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Live From HIMSS17: Former CMS Administrators Slavitt, McClellan on the Future of Value-Based Care Reform Efforts

February 20, 2017
by Heather Landi
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During a fireside chat session at HIMSS17 Monday afternoon, former Centers for Medicare & Medicaid (CMS) Administrators Andy Slavitt and Mark McClellan, M.D., Ph.D., shared their perspectives on the path ahead for healthcare reform and health policy, and the health IT industry’s role in moving healthcare forward. While they both acknowledged that there continues to be a great deal of uncertainty and challenges ahead, Slavitt, who served as CMS’ acting administrator under the Obama Administration from March 2015 until just last month, and McClellan, who served as CMS Administrator from 2004 to 2006 under President George W. Bush, both agreed that the value-based care reforms are “here to stay.”

John Kansky, CEO and president of the Indiana Health Information Exchange, moderated the discussion and asked the two former CMS administrators about their thoughts about a current hot-button issue: what will happen with healthcare reform under President Donald Trump, especially given his stated intentions to repeal and replace the Affordable Care Act (ACA)?

“There is a lot of pressure to get a repeal vote, and that could mean a lot of different things,” Slavitt said, adding that he thinks a repeal vote is more likely in the House of Representatives, yet he added that a repeal vote passing in the Senate is not as definite. “The country has moved far forward, such as with expanding Medicaid and if you repeal the ACA, you don’t just repeal the policy, you repeal the money and replacing that is very hard.”

He continued, “Hospitals that have built their lives around expansion will be very challenged. There is a lot of debate, and then coming into this, we have a new CMS administrator and a new Secretary [of Health and Human Services], and they have their own views. The main point is, people said on Nov. 9th and Nov. 10th, we will definitely have repeal, but it’s not so definite anymore and there’s an opportunity for people to be heard.”

McClellan, now the director of the Duke Robert J. Margolis, Center for Health Policy in Durham, North Carolina, said, “There is a lot of debate about how this will move forward. The Republicans have been running very consistently around a repeal platform and that didn’t come out of nowhere, it came out of fundamental issues. This is the lead issue, what the role of federal government should be, and philosophy on the size and activity of government. I agree with Andy, and I don’t know what easy and straight forward repeal legislation would look like. If I were to put money on it, the odds are still pretty good that some legislation will be passed by Congress and signed by the President that will say at the top, ‘repeal and replace,’ but what exactly the content underneath that is, is less clear. It’s going to take time to sort that out.”

“This issue is going to be with us for a while,” McClellan said, regarding the ongoing discussions about healthcare reform and repealing, replacing or reforming of the ACA. However, he added that there is an opportunity for healthcare leaders to engage in the discussions to help find a way to address some of the concerns and issues that some in the industry have about the ACA. “Republicans did have some important concerns about this. Our spending on healthcare programs, at the federal level, are very high and growing,” he said.

Kansky also asked for the panelists’ views on President Trump’s nomination for CMS Administrator, Seema Verma, who has yet to be confirmed.

“She is a very smart person. If the focus is on state-based innovation, she’s the person you bring on board. She’ll want to do productive things,” Slavitt said.

McClellan said he wrote a letter in support of her confirmation. Further, he said, “In addition to people they will bring on in the next days, weeks and months, there is a tremendous amount of capacity in the existing CMS career staff. There has been some turnover, but there are a lot of really good people who have been through different administrations and are committed to the mission of the agency. There will be continued momentum on reforms.”

Both Slavitt and McClellan agreed that, politically speaking, bipartisan work on healthcare reform and healthcare policy was needed and would be in the best interest of the healthcare system.

“We both agree that we can’t go through another cycle where one party owns it and the other party pokes holes in it. Getting both parties to the table is a recipe for success. How we get there is going to be tricky. We’ve got some entrenched sides here,” Slavitt said, adding, “But I’m optimistic. When you get out of Washington, I find that people don’t want to answer the question, do they like Obamacare? Do they like Trump? They are more interested in the question, what makes sense for improving healthcare? The big question is, can you get the politics away from this issue and focus on improvement?”

The Future of Value-Based Care

There has been significant work in the healthcare industry to implement value-based payment models and some healthcare organizations have made significant investments in this area, Kansky said, and he questioned both Slavitt and McClellan for their insights about where value-based care was headed.

“The value-based care reforms are here to stay,” McClellan replied, noting there are many factors driving the transition from fee-for-service to value-based payment, including the increasing focus on improving quality and reducing costs. Additionally, care management and care coordination “increasingly requires targeting a complex range of interventions that are not traditional healthcare that are a part of achieving quality care at lower cost.”  However, he did predict that value-based care and payment initiatives might take a different direction under the new Administration, such as more work through Medicare Advantage and more state-based efforts.

“Reform has been on the provider side so far, but the new models of care that providers are trying to implement require new efforts to make them sustainable, and a lot of these ideas applied to providers, such as shared savings, could, in theory, work on consumers too,” he said.

Slavitt noted that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation passed Congress with bipartisan support. “There will be new progress. What’s the shape of that progress and how aggressive is that progress? I think the one good way to think about health system reform is to consider different parts of the country are in different places and different parts of the journey—those out in front, those in the middle and those just beginning the journey,” he said.

“In the middle, where a lot of people are right now, and where a lot people get stuck, the best tool right now is mandatory bundles,” Slavitt said, noting that bundled payments allow hospitals to work with the post-acute community. “Price [HHS Secretary Tom Price] could back that off a bit,” Slavitt commented, referring to the new HHS Secretary nominated by President Trump and recently confirmed.

For organizations just starting the journey, he said, “The real question is, how do you move that 50 to 60 percent of communities, the rural providers, the small practices, get them their flavor of this. That’s just beginning, MACRA is the beginning of that. It will happen, slowly, carefully, those organizations don’t have the same set of resources. And, there is an opportunity for the health IT industry to make it easier for that to happen.”

Kansky then posed the question, “If you’re a hospital CEO or managing director of a physician practice and you are steering investments to prepare for value-based care, do you need to freeze or pull back from that investment?”

Slavitt replied, “Only if there is repeal.”

McClellan remarked,” The chance of just repeal legislation without some replacement is unlikely.”

To which Slavitt said, “I think if you repeal, unless you have something to slide in there, something slipped into [a reconciliation bill], unless you already have that wired in, the replacements are pretty slim.”

For hospitals investing in value-based payment models, funding will get tight, McClellan asserted, yet he said that for organizations that are making reforms and succeeding, it’s time to redouble those efforts. He added, “You might want to take a closer look at what we are learning about organizations dealing with the ‘one foot in each canoe’ problem with a culture focused on value and achieving better results at lower cost for all patients. It’s challenging, but it’s not impossible and there are a lot of examples of organizations succeeding with that now.”

Interoperability, and the Role of the Health IT Industry

On the issue of health IT, Kansky also raised the question of how much time the CMS Administrator is able to think about data and health IT.

“For me, quite a bit,” Slavitt replied, noting that CMS created the first Chief Data Officer position while he headed the agency. “I would say, for CMS today, the information we provide is equally important to how we make payments.”

McClellan said the private health IT sector and health IT innovators have been “critical for CMS progress and data systems.”

On the issue of moving data across the care continuum, Kansky asked both panelists about their perspectives on the role on non-government players, such as vendors, payers, and HIEs, to move data.

McClellan noted that the Office of the National Coordinator for Health IT has tried to increase focus on use cases and ways in which critical information is needed for valuable healthcare functions, such as managing patients and avoiding medication errors, and “that all requires data to flow.” He mentioned ONC’s Interoperability Roadmap, yet he also believes there is an opportunity and a need for more private sector leadership “to turn use case concepts into real practical results.”

Slavitt asserted there is a great deal of frustration among healthcare providers about technology and the lack of interoperability. “Primary care physicians, when asked about technology they use, they hate it. Because it’s not speeding up their lives, and, even further, they think it’s purposeful. With other technology they use, they get productivity and usefulness out of it. They think someone is purposefully screwing things up and I think they are right,” he said. According to Slavitt, CMS played a part by creating regulatory hurdles. “We reduced those regulations down, and planted the seeds to make the regulations flexible, to give the IT industry a little bit of a roadmap to talk to clients and design around their needs,” he said.

Slavitt also leveled a fair share of criticism on healthcare provider organizations. “I think the industry is still doing two things—it’s siloing data and everybody who is siloing data needs to be called out for that. It’s for business model reasons, not for technical reasons. And, the products are still not doing what physicians and patients find useful and valuable. That has to happen.”

Finally, Kansky asked Slavitt and McClellan about the feedback they have heard from providers and technology companies during their tenures at CMS and the feedback they’d like to share with audience members.

Regarding the ongoing political disagreements about the future of the ACA, McClellan asserted that healthcare leaders should look at the big picture. “We are making some meaningful progress in changing the way that we pay, so organizations that horde the data to maximize billing and revenues, that’s not a good long-term business model. We’re making progress in identifying what does work and the sustaining financial models for them and that’s increasingly good business opportunities. You don’t have to support meaningful sharing of data because you think it’s the right thing to do, but there is a sustainable business model there." He added, "Don’t get too caught up on the politics in the moment, the more fundamental trends will still be there.”

Focusing on where technology is headed, Slavitt said open APIs will “change the game” for healthcare providers. “As soon as you can build APIS to pull data out of a system, the game is going to change and you should be able to start innovating. The system that captures your data is not necessarily the system you have to work in. You will be able to capture information and take it out and put it back in in a secure way.”

Slavitt also called out health IT vendors. “[The health IT industry] is not satisfying its customers…The vast majority don’t like technology they are using. There’s an enormous opportunity to use the new openness to make things better.”


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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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