Wilson Strategic : Thought Leadership

Wilson joins CAPG panel in San Diego

Wilson joins CAPG panel in San Diego

DJ Wilson, Wilson Strategic President, was invited on June 13 to speak on a distinguished panel of health care leaders at the California Association of Physician Groups (CAPG) 12th Annual HealthCare conference.

The panel “Hot State Issues-Recent Changes to Network Adequacy and Transparency Rules, Patient Protection Against Surprise Billing and Out-of-Network Provider Payment” featured California Assembly Member Rob Bonta (D-18), the California Director of the Department of Managed Health Care (DMHC) Shelley Rouillard, and Bill Barcellona, Senior VP for Government Affairs at CAPG.

Barcellona introduced Wilson as “the wisest man in the Pacific Northwest” and asked him to be the voice on what is new in Washington, Oregon, and Alaska for the California audience. While Wilson jovially declined the title, he talked at length about his take on actuarial value and narrow networks.

See a clip of Wilson in action below:

 

 

Assembly Member Bonta also updated the audience on four health care bills that he is actively working on this year. AB 533, which passed the Assembly 74-1, seeks to protect consumers from receiving bills from out-of-network providers for services performed at an in-network facility. Bonta stated that “surprise” billing is an growing problem in California health care.

“A patient who has coverage, does everything right, and believes that he or she is receiving in-network care should not be be subject to hidden costs and unfair charges,” said Bonta.

Shelley Rouillard spoke about incomplete provider directories as a stumbling block to consumers being able to understand their in-network benefits. She explained the work that her department is currently undertaking to ensure more transparency from health plan directories. She also discussed the work that they now face as a result of the passage of SB 964 which requires annual assessments of health plan networks.

“Narrow networks are nothing new, although they’ve been getting a lot of attention lately,” said Rouillard. “We consider networks adequate if they meet the legal standards of geographic access, ratios of specialists and providers to the community’s needs, timely access, and in some cases alternate access for rural areas.”

The audience of health administrators and executives shared anecdotes, both personal and professional, around the difficulty of contracting networks and navigating the regulatory environment.

 

steph and jj
JJ Lee and Stephanie Wick, senior associates, at the CAPG Welcome Reception

Wilson Strategic staff members JJ Lee and Stephanie Wick also attended the three-day conference at the Manchester Grand Hyatt.

Wilson Strategic met some  long-time friends and familiar faces from the Pacific Northwest at the event-including newly-retired PeaceHealth President and CMO Alan Yordy and Washington State Health Care Authority Director MaryAnne Lindeblad, who also spoke on a panel titled “Medicaid and Accountable Care: New Models to Improve Health of Individuals and Communities.”

Joe Gifford, Chief Executive, Accountable Care Organization of Washington, Providence Health & Services also gave a presentation “Employer Group Direct Contracting: the Providence, Boeing and Intel Experience.”

The 2015 CAPG Healthcare Conference drew approximately 1,800 members of the health care industry-including independent practice associations, hospitals, and health plans-to the San Diego area.

Special thanks to Lura Hawkins, Bill Barcellona, and CAPG CEO Donald Crane for welcoming Wilson Strategic to their event.

 

 

Wilson speaks at UW health law conference

Wilson speaks at UW health law conference

Wilson Strategic Communications President, DJ Wilson, gave a talk on April 24th before the Washington State Society of Healthcare Attorneys (WSSHA).

DJ fielded questions from healthcare attorneys and law students on topics ranging from state-wide behavioral health integration to the status of the House and Senate budgets for the Washington Health Benefit Exchange.

His talk defined the four key thoughts held by legislators as of 2014:

    • Medicaid’s administrative complexity drives sub-optimal health and health care costs.
    • Regulatory activity from the ACA related to the commercial market will drive Medicaid, and vice versa.
    • There is a need to learn from and implement the latest thinking related to non-healthcare impacts on health.
    • The 2015-2017 budget is comparable to 2009-2011 recession budget in terms of difficulty.
UW healthcare attorneys
WA healthcare attorneys and law students listen to speakers at Gates Hall, UW Law School.

 

Attorneys asked a host of questions about the state Exchange, including pondering how the Washington differs in leadership, funding stream, and legislative support from the now-defunct Cover Oregon.

The WSSHA Spring Health Law Conference takes place at the University of Washington (UW) Law School every year. This year’s event drew a group of roughly 120 attorneys and students of law.  Participants included Washington Supreme Court Justice Mary Fairhurst and panelists from Luvera Law Firm, Hagens Berman Sobol Shapiro, and Bennett Bigelow & Leedom, in addition to speakers from Harborview Medical Center and Seattle Children’s Hospital.

Dissecting Washington’s Regional Support Networks

Dissecting Washington’s Regional Support Networks

Any agency involved with mental health services has likely engaged a Regional Support Network (RSN) to access state and Medicaid funds. Every hospital, clinic, therapist, even homeless service provider must go through their respective RSNs in order to receive any support. These RSNs have wide-ranging authority over who receives funding, and how much they receive.

Washington state consists of 11 RSNs, operated by both public and private entities. RSNs are empowered to provide or manage everything from psychiatric care to crisis residential services, dictated by a number of different contracts with the state Division of Behavioral Health and Rehabilitation.

These contracts are public record but are not easily obtained. After several months of public record requests, State of Reform was able to obtain almost 4500 pages worth of contracts with all eleven Washington RSNs. You can access an RSN Map here.

Despite the ubiquity of RSNs in health administration, too few truly understand the nature of the relationship between the RSNs and the state while even fewer understand what outcomes and metrics to which the RSNs are held.

That is why we are providing you with not only an analysis of the different contracts, but the actual copies of the contracts themselves. Click through the menu below to find li

Primary contracts cover several areas, from direct therapeutic services, inpatient treatment, even housing in some cases. Each base contract is amended on an annual basis in order to change or introduce newly-required services or processes that the RSN must follow. The contract categories include:

Mental Health Block Grant Contracts (MHBG): The purpose of the MHBG contract is to provide services to promote recovery for seriously mentally ill (SMI) adults and resiliency for seriously emotionally disturbed (SED) children, as dictated by federal laws and regulations. Contractors are required to submit an MHBG plan, which dictates the types of services for which the RSN will be responsible. Regular progress reports are required in order to track the outcomes identified in the MHBG plan. It should be noted that while certain expectations are outlined, the special terms and conditions do not include specific methods or metrics that the RSN would use to show progress, outside of those established by the RSNs in the plan.

State Mental Health Contract (SMHC): SMHC concerns mental health services supported by state funds only. These contracts are similar to PIHP contracts in structure. Amendments to these contracts include some region-specific changes focused around local fund dispersal, among other things. The most recent amendment adds the same transfer protocol established in the PIHP contracts.

Prepaid Inpatient Health Plan Contracts (PIHP): PIHP consists of prepaid capitated payments for inpatient hospital or institutional services. PIHP contracts are more extensive than most other RSN contracts in that they go into much more detail regarding definitions, processes, and requirements. The base contract includes 17 sections and is 67 pages long not including anywhere from one to five exhibits. Amendments to PIHP contracts authorize continued funding, establish new rates, and highlight new services, such as Wraparound Intensive Services (WISe). The most recent amendment also established the RSN Transfer Protocol, which requires RSNs to establish protocols for transferring individuals to other RSNs when necessary. The referring RSN is responsible for specialized, non-Medicaid services for a period of time between six and twelve months, determined by the number of risk-factors present at the time of transfer.

Projects for Assistance in Transition from Homelessness (PATH): Services provided under PATH include case management, housing assistance and mental health services for homeless adults with a diagnosable and persistent mental or emotional impairment, including co-occurring substance use disorders. A federally-funded program with a non-federal funding match, the PATH contract authorizes an RSN to provide these services as dictated by federal regulation.

Permanent Supportive Housing (PSH): PSH is an evidence-based practice of the Permanent Options for Recovery-Centered Housing (PORCH) grant. The structure of these contracts is similar to others with the exception of its performance standards, which are much more extensive and detailed. In fact, much of the funding provided under this contract is contingent upon timely filing of reports showing progress towards outcomes identified in the contract.

All of these contracts are intended to ensure that RSNs are providing adequate mental health and supportive services for a wide spectrum of individuals, including single adults, families, children and those experiencing, or at risk of experiencing, homelessness.

While many changes are on the horizon for RSNs, maintaining a clear understanding of their roles is good practice in holding them accountable moving forward.