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BREAKING: CMS Officials Unveil Highlights of New MACRA Quality Payment Program In a Press Conference

October 14, 2016
by Mark Hagland, Rajiv Leventhal, and Heather Landi
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CMS officials on Friday morning offered the press their comments on the new Quality Payment Program

In a press conference on the morning of Oct. 14, senior officials at the federal Centers for Medicare and Medicaid Services (CMS) discussed the details of the new final rule that the agency had just released on its website, for the finalized and highly anticipated finale rule for the provisions of the new Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Final Rule, which has been finalized by the Department of Health & Human Services (HHS). The MACRA legislation, passed in the spring of 2015, replaced the provisions of the Sustainable Growth Rate (SGR) formula for physician payment under Medicare that had been prevailing for years.

(For an analysis of some of the provisions of the final rule, please turn to this article by Healthcare Informatics Senior Contributing Editor David Raths.)

Three senior federal healthcare officials spoke at the telephonic press conference. First to speak was Kristie Canegallo, White House Deputy Chief of Staff for Implementation in the Obama administration. “I want to talk briefly about the President’s enthusiasm for the work represented in the final MACRA rule,” Canegallo said. “Today’s announcement is an important step in this Administration’s commitment to improving quality, affordability and accessibility of US healthcare system. Most of you know that this Administration has worked aggressively to move our healthcare system to one that provides better patient care, spends taxpayer dollars in a smarter way and ultimately leads to healthier individuals, healthier communities and a healthier nation.” Referencing a speech given on Thursday by President Barack Obama, she said, “As you may have heard him talk about just yesterday when we were in Pittsburgh at the Frontiers conference, [the President] spoke about the imperative of incentivizing our healthcare system to look holistically at patients and moving that system to one that provides the right incentives to doctors to think this way.”

Canegallo went on to note that, “Thanks to the incentives in the ACA, hospital-acquired conditions have fallen 17 percent since 2010, saving 87,000 lives and $20 billion in healthcare costs. Over 75 percent of physicians and 95 percent of hospitals have adopted and are using electronic health records. And, 30 percent of Medicare payments are in alternative payment arrangements.”

After Canegallo had concluded her comments, CMS Acting Administrator Andy Slavitt then spoke at length about the philosophy and strategy behind the development of the final rule, saying that “This is a landmark effort to move the healthcare system forward. The Medicare program not only serves 55 million people and works with the vast majority of the nation’s clinicians, but it’s also a promise to the millions of taxpayers, including the 10,000 people who turn 65 every day, to be here when we need it. So transforming something of this size is something that we focused on with great care,” he said.

Slavitt continued, saying that “The policy we’ve finalized is the result of a user-driven policy effort, where our staff put down our pens and went into the field to hear from physicians and patients. Overall, many of us traveled the country and received more than 4,000 comments on our proposed rule, and nearly 100,000 people attended our outreach sessions. This was a good opportunity for us to understand the realities of practices today and what we can do to best support care for their patients, how Medicare and other payers interact with their daily practice, how much time they spend on reporting requirements and how burden takes time away from the practice of medicine.”

Highlighting what he considers to be key elements of the final rule, Slavitt said, “First of all, physicians will be able to pick their own pace of beginning to participate in the program and decide how to gradually increase their involvement in the first several years. We will continue to take comment on the rule so that we can make sure that the program evolves as the healthcare system evolves.  Second, we’re offering choices to allow physicians to tailor many elements of the program for their specialty and even their practice.”

In fact, he noted, “Based on significant feedback on how physicians want to interact with the program, we’ve launched today a new one-stop shop portal and service center. The portal, which is at qpp.cms.gov, is designed side by side with physicians and with CMS and the great technology team at U.S. Digital Services, the same team that worked on the relaunch of healthcare.gov. We heard critical feedback to make it easier for physicians to join advanced payment models [APMs], which are locally formed, physician-led approaches to care delivery, like medical homes and bundled payments that pay a 5 percent bonus under MACRA. So, the CMS Innovation Center undertook a number of steps.”

Among other elements, Slavitt noted, “We’re announcing today that we will be adding a significant new option in 2018 that will appeal to smaller practices, called ACO Track 1. It will have lower levels of risk to qualify as an advanced payment model. We’re now in the middle of reviewing and opening other popular models in the CMS Innovation Center to be announced shortly. The Innovation Center is also developing opportunities for specialists to participate in advanced APMs. As already announced, we are opening up episode-based models in cardiology and orthopedics to count as advanced APMs, in addition to the oncology and nephrology models that the Innovation Center has already developed.”

In that context, Slavitt said, “In 2018, we expect approximately 20 percent of physicians to participate in an advanced APM and expect that to be on a significant growth trajectory. The Innovation Center and the ability that it has to move quickly and expand models we make advanced APMs available to most interested physicians over the next several years.”

What’s more, Slavitt said, “We’ve also received feedback to simplify how the scorekeeping, the rules, and the reporting work in what is known as the MIPS program, which is the program that will determine bonus payments in the core Medicare program, so that physicians can focus on patient care, not paperwork. We’ve made major steps, which will continue over the coming year, by cutting the number of measures in half, and simplifying how the program works.” In addition, he said, “We announced a major permanent effort yesterday to reduce physician burden. And, in 2017, we estimate that we will pay approximately $1 billion in bonuses for high-quality care to commissions in both advanced APMs and MIPs, in addition to positive payment adjustment of 0.5 percent, under MACRA.”

In all this, Slavitt said, “The bottom line is we’re trying to get doctors back to doing what they do best, care for patients, through a lot of simplification and support. We view the coming years as just the first steps into a program that will continue to improve, not an attempt to create a perfect system.”

Then Slavitt turned the microphone over to CMS Principal Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., who shared some more granular information with the telephonically assembled press. “First of all,” Dr. Conway said, “very few things change for physicians in the first year, other than a 0.5 percent positive payment adjustment. If you participate in an advanced APM, that continues. If you don’t, many more options are becoming available. If you participate in the standard Medicare quality reporting and HER incentive programs, you will find those programs got far simpler with MIPS. And if you see Medicare patients but have never participated in a quality program, there are a number of paths to choose from to get you started, you can pick your pace.”

With regard to the burden on physicians in smaller practices, Conway said, “We understand in particular the challenge any changes and any burden that is placed on smaller and independent practices. That’s why we include important support for physicians and other clinicians, especially for smaller practices and those in rural areas or serving vulnerable patients. We know small practices can provide the same high-quality care as larger ones and can be just as successful in MACRA. Based on a lot of feedback we received, we made a number of adjustments.” He noted the following broad changes:

>  reducing the time and cost to participate

>  raising the threshold to exclude more small practices

>  increasing the number of APMs available to small practices, including the new ACO Track 1+ and CPC Plus, both of which will provide opportunities for small practices to join

>  allowing practices to begin participation based on their own pace

>  allowing the qualification for participation in advanced APMs to be revenue-based, based on the practice, rather than total cost-of-care-based

>  conducting significant technical support and outreach to small practices, using $20 million per year over the next five years

“We have updated our assumptions from our original proposal, where we estimated that many small practice physicians would only participate in QPP at the same level of participation in the precursor PQRS program to a rate closer to that of all other practice sizes.” Following these adjustments, Conway said, “We think the vast majority of small practices can succeed.”

Conway went on to say, “II would also add that in addition to the positive payment adjustment that as Andy said, we expect to award approximately $1 billion in additional Medicare payments to clinicians for providing high quality care in the first payment year of the program. And we made avoiding negative adjustments incredibly easy. In summation,” he said, “today’s rule protects small practices, reduces administrative burden and jumpstarts all of our desires to transform our healthcare system that supports healthier people and value.”

With regard to the forward evolution of the Quality Payment Program, Conway said that “We all recognize that that this will be a gradual implementation and involve a lot more listening and learning and adjusting along the way. We fully intend to keep the lines of communication open. We want to get this right. We want to partner with physicians and other clinicians across the country to achieve smarter spending, better care and better health for all people.”

Former National Coordinator Mostashari shares some initial thoughts

Shortly after the final rule had been posted to the CMS website, Farzad Mostashari, M.D., founder of Aledade, a company that focuses on physician-led accountable care organizations (ACOs), and former National Coordinator for Health IT, shared some initial thoughts with Healthcare Informatics. According to Dr. Mostashari, the single most important part of today’s final rule revolves around the changing one of the qualifications for participation in advanced APMs to be practice-based as an alternative to total cost-based. Mostashari takes particular interest in how CMS redefined what counts as “nominal risk,” stating that, given how the proposed rule had been outlined, participating physicians would have to take on total cost of care downside risk, meaning payments to Medicare totaling millions of dollars. For small and solo practices, this was considered detrimental to their independence.

But Mostashari says that’s no longer the case. “The most significant thing they did was create a smart way of defining what nominal risk was based on your income for Medicare Part A and Part B,” he says. So it starts at 8 percent and goes up to 15 percent, meaning if more than that number of your Medicare revenue is at risk, in a two-sided risk model, then that is more than nominal risk for you. This will absolutely shift the equation in terms of how many doctors will be in advanced APMs and out of MIPS,” he says. Indeed, previous estimates had 5 percent of eligible Medicare physicians patriating in the APM path early on—a small estimation that Mostashari says “was generous”—and now CMS has said that as soon as 2018, as many as 250,000 doctors could be in the APM track. “This is right; we want physicians to be focused on outcomes, not checking boxes,” he says.

Core to this is CMS’ new ACO Track 1+ model to begin in 2018, which the agency said has lower levels of risk than other ACOs. According to the final rule, the model would be voluntary for ACOs currently participating in Track 1 of the Shared Savings Program or ACOs seeking to participate in the Shared Savings Program for the first time.  It would test a payment model that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Shared Savings Program but sufficient financial risk in order to be an advanced APM. Mostashari says “separate rulemaking will be required to create this program.”

 

 

 


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CMS: 93% of Clinicians Get Positive Payment Adjustments for MIPS Year 1

November 8, 2018
by Rajiv Leventhal, Managing Editor
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Ninety-three percent of MIPS (Merit-based Incentive Payment System)-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment, according to a CMS (Centers for Medicare & Medicaid Services) announcement today.

The first year of MIPS under MACRA’s Quality Payment Program (QPP) was dubbed by CMS as a “pick your pace year,” which essentially enabled clinicians to avoid payment penalties as long as they submitted at least the minimum amount of quality data. As such, in its announcement, CMS did admit that the overall performance threshold for MIPS was established at a relatively low level of three points, and the availability of “pick your pace” provided participation flexibility through three reporting options for clinicians: “test”, partial year, or full-year reporting.

CMS said that 93 percent of MIPS-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment. CMS specifically calculated that approximately 1.06 million MIPS-eligible clinicians in total will receive a MIPS payment adjustment, either positive, neutral, or negative. The payment adjustments for the 2017 program year get reflected in 2019.

Breaking down the 93 percent of participants that received a positive payment adjustment last year, 71 percent earned a positive payment adjustment and an adjustment for exceptional performance, while 22 percent earned a positive payment adjustment only. Meanwhile, just 5 percent of MIPS-eligible clinicians received a negative payment adjustment, and 2 percent received a neutral adjustment (no increase or decrease).

Of the total population, just over one million MIPS-eligible clinicians reported data as either an individual, as a part of a group, or through an Alternative Payment Model (APM), and received a neutral payment adjustment or better. Additionally, under the Advanced APM track, just more than 99,000 eligible clinicians earned Qualifying APM Participant (QP) status, according to the CMS data.

CMS Administrator Seema Verma noted on the first pick-your-pace year of the QPP, “This measured approach allowed more clinicians to successfully participate, which led to many clinicians exceeding the performance threshold and a wider distribution of positive payment adjustments. We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.”

For 2018, the second year of the QPP, CMS raised the stakes for those participating clinicians. And in the third year of the program, set to start in January 2019, a final rule was just published with year three requirements. Undoubtedly, as time passes, eligible clinicians will be asked for greater participation at higher levels. At the same time, CMS continues to exempt certain clinicians who don’t meet a low-volume Medicare threshold.

Earlier this year, CMS said that 91 percent of all MIPS-eligible clinicians participated in the first year of the QPP, exceeding the agency’s internal goal.

What’s more, from a scoring perspective in 2017, the overall national mean score for MIPS-eligible clinicians was 74.01 points, and the national median was 88.97 points, on a 0 to 100 scale. Further breaking down the mean and median:

  • Clinicians participating in MIPS as individuals or groups (and not through an APM) received a mean score of 65.71 points and a median score of 83.04 points
  • Clinicians participating in MIPS through an APM received a mean score of 87.64 points and a median score of 91.67 points

Additionally, clinicians in small and rural practices who were not in APMs and who chose to participate in MIPS also performed well, CMS noted. On average, MIPS eligible clinicians in rural practices earned a mean score of 63.08 points, while clinicians in small practices received a mean score of 43.46 points.

Said Verma, “While we understand that challenges remain for clinicians in small practices, these results suggest that these clinicians and those in rural practices can successfully participate in the program. With these mean scores, clinicians in small and rural practices would still receive a neutral or positive payment adjustment for the 2017, 2018, and 2019 performance years due to the relatively modest performance thresholds that we have established. We will also continue to directly support these clinicians now and in future years of the program.”

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HHS Secretary Azar: HHS Is Planning New Mandatory Bundled Payment Models

November 8, 2018
by Heather Landi, Associate Editor
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The Centers for Medicare & Medicaid Services (CMS) is revisiting mandatory bundled payment models, possibly for radiation oncology and cardiac care, according to Health and Human Services Secretary Alex Azar, which signals a strong about-face in the Trump Administration’s policy about bundled payment initiatives.

HHS is reexamining the role that mandatory bundled payment models can play in the transition to value-based care, Azar said in a keynote speech at the Patient-Centered Primary Care Collaborative Conference on Thursday. HHS published Azar’s comments.

In the published remarks, Azar said the Trump Administration is revisiting mandatory bundled payments and exploring new voluntary bundled payments as part of the Administration’s goal of paying for outcomes, rather than process.

“We need results, American patients need change, and when we need mandatory models to deliver it, mandatory models are going to see a comeback,” Azar said.

In his speech, Azar said, “Imagine a system where physicians and other providers only had to worry about the outcome, rather than worrying about their staffing ratios and the individual reimbursements for every procedure they do and every drug they prescribe. That kind of payment system would radically reorient power in our healthcare system—away from the federal government and back to those closest to the patient.”

He continued, “One way we can do that is through bundling payments, rather than paying for every individual service. This is an area where you have already seen testing from CMMI for several years now—and I want to let you know today that you are going to see a lot more such ideas in the future.”

Azar highlighted the Bundled Payments for Care Improvement (BPCI), which, he said, has shown significant savings in several common inpatient episodes, including joint replacement and pneumonia.

During his speech on Thursday, Azar said, “I want to share with all of you for the first time today: We intend to revisit some of the episodic cardiac models that we pulled back, and are actively exploring new and improved episode-based models in other areas, including radiation oncology. We’re also actively looking at ways to build on the lessons and successes of the Comprehensive Care for Joint Replacement model.

“We’re not going to stop there: We will use all avenues available to us—including mandatory and voluntary episode-based payment models,” he said.

One industry group, the American Society for Radiation Oncology (ASTRO), already has voiced concerns about a mandatory payment model. In a statement issued Thursday afternoon, Laura Thevenot, CEO of ASTRO, made it clear that the organizaiton strongly supports a radiation oncology alternative payment model (RO-APM). "ASTRO has worked for many years to craft a viable payment model that would stabilize payments, drive adherence to nationally-recognized clinical guidelines and improve patient care. ASTRO believes its proposed RO-APM will allow radiation oncologists to participate fully in the transition to value-based care that both improves cancer outcomes and reduces costs."

Thevenot said ASTRO has aggressively pursued adoption of this proposed model with the Center for Medicare and Medicaid Innovation (CMMI). However, Thevenot said the group has concerns "about the possibility of launching a model that requires mandatory participation from all radiation oncology practices at the outset."

Further, Thevenot said any radiation oncology payment model will represent "a significant departure from the status quo." "Care must be taken to protect access to treatments for all radiation oncology patients and not disadvantage certain types of practices, particularly given the very high fixed costs of running a radiation oncology clinic," Thevenot stated.

Back in January, CMS announced the launch of the voluntary BPCI Advanced model, noting that it “builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value.” The BPCI Advanced model includes more than 1,000 participants that are receiving episode-based payments for over 30 clinical areas, Azar said.

“BPCI Advanced is a voluntary model, where potential participants can select whether they want to join. But we’re not going to stick to voluntary models. Real experimentation with episodic bundles requires a willingness to try mandatory models. We know they are the most effective way to know whether these bundles can successfully save money and improve quality,” Azar said.

The Obama Administration introduced mandatory bundled payment for care for heart attacks and for cardiac bypass surgery in July 2016.

In the past, CMS Administrator Seema Verma has said that she does not support making bundled payments mandatory, and former HHS Secretary Tom Price, M.D. had strongly opposed mandatory bundles, going so far as to direct the end of two mandatory bundled payment programs—one existing and one previously announced. In November 2017, CMS finalized a rule, proposed in August 2017, that cancelled mandatory hip fracture and cardiac bundled payment models.

As per that final rule, CMS also scaled back the Comprehensive Care for Joint Replacement Model (CJR), specifically reducing the number of mandatory geographic areas participating in CJR from 67 areas to 34 areas. And, in an effort to address the unique needs of rural providers, the federal agency also made participation voluntary for all low-volume and rural hospitals participating in the model in all 67 geographic areas.

On Thursday, Azar acknowledged that his statements signaled HHS was reversing course on its previous stance, noting that last year the administration reduced the size of the CJR model and pulled back the other episode payment models, including those on cardiac care, before they could launch.

Azar, who was confirmed as HHS Secretary earlier this year, signaled early on that he diverged from Verma and Price on his views about mandatory bundled payments. During a Senate Finance Committee hearing in January on his nomination for HHS Secretary, he said, on the topic of CMMI [the Center for Medicare and Medicaid Innovation] pilot programs, “I believe that we need to be able to test hypotheses, and if we have to test a hypothesis, I want to be a reliable partner, I want to be collaborative in doing this, I want to be transparent, and follow appropriate procedures; but if to test a hypothesis there around changing our healthcare system, it needs to be mandatory there as opposed to voluntary, then so be it.”

During his speech Thursday, Azar pointed to the Administration’s first mandatory model, which was unveiled two weeks ago, called the International Pricing Index (IPI) Model for payments for Part B drugs. Azar said the model is a “mandatory model that will help address the inequity between what the U.S. and other countries pay for many costly drugs.”

Further, Azar said CMMI also will launch new primary care payment models before the end of the year, with the aim of introducing a spectrum of risk for primary care providers, Azar said.

“Before the end of this year, you will see new payment models coming forth from CMMI that will give primary care physicians more flexibility in how they care for their patients, while offering them significant rewards for successfully keeping them healthy and out of the hospital,” he said.

“Different sizes and types of practices can take on different levels of risk. As many of you know, even smaller practices want to be, and can be, compensated based on their patients’ outcomes,” he said. “We want to incentivize that, with a spectrum of flexibility, too: The more risk you are willing to take on, the less we’re going to micromanage your work.”

Azar also noted HHS’ efforts to examine impediments to care coordination, such as examining the Stark Law, the Anti-Kickback Statute, HIPAA, and 42 CFR Part 2. CMS has already launched and concluded a request for information on the Stark Law, and the Office of the Inspector General has done the same on the Anti-Kickback Statute, he noted.

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Dr. Sanjay Gupta’s Heartening Speech at CHIME18 Should Inspire U.S. Healthcare Leaders

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The story of an Amazonian tribe could serve as a motivational lesson for U.S. healthcare stakeholders

It was inspiring to hear Sanjay Gupta, M.D., the well-known neurosurgeon and medical reporter, give the closing keynote at the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego last week. Dr. Gupta, who serves as associate chief of the neurosurgery service at Grady Memorial Hospital in Atlanta, while also best known as CNN's multiple Emmy Award-winning chief medical correspondent, discussed the fascinating balance that he strikes between medicine and media.

“Oftentimes, I see people at their best, and sometimes at their worst. I get to travel the world, where I learn so much, but also teach others. Sometimes the dance between medicine and media can be awkward and emotionally challenging. But almost always, the stories we do have a significant impact,” Gupta told the Fall CIO Forum attendees.

What was perhaps most captivating about Gupta’s speech was when he spoke about visiting a primitive Amazonian tribe that appears to have the best heart health in the world. The Tsimane people of Bolivia do not speak a language, live a simple existence, and are disease-free, explained Gupta. So he went to visit the tribe with the goal to understand its lifestyle and what led to its members having such healthy hearts.  

Sanjay Gupta, M.D.

“I went spearfishing with one [tribe member], who thought he was 84-years-old, but he really didn’t know for sure. His shirt was off, and he was ripped, balancing himself on the canoe, just looking at the water, spearing fish. His eyesight was perfect. The entire indigenous tribe was just like this,” Gupta recalled.

After examining the Tsimane tribe’s diet, Gupta noted it was a hunter-gatherer society, meaning there was nothing technological. “The most mechanical thing I saw was a pulley for the well,” he said. Seventy percent of what they eat is carbohydrates—unrefined and unprocessed—while 15 percent of their diet is protein, and 15 percent fat, he added. “You need farmed food because oftentimes you don’t have successful hunting days, so the farmed food was the food in the bank. And they would do intermitting fasting, too. These are the people with the healthiest hearts in the world,” Gupta exclaimed.

When it comes to activity, when hunters are hunting, they’re never outrunning their prey, but rather outlasting it, noted Gupta. “We found that they walked about 17,000 steps per day. But they didn’t run; they only walked. They are active, but not intensively active. They also hardly every sit—they are either lying or standing all the time. And they would get nine hours of sleep per night, waking up to the rooster’s crow. There are no devices. Again, these are the people who have the healthiest hearts in world. They don’t have a healthcare system and don’t spend a dollar on healthcare,” Gupta stated.

What’s even more interesting about this tribe is that each of its members lives with some degree of a parasitic infection, which they usually get it early in life, have a few days of illness, and then just live with these parasites in their bodies for their entire lives. “The belief is that so much of the disease we talk about—that leads to this $3.3 trillion price tag [the total cost of U.S. healthcare spending in 2016]—is actually ignited or worsened by our immune systems. So the parasitic infections could be part of the reason they are protected from all types of diseases,” Gupta offered.

Essentially, it’s living this basic, undeveloped life that “inadvertently provides them extraordinary protection against heart disease,” noted a report in HealthDay last year. “Thanks to their unique lifestyle, most Tsimane [members] have arteries unclogged by the cholesterol plaques that drastically increase the risk of heart attack and stroke in modern Americans,” Gregory Thomas, M.D., medical director of the Memorial Care Heart & Vascular Institute at Long Beach Memorial, in California, said in that report.

Tsimane tribe (source: University of New Mexico)

You might be asking what the story of the Tsimane tribe has to do with U.S. healthcare since its lifestyle would obviously never be replicated in a developed country. And while that is true, it’s tough to ignore the $1 billion per day that our healthcare system spends on heart disease—compared to the Tsimane tribe that doesn’t spend a single dime, yet has the healthiest hearts in the world.

In this sense, perhaps we can use the Tsimane story to push ourselves to develop a greater understanding of why we spend so much money on healthcare and don’t have the results to show for it. Gupta asked this $3.3 trillion-dollar question in his speech—why does healthcare in the U.S. cost so much and what do we get in return?

“If you look at the statistics, it’s not impressive. More people die from preventable disease in the U.S. than in 12 other nations. People live longer in 30 other countries compared to the U.S.—including places like Chile and Costa Rica. We still have tens of millions of people who don’t have access, and we still spend all this money on healthcare. Why?” he asked.

Gupta explained that the nation’s high healthcare costs come down to the following: high administrative costs, technology, new drugs and development, and the cost of chronic disease—the last which is incredibly self-inflicted. About 70 to 80 percent of chronic disease is self-preventable, he said.

Indeed, as most of us know, about 5 percent of the U.S. population accounts for 50 percent of the healthcare costs. These are folks who are defined by illness, not by health, Gupta stated. This is why the modern-day healthcare system has proactively taken to targeting that 5 percent to improve their chances of preventing disease and staying healthy. “Data shows that home visits, nutritional counseling, one-on-one coaching, and diligent follow-up care can go a long way in preventing someone from getting sick in the first place, and from turning a disease into something more chronic. Some of these interventions can actually reverse disease. The die is not cast,” Gupta said.

For me, Gupta’s keynote highlighted the need for efforts around value-based care, care management, and population health to be intensified. A big part of that, as noted in the speech, is addressing patients’ social and environmental factors. It’s not at all surprising to see studies such as this one from earlier this year, conducted by researchers at the University of South Florida (USF) College of Public Health, Tampa, and WellCare Health Plans, and published in Population Health Management, which found that healthcare spending is substantially reduced when people are successfully connected to social services that address social barriers, or social determinants of health, such as secure housing, medical transportation, healthy food programs, and utility and financial assistance.

And with that, there is also an enormous opportunity for data and IT to play a role. Information sharing, so that providers have access to the right information at the point of care—no matter where the patient is—will be critical to reducing unnecessary costs. As will the robust use of data analytics, so that patient care organizations can be proactive in predicting which patients are at highest risk, when they might need services, and how to intervene at the appropriate time.

But to this point, Gupta, who noted that our society can get too caught up in high-tech, also suggested that “medicine seems to play by slightly different rules when it comes to innovation as opposed to other sectors. Sometimes, innovation moves painstakingly slow in respect to medicine.” At the end of the day, he said, it will be “the innovations that make us, [as a society], healthier, happier, and connect us in frictionless ways, that will be the biggest winners.”

So, will the U.S. population suddenly turn off their iPhone alarms, wake up to the rooster’s crow, and become a hunter-gatherer society? No, I would say that’s quite unlikely to happen. But hearing stories such as the one of the Tsimane tribe might just serve as good enough motivation to bring down the astronomical and unsustainable costs of U.S. healthcare.

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