June 4, 2014
Kevin Quigley
Secretary, Department of Social and Health Services
Dorothy Teeter
Director, Health Care Authority
VIA ELECTRONIC MAIL
Re: HealthPath Washington, Strategy 2
Dear Secretary Quigley and Director Teeter,
On behalf of the undersigned organizations representing consumers and providers, we are writing to
encourage you to delay the launch of the HealthPath Washington, Strategy 2 capitated demonstration
project. It is our understanding that a four month delay is under discussion. We encourage as long of a
delay as is necessary to ensure a smooth transition for the dually eligible population.
Each of our organizations is fully committed to the development of a demonstration project that
improves the health outcomes of the dual eligible population of King and Snohomish counties and, in
doing so, contains the cost of their care. Indeed, we believe that if done well, the demonstration project
holds the potential to improve the quality of life of these beneficiaries while also transforming the
health system in important ways. Given the slow and troubled launch for Strategy 1 we are concerned
about avoiding a similar outcome for Strategy 2.
This letter outlines our key issues of concern and areas in which we wish to see improved clarity and
progress before launch. Specifically, we would like to be certain that consumers have clear choices,
proactive enrollment assistance and ombudsman support; and that providers understand the program,
have clear information about rates and have the opportunity to join networks in time for the launch.
Clear Choices & Enrollment Assistance
There is significant confusion among beneficiaries and providers alike about the demonstration project.
We are pleased to see that an education and outreach effort is underway but within the present roll-out
timeframe, it is too little and too late. We hope that the provider and consumer facing materials and
educational forums now planned will help to clear confusion before the launch.
Our top concern is the experience of consumers as they receive enrollment information. The population
in the demonstration project is known to have lower literacy rates, higher rates of limited English
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proficiency, and the demonstration will represent a sea-change in the way they are used to accessing
and providing care. To make informed decisions, consumers need clear and easy to understand
information. We are very concerned that the draft 60 day passive enrollment letter shared with
stakeholders does not clearly indicate that potential enrollees have the option to opt out.
Communications to beneficiaries need further review and testing to ensure that they do not mislead
consumers into making decisions that will not be in their best interests.
It is our understanding that the Area Agencies on Aging and (AAA) and the State Health Insurance
Benefit Advisors (SHIBA) will receive funding to provide enrollment assistance. Will they have sufficient
funding and capacity to shoulder this new and expanded area of work? A great deal of one-on-one
personal assistance will be necessary to help beneficiaries understand the pros and cons, check if their
providers are in network and make informed decisions.
To be effective, enrollment assistance must be pro-active. Beneficiaries who do not have an advocate or
family caregiver may not have the capacity to understand the enrollment materials they receive or the
wherewithal to ask for help. They risk the danger of being passively enrolled into a health plan that does
not include in its network the nursing home, assisted living , adult family home that they reside in or
other providers they rely on. While continuity of care provisions will ease this and other potential
problems, there is the potential for grave distress for this vulnerable population. To avoid this and
similar scenarios, potential enrollees who are deemed most vulnerable or incapacitated should be
proactively contacted by an assistor (either the AAA or a SHIBA volunteer) to ensure they understand
the choice before them.
Rate Setting
Appropriate rate setting is critical to the success of the project. What is the status of the rate setting
process? Our concern is that rates be finalized in time for providers to make informed decisions about
whether or not to join a network and in time for consumers to know whether or not their provider is
included in a plan being marketed to them. There are many steps involved in ensuring that plans have
adequate provider networks, beginning with rate setting. It is critical that there be sufficient time to
complete this complex process, even if doing so requires a further delay of the launch.
Incentives must be put in place to make it financially feasible for providers to furnish services to
beneficiaries, particularly those with the most complex medical and nonmedical needs. We would like
assurances that the rate calculations and associated savings targets are not overly ambitious and
arbitrary and do not create incentives to cherry pick or deny care. We do not have enough information
about the basis for selecting the savings targets, but we are concerned that the upfront savings
requirements put undue financial pressure on plans and place beneficiaries at unnecessary risk. Further,
it’s critical that the demonstration take advantage of important mitigation strategies, such as risk
corridors and reinsurance, to reduce the risk to beneficiaries.
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Networks - Plan Readiness
We understand that the readiness review is underway, that the state and CMS have completed the desk
review and that they have sent letters to plans describing deficiencies. While we are not privy to the
details of these deficiencies, we believe they are significant. Indeed, there is a high level of anxiety
within the consumer advocate and provider communities that the plans are unable to demonstrate the
readiness, capacity, and competency to care for dually eligible individuals, and that they will be unable
to do so in time for a successful launch.
Specifically, we are concerned that the plans’ provider networks are still largely inadequate and will be
unable to offer timely and accessible care that meets this population’s often complex needs. Continued
uncertainty about rates and the diffuse nature of the long term care system are both challenges. We are
concerned that a large number of small LTSS providers including hundreds of Adult Family Homes in King
and Snohomish County are not yet informed about or likely to be included in the demonstration project.
Finally, we fear that the plans lack the capacity and competence to conduct the required comprehensive
health assessments, provide care coordination and develop health action plans that are thoughtful,
thorough, and appropriate.
Ombudsman Program
While we are pleased that the state applied for funds to create an ombudsman program for HealthPath
Washington, we are concerned that the level of funding and the payment structure will hamper the
program’s ability to provide independent, well-coordinated, and effective advocacy. The funding
awarded to the state is less than half of what was requested and will simply not cover the basic
infrastructure, training and materials development costs necessary to create an effective program and
serve the anticipated number of individual calls. Further, the payment structure of the program
requiring piece-meal reimbursement for services is unreasonable and unsustainable. A workable
ombudsman program must be in place before the demonstration begins in order to assist enrollees right
from the start.
Thank you for delaying the launch of Strategy 2 and for listening to our concerns. We ask for your
response on the issues raised and urge you to take as much time as is necessary to ensure a smooth
transition for King and Snohomish County dual eligible beneficiaries. A four month roll back of current
program deadlines is likely to be insufficient to complete an enormous amount of work and address the
range of challenges that this project presents. We ask that you consider a longer delay. Again, we
support this effort and strongly encourage you to delay as needed to set the duals eligible
demonstration on the right course and assure its success.
Sincerely,
Bob Le Roy, Executive Director, Alzheimer’s Association Western and Central Washington Chapter
Daniel S. Gross, Senior Staff Attorney, Northwest Health Law Advocates
Deb Murphy, CEO, LeadingAge Washington
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Eric Erickson, President, Washington Home Care Coalition
Hilke Faber, Founder/Advocacy Coordinator, Resident Councils of Washington
Ingrid McDonald, Advocacy Director, AARP Washington
Jerry Reilly, Chair, ElderCare Alliance
Jim Freeburg, Advocacy Director, National Multiple Sclerosis Society, Greater Northwest Chapter
John Ficker, Executive Director, Washington State Residential Care Council
Maria Britton-Sipe, Executive Director, Retired Public Employees Council of WA
Mark Stroh, Executive Director, Disability Rights Washington
Misha Werschkul, Legislative and Policy Director, SEIU Healthcare 775NW
Patricia L. Hunter, MSW, Washington State Long-Term Care Ombudsman
Robin Dale, President and CEO, Washington Health Care Association
Teresa Mosqueda , Government Affairs Director, WA State Labor Council, AFL-CIO
Walt Bowen, Presiden, Washington State Senior Citizens' Lobby
CC: Maryanne Lindeblad, Bill Moss, Jane Beyer, Karen Fitzharris
Bob Crittenden, Jason McGill
Senator Randi Becker, Representative Eileen Cody, Senator Bailey, Representative Tharinger
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