November Elections – What Does it Mean for Healthcare?

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By Todd Johnson, CEO

As someone who is very hopeful on the progress that the Centers for Medicare & Medicaid Services (CMS) has made over the last few years, I’m eyeing the November elections with a bit of caution.  At the Health Evolution Summit in April, CMS Administrator, Andy Slavitt, articulated some of the changes he’s made to CMS under his leadership.  Notably, he likened the blistering pace of regulatory announcements put forth by CMS to acting like Apple Computer releasing iPhone App Updates with a high degree of speed and flexibility.  He also recognized the fact that CMS won’t always get it right, and that if they can adopt some of the agility that Silicon Valley has brought to innovation, CMS may be able to take rapid action to correct course when things aren’t perfect.

If you look back just one year, think of all the innovation that CMS has pressed into the delivery system: advanced models for shifting primary care to value based care (Comprehensive Primary Care Plus – CPC+), launching the first ever mandatory bundled payment model (Comprehensive Care for Joint Replacement – CJR), restructuring Meaningful Use to focus on outcomes rather than activity (the Merit Based Incentive Payment System – MIPS, and Alternative Payment Models – APMs) and launching an outcomes based registry to begin to unleash quality data for the masses (the Measure Development Plan – MDP).  I think the work that has been done is both necessary and on target.  Further, I don’t think that CMS is done pushing for the necessary changes required to achieve the Quadruple Aim (cost, quality, patient satisfaction, and physician satisfaction) before the shift in administration next year.  We’ll see more innovation and regulation as the year wanes.

So what is going to happen next?  Clearly, there will be a changing of the guard in Washington, and not at just the presidential level, but also the administration at CMS.  While there has been a relentless call to defund or rollback the Affordable Care Act, these issues largely remain as talking points on headline news.  Probably the most controversial is the individual mandate for healthcare coverage.  With the increasing decline in uninsured Americans, it’s hard for anybody to argue against the benefit of increasing access and coverage for individuals. The question is, however, “How do we pay for them?”  That’s what the individual mandate, at its core, is doing.  When you dig further into the weeds of the Affordable Care Act, the real power, in my opinion, is the authority that the Secretary of Health and Human Services has been granted to accelerate payment innovation without seeking congressional approval.  Given that all of the payments being presented by CMS incorporate a 2-3% cost reduction to taxpayers, it’s hard to argue that there is any reason to not continue these programs.  Further, providers simply cannot afford to backtrack on their efforts to redesign their delivery models towards value based care.  In my opinion, both the American Hospital Association and the American Medical Association should be lobbying to increase the speed of transformation to get us ‘tipped into value’ sooner rather than prolong the awkward transition of having to support both Fee For Service and Value Based Care.

So, here are my predictions following November:

  1. Not much will change. The programs that are in flight will remain in flight.
  2. The Administrator for CMS under the new administration will become even more impactful than the sitting presidential administration in setting the country’s course on value based care.
  3. We’ll see a slowdown in regulatory moves in 2017 as the new leadership establishes their goals for the first presidential term, but the models they prescribe will fit the molds established by CJR and MIPS.  The templates for change have been set, and now it’s a function of expansion rather than invention.

Hopefully the hardworking staff at CMS has been empowered to do what is necessary to lead the country towards an ‘outcomes oriented’ delivery model.

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