay in business you need to make a profit, but we need to manage that profitability as well.

Q:  Setting the ACA aside, if possible, to answer this question, what would you say is state health policy like in 2014 in an Inslee administration compared to the Gregoire administration or the Locke administration?

A:  Gosh, that’s a great question.  I think I’ll go back to what I would call simpler times.

Many of the things that we’re moving on todaywere the same things we talked about in the 90s.  The conversations around payment reform and pay for performance – we just used different names for what we call accountable care organizations today.

There wasn’t the readiness that there is today. The kind of infrastructure that was needed for that wasn’t available.Looking at things like technology in a different way, evidence-based services, small area analysis to find outliers in terms of performance.  Those may have been conversations that had been going on for years.  But the timing is finally been right to move forward and implement some of those very exciting things.

While delivery system reform has centered on cost, quality and access, we have more tools and more levers today for that conversation today than before.There is more recognition now that we’re ready to start making some changes to the fee-for-service system in a much more robust way than we could in the ‘90s.

In the 90s, it was more about coverage.  We added a lot of children to the program in the 90s, so the focus then was really more about access.

Today, the focus is really more about quality and accountability.    Our quality assurance programs were much more limited back then in what we did and what we were able to do.

Gov. Locke and Gov. Gregoire were both incredibly progressive in their vision of what a health care delivery system could look like, and they helped create the foundation for where we are today.

Now we have the opportunity to take the next step and look at more fully integrated products and decide how we take the next step to take the delivery system to the next evolution.

Q:  For those folks that only know you through health policy, what is MaryAnne like outside of health policy?

A:  Well, I talk a lot about health policy!

You know, my passion is really around health care access for low income populations and making it available so that that no one in our country goes without health care.

I work with a free clinic here in Olympia.  I’ve helped open two free clinics.  That movement is really important to me. It may be a pebble dropping in a big pond, but I think as individuals, helping our other community members is some of the most important work we can do.

 I’m a great Husky football fan and Husky basketball fan.  I love music. Music is a big part of my life, whether its opera or rock, you name it.  I love concerts.

I love to discover new things, to be out and to explore.  This job doesn’t always allow as much time as I’d like to do those sorts of things, but I do try to find that work-life balance.

As part of that balance, I try to explore how best I can, as an individual, the things that matter to me personally — like efforts to support improving health care access and outcomes for all.  That’s a big piece of who I am.

Q:  Last question.  What advice would you give would you give the health care sector to be able to respond to changes in Medicaid in the next 12-24 months.

A:  I think it’s going to take all of us to be thoughtful, to be nimble, and to try some things out.  I think we should all be less risk-averse.  It’s a good time to take some risks and not be too quick to draw conclusions if things aren’t going exactly how we’d like them to be.

Instead, we should look at taking a continuous quality improvement approach. We need to continue to refine and build on those things we know can work for the people we serve.