Deal pending on Chartered Health Plan’s unpaid bills


Another revenue windfall for D.C. government

D.C. business owners launch new advocacy group

Jun 21, 2013, 2:14pm EDT Updated: Jun 21, 2013, 3:47pm EDT

D.C. business owners launch new advocacy group

Michael Neibauer

Staff Reporter- Washington Business Journal

The District’s small business community has a new advocate — and it’s coming out firing.

Dave Oberting, managing partner of Capstone Partners LLC, and a half dozen other D.C. business owners recently formed Economic Growth D.C., an organization focused "on increasing the rate of economic growth in the D.C. economy." The group’s 501(c)(4) application is awaiting action by the Internal Revenue Service.

"The District wants to do a lot of things and has a lot of plans, from increasing affordable housing to increasing Medicaid," Oberting told me Friday. "Our premise is that the District’s economy needs to grow faster in order to do all those things you say you want to do. We are hoping to be a catalyst to make D.C. a better place to do business, and an easier place to do business."

"Everything we do," he added, "is devoted to that purpose."

Oberting, a lobbyist headhunter by trade, reached out to the Washington Business Journal on Thursday, shortly after the D.C. auditor released a report claiming that 68 percent of District businesses are now offering their employees paid sick leave. In response to that audit, D.C. Council Chairman Phil Mendelson issued a statement accusing business owners of lying (his exact words, "they may not choose to be truthful") about their compliance with the city’s Sick and Safe Leave law.

"To just flat out call business owners liars is just shocking to me," Oberting said. "The idea of making somebody like Phil more aware that it’s the private sector that pays the bills and having him be more cognizant of that would be one of the goals for Economic Growth D.C."

As is legislative reform (in workforce development, for example) and political advocacy.

"At some point we’re going to make a determination about which of the [mayoral] candidates is the most pro-growth, and we will in all likelihood support that candidate," said Oberting, who opted to launch Economic Growth D.C. rather launching a run for political office.

Oberting’s organization will compete to a degree, he said, with the D.C. Chamber of Commerce — its money will come from the same place, businesses. Unlike the chamber, Oberting said, Economic Growth D.C. is not a membership organization. And it will generally target issues affecting small businesses, he said, where "I think the chamber sometimes has a focus on its bigger members."

Economic Growth D.C. has seven paid, part-time employees.

J.R. Meyers, president of The Meyers Group LLC (and former chief of staff to D.C. Councilwoman Yvette Alexander), is the group’s vice president of government affairs. Lisa Pinter, director of sales planning and enablement with Cisco Systems Inc., will serve as director.

Derek Ford, an independent consultant, is the compliance officer. Sara Dajani, associate attorney with Berenzweig Leonard LLP, will serve as counsel. Colby Waller, owner of Thor Design Studio, is communications director, and Sarah Massey, founder of Massey Media LLC, is press secretary.

Check out the organization’s website, and read Oberting’s blog, which has tackled the D.C. health exchange, District corruption and LivingSocial Inc., among other issues, since late May.

Michael Neibauer covers economic development, chambers of commerce, transportation and politics.

Can Trusted be trusted? D.C. Medicaid’s newest vendor still has a lot to prove to clients

Jun 21, 2013, 6:00am EDT

Health Care

Can Trusted be trusted? D.C. Medicaid’s newest vendor still has a lot to prove to clients

Ben Fischer

Staff Reporter- Washington Business Journal

Questions continue to swirl around Trusted Health Plans, one of the District’s three new Medicaid contractors that narrowly won a fight for its life in April after some D.C. politicians questioned its ability to handle the lucrative, complex business.

On June 18, it emerged that Trusted has cut ties with its would-be CEO, Sharon Baskerville, a veteran District health care activist whose reputation helped smooth the path from startup to major contractor. Trusted, a 2-year-old company whose two co-founders are based in Detroit and Los Angeles, is entering the D.C. market for the first time with this contract, sharing business worth up to $543 million with two other companies.

Further, just two weeks earlier, Kaiser Permanente — one of the country’s best known health care brands — forced it to change its name to Trusted, because the old name, Thrive Health Plans, was encroaching on Kaiser’s “Thrive” marketing campaign that dates back to 2004.

Trusted executives declined to comment.

City officials say they remain confident in Trusted, which is undergoing final testing this week to prove its operational mettle. “They’ve done a very good job in a very short period of time to get themselves ready.” said Wayne Turnage, D.C. health care finance director.

But medical industry players are not yet convinced. The last-second changes to the name and leadership ranks have come at a time when scores of hospitals and doctors are fighting to get repaid by D.C. Chartered Health Plan, the city’s previous, longtime contractor now in receivership. That, combined with a general unease about any newcomer to the Medicaid business, likely makes for a tough few weeks ahead for Trusted.

“All of these things contribute to a sense of anxiety,” said Vincent Keane, CEO of Unity Health Care, the city’s largest network of community clinics. “They may not add up to a conspiracy or anything like that, but they definitely do add up to confusion on the part of the residents who are Medicaid HMO eligible.”

A lot’s riding on a successful start to the new Medicaid contracts, which also went to AmeriHealth Caritas and MedStar Family Choice. After the collapse of Chartered, the city desperately wants privatized Medicaid to work again. The good news: Providers and patients will know within days in July if the new contractors, including Trusted, are succeeding.

Ben Fischer covers health care and law.

Gray administration backs Trusted Health Plans

Jun 18, 2013, 2:55pm EDT

Gray administration backs Trusted Health Plans

D.C. Mayor Vincent Gray

Ben Fischer

Staff Reporter- Washington Business Journal

A senior official from D.C. Mayor Vincent Gray‘s administration expressed confidence in new Medicaid contractor Trusted Health Plans on Tuesday, shortly after leaving a meeting designed to test the startup’s ability to start processing claims on July 1.

Trusted, known until recently as Thrive, has raised eyebrows in the District’s health care circles after it had to abruptly change its name because of complaints of trademark confusion from Kaiser Permanente. Also, its owners have cut ties with Sharon Baskerville, a well-known fixture in the D.C. health care community who had originally been tapped as its first CEO.

"They acquitted themselves well," said Wayne Turnage, director of the Department of Health Care Finance. "I didn’t sense any foreboding concern from CMS, and my staff seems to be pleased with what they’re hearing. They’ve done a very good job in a very short period of time to get themselves ready."

Trusted was one of three companies, along with MedStar Family Choice and AmeriHealth Caritas, to win the multimillion-dollar contracts. It beat back concerns from some D.C. Council officials who questioned whether a startup could do the complicated work of handling medical claims for Medicaid beneficiaries.

Turnage said the company’s executive team appears capable, even if it does not include Baskerville as originally planned.

"At the meeting today, there was a lot of local talent in the room, and frankly, I was impressed with who I met with, some of whom I knew and some of whom I didn’t," Turnage said. "I didn’t leave that meeting with any concerns. [My department] doesn’t get involved in any particular negotiations with vendors and their potential employees, but I did not leave that meeting feeling they did a bait and switch."

Ben Fischer covers health care and law.

Five things you should know about the D.C. health exchange

Health Care

Five things you should know about the D.C. health exchange

Joanne S. Lawton / Staff

Mila Kofman, executive director of the D.C. Health Benefit Exchange, acknowledges it’s a work in progress — but one with competitive pricing.

Ben Fischer

Staff Reporter- Washington Business Journal

We’ve invested a lot of ink and pixels on the policy side of the new D.C. Health Benefit Exchange, which culminated in a D.C. Council vote on June 4. Now that the legislating is out of the way, here’s a primer to understand it all.

1. Prepare for a small biz mandate.

Council members didn’t exactly simplify things. They voted to require small businesses with 50 or fewer workers to use the exchange starting January 2015, but did so via a temporary law that will expire several months before then. That means reopening the door to lobbying, amending and tinkering that could upend the mandate.

But the safe money’s on the mandate staying put. Opponents would have to turn at least seven out of the 13 yes votes (it was unanimous). That’s a long shot.

2. Some of you have to start using it right away.

If you buy insurance for yourself — or your company wants to start providing insurance for the first time — the mandate applies to you on Jan. 1, 2014. You could fit into those categories without knowing it. That’s because some companies are considering ending their internal health plan, paying the fine and sending workers to government exchanges. If that happens, you’ll have to use the exchange.

3. So far, it looks similar to the existing market.

Your four current options will all be available. Aetna Inc., CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare have each filed for permission to offer a combined 300 plans through the exchange, and all are participating in the business market. Only United will stay out of the individual market.

District officials had hoped to convince Maryland insurers to sell plans on the D.C. exchange, but failed.

4. No rate shock — yet.

Based on our limited information so far, the rates insurers are hoping to charge “are largely in line with current premiums for policies in the market today,” planners claim.

For instance, a business would pay about $318 per month to cover a hypothetical 40-year-old employee on a mid-tier, standard CareFirst plan. If you want to tinker with his or her benefits or try a competitor, it could cost as little as $249 or as much as $552.

5. Customer, pricing experience only comes with time.

Will the exchanges work? Will it give a good customer experience? Will the website be intuitive? Will prices stay low? None of those answers will emerge until transactions are actually being logged. “We’re at the tip of the iceberg,” said Scott Golden, a Gaithersburg insurance broker.

Exchange Executive Director Mila Kofman agrees there’s much to learn, but says she can already guarantee more options and competitive pricing.

“Those two things are tangible now,” she said.