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.
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