By: Samantha Slaughter, Psy.D. WSPA Federal Advocacy Coordinator
The 2018 Washington State of Reform Health Policy Conference took place in Seattle, WA, on January 4, 2018. Per the State of Reform website, this is the eighth annual conference and “is the state’s largest gathering of health care leaders and insiders. This all-day event features industry experts and policy-makers, covering the most complex issues facing health care today.” Given that description, I was eager to attend for two reasons. One, as APA’s Federal Advocacy Coordinator (FAC) for Washington, I am regularly learning about federal healthcare legislation and educating local psychologists on how the legislation impacts our profession in Washington and nationwide. I believed attending this conference would aid me in my role as FAC as I anticipated better understanding our state’s current healthcare climate (a video wrap up is embedded towards the end of this article). In addition, I am quite invested in the future of healthcare in our state. I started a group practice in 2015 that focuses on integrated healthcare for adult trauma survivors. Creating a group practice that can not only survive but thrive means knowing what state-level healthcare leaders are thinking and how they envision the future of healthcare in Washington. I approached the WSPA Board about funding me to attend this conference as their representative, and I am grateful they agreed.
I walked into the conference and was initially quite overwhelmed. There were so many important presentations, and I could not attend them all. Speakers included the Attorney General Bob Ferguson; the CEOs of the Washington Health Benefit Exchange, Virginia Mason, Compass Health, Community Health Plan of Washington, and The Polyclinic; the Insurance Commissioner Hon. Mike Kreidler; the Executive Vice President of Healthcare Services at Premera Blue Cross; the Medical Director of the Health Care Authority; the Executive Director of Kitsap Mental Health Services; and other healthcare movers and shakers. I was given a thumb drive full of information that I still have not sifted through entirely. Needless to say, I found the conference quite informative. For example, I learned there are eight agencies involved in healthcare in Washington, so it is no wonder that change happens slowly. Let me detail the sessions I attended.
Four-years later: How expansion has changed the Medicaid system –
Presenters: Doug Bowes – President, UnitedHealthcare Community Plan Washington; MaryAnne Lindeblad – Medical Director, Health Care Authority; and Joe Roszak – Executive Director, Kitsap Mental Health Services
What I learned: Since Medicaid was expanded, it now covers over 600,000 lives and has led to decreasing Washington’s uninsured rate to less than 6%. Washington is on track for full integration of healthcare with 90% of payments being connected to value by 2021.
Envisioning a post-ACA health care system in WA –
Presenters: Caitlin Safford – Director of Government Relations, Amerigroup; Lonnie Johns Brown – Legislative Director, Office of the Insurance Commissioner (OIC); and Tom Sebastian – CEO, Compass Health
What I learned: Caitlin said she hopes eventually healthcare moves to outcome measures that are more associated with health than treating the sick as a large number of their members do not need regular visits with a physician. She believes the biggest challenge is figuring out how to provide equity in healthcare.
Lonnie talked about reinsurance programs that the OIC was trying to create with legislation. These programs would stabilize the market for 2019. He noted that some people favor a single-payer option in Washington, but to do that we have to figure out how to decrease our need for federal dollars.
Trends in contracting, reimbursement, plan-provider relations –
Presenters: Beth Johnson – Senior Vice President, Premera Blue Cross; Karl Rebay – Partner, Moss Adams; and Paul Williams, OD – Chief Medical Officer, Vision Source
What I learned: This session was data focused in that all presenters talked about the need for data and the sharing of data with providers. Beth indicated that while some things in healthcare have not changed (e.g., negotiation of fee-for-service rates, a desire to decrease cost), some things have. She noted that Medicare and the Apple Health (Medicaid) plans are now utilizing values-based payment and capitation models. She added that the other major change is the embracing of the Triple Aim instead of focusing solely on cost reduction.
Navigating uncertainty in health care today –
Presenters: Gary Kaplan, MD – CEO, Virginia Mason; Leanne Berge – CEO, Community Health Plan of Washington; and Sally Watkins, PhD, MS, RN – Executive Director, Washington State Nurses Association
What I learned: The overall theme of this panel was that Washington is a leader in the nation when it comes to healthcare and that we are moving in the right direction. Gary presented on the need for providers to focus on creating value and being part of the solution. He emphasized watching for waste and not providing a service just because you can versus if the service is really needed.
Strategies to manage population health –
Presenters: Pablo Rodriguez – Senior Director, Product and Innovation, SEIU 775 Benefits Group; Paul Ciechanowski – Founder and Chief Medical Officer, SamePage Health; and Sallie Sanford – Associate Professor of Law, University of Washington
What I learned: It was noted that life expectancy in the US decreased in 2017; panelists wondered about this and its impact on healthcare. They also discussed the release of new CPT codes for collaborative care from the Centers for Medicare and Medicaid Services (CMS) and the possible influence they will have on how and what services are billable.
A conversation with insurance commissioner Mike Kreidler –
Presenter: Hon. Mike Kreidler – Insurance Commissioner, State of Washington
What I learned: Mike stated he is focused on a Market Stability Project (see above mentioned legislation) with a bill sponsored by Senator Annette Cleveland (WA 49th District) and Representative Eileen Cody (WA 34th District). He said the rate filings received from the insurance companies in 2017 “freaked” him out, and he does not want to repeat that again. He is eager to see the numbers on network adequacy that are due to come out later this year.
Forming new partnerships and affiliations in healthcare today –
Presenters: John “Espi” Espinola, MD – Executive Vice President, Healthcare Services, Premera Blue Cross; Tom Donohoe – Managing Partner, Hall Render; and Lloyd David – CEO, The Polyclinic
What I learned: Lloyd emphasized strategic alignment when it comes to successful partnerships. He said, “If I could move to capitation in a commercial market, I would.” Each presenter was asked to give a “guiding principle for 2018.” Lloyd said his guiding principles for 2018 are to 1. focus on the patient and what they really want, help them figure out what they really need and 2. figure out how to enhance value.
Espi stated, “Nobody know how to make healthcare work better.” He seemed a bit pessimistic. I will add that this statement made me feel better, though, because it seems clear that his statement is true, and no one is acknowledging this truth. His guiding principles for 2018: 1. focus on making healthcare work better and 2. focus on being a winner because there will be winners and losers as performance is exposed.
Tom, who is a healthcare lawyer, noted that cultural compatibility is important for successful partnerships. This was an important point as I typically thought about compatibility of services, but had not considered culture and values as something to prioritize in partnership considerations. His guiding principles for 2018: 1. know/understand where you are in the marketplace and 2. be open to creative solutions.
By the end of the conference, I still felt overwhelmed and now knew that I was not alone with this feeling. However, I walked away with a better understanding our state’s current healthcare climate and what healthcare leaders see as important as we move forward. This understanding will definitely help in my role as FAC as I will be able to think about federal healthcare legislation within the context of what Washington is doing at the state level. I also now have a better idea of where my group practice fits within the larger healthcare system of Washington. This conference was very worth attending as I met a lot of people and found it to be a great opportunity to network.
I sincerely appreciate WSPA funding my attendance and encourage all psychologists to attend either the 2018 Inland Northwest State of Reform Health Policy Conference in September with its focus on “the opportunities and challenges facing our health care system on the east side of Washington” (https://stateofreform.com/conference/2018-inland-northwest-state-reform-health-policy-conference/) or the 2019 Washington State of Reform Health Policy Conference in January (https://stateofreform.com/conference/2019-washington-state-of-reform-health-policy-conference/).
Feel free to contact me with questions or comments by email: SamanthaSlaughterPsyD@gmail.com.