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This course provides an overview of the state of managed care today and discusses how and why it has evolved. It also identifies major initiatives that are currently affecting managed care and will continue to do so in the future, as the U....
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This course discusses the healthcare delivery system in the U.S. and describes how various managed care models affect the quality and cost of care. It also describes the various relationships between providers and payers. Finally, it addres...
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Course | Overview | Managed Care
This course provides an overview of cost-accounting strategies related to managed care payment and contract issues. It also explains some of the modeling tools that providers can use to evaluate managed care contracts. It presents a broad o...
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Course | Intermediate | Managed Care
This course discusses financial management, the central thread that interconnects the various elements of managed care. It explains various reimbursement methodologies commonly used in managed care and the underlying assumptions and risk ma...
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Blog | Managed Care

State public option efforts waiver in face of the COVID-19 pandemic

Blog | Managed Care

State public option efforts waiver in face of the COVID-19 pandemic

  • Washington state is planning a limited rollout of its first-in-the-nation public option later this fall, as some hospitals and health insurers say the coronavirus emergency has dampened enthusiasm for an overhaul they never truly embraced, according to the subscription-required PoliticoPro.
  • Democratic Gov. Jay Inslee in a new letter to state health officials said the administration will take a preliminary approach to the public option in its first year, and he expects it will take a multi-year effort to build up the government-run alternative to private coverage, according to PoliticoPro.
  • Earlier this month, sponsors of public option legislation in Colorado also announced that they were pulling their bill because of COVID-19.       

According to subscription-required policy intelligence platform PoliticoPro, “Washington state is planning a limited rollout of its first-in-the-nation public option later this fall, as some hospitals and health insurers say the coronavirus emergency has dampened enthusiasm for an overhaul they never truly embraced. Democratic Gov. Jay Inslee in a new letter to state health officials said the administration will take a ‘preliminary approach’ to the public option in its first year, and he expects it will take a ‘multi-year effort’ to build up the government-run alternative to private coverage. At least one leading advocate of the plan said it's unlikely the public option will be available statewide right away."

Takeaway

While COVID-19 may have “dampened enthusiasm” for the public option, I’m not sure the blame for its slow start rests solely, or even partly, on COVID-19. The Washington State public option relies on commercial plans to offer a public option product on the State’s Exchange. The plans would contract with hospitals and physicians to deliver care at rates that do not exceed 160% of Medicare for most providers. However, providers were not compelled to participate in the public option plans’ networks. Robust provider participation was probably a stretch in the best of times; in the worst of times it will be interesting to see if the public option plans will meet network adequacy requirements in all the state’s ratings areas.

In related public option news, sponsors of public option legislation in Colorado announced that they were pulling their bill earlier in May as a result of COVID-19.       

About the Author

Chad Mulvany, FHFMA,

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office.

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