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What Impact will Trump’s Victory Have on Value-Based Healthcare?

November 9, 2016
by Rajiv Leventhal and Heather Landi
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Healthcare IT experts weigh in on key policy issues moving forward as Republicans take both executive and legislative branch control

With the stunning presidential election upset Tuesday night, Donald Trump will become the 45th president of the United States while Republicans maintained control of both the U.S. House and Senate. Indeed, the transition to a Republican administration and a Republican-controlled Congress come January will require the health IT industry to consider the short and long-term implications for healthcare policy and health IT-specific polices.

What are the prospects for healthcare legislation in Congress during the lame duck session? With a Republican-controlled Congress beginning in 2017, how will the landscape for legislative activity change? What will be President-elect Trump’s healthcare policy priorities and how will that impact health IT initiatives? Healthcare Informatics spoke with health IT industry associations and policy leaders Wednesday morning to get a sense of how the industry is assessing the impact of the election on healthcare policy and initiatives.

In the near-term, progress on health IT legislation, such as the 21st Century Cures Act, during the lame duck Congressional session will be a key focus, according to Tom Leary, vice president of government relations at the Chicago-based Healthcare Information and Management Systems Society (HIMSS).

“With the House and Senate maintaining Republican majorities, we have a pretty good sense of what their priorities were for this year and what will roll over into 2017. I think what we’re trying to reassess this morning is what will be the priorities during the lame duck and whether health IT and healthcare is part of it, or if a newer version of the Cures bill gets reintroduced in January 2017. As of yesterday, we were thinking it was primed to be moved in the lame duck in the Senate and then reconciled with the House and then to the President’s desk before the holidays, and we’re trying to reassess that today. So the next 48 hours or so will be telling for us,” he says.

He continues, “I do believe that the House and Senate are still are very much interested in ensuring the U.S. maintains its high level of superiority in biomedical research and the tenants of the Cures Act, whether it’s passed now or a newer version comes up in the new year, is really to keep the U.S. at the forefront of biomedical research, well into the 21st century. That’s bipartisan and bicameral, that’s a national priority.” He also expects a Trump administration and a Republican-controlled Congress will continue to move forward healthcare-related initiatives such as the Precision Medicine Initiative and Vice President Biden’s Cancer Moonshot.

There is a great deal of uncertainty about President-elect Trump’s specific healthcare priorities and policy platforms, yet during his acceptance speech early Wednesday morning, Trump promised to improve several aspects of the national landscape, including hospital infrastructure.

“We are going to fix our inner cities and rebuild our highways, bridges, tunnels, airports, schools, hospitals. We’re going to rebuild our infrastructure, which will become, by the way, second to none. And we will put millions of our people to work as we rebuild it. We will also finally take care of our great veterans,” Trump said during his victory speech.

Leary continues, “He’s [Trump has] also talked about telehealth for veterans in his speeches and last night in his victory speech, he talked about healthcare and hospitals, as part of restoring a strong infrastructure within the U.S. So I would anticipate that his telehealth for veterans is not just a veteran’s issue but that he’ll utilize telehealth as a way to address some of the access needs whether it’s rural or urban communities that could equally benefit from telehealth services.” And, he says, “The other thing we’ll be looking at, is what his stance is going to be on standards development and innovation? So we’ll be looking very closely at those types of issues.”

Obamacare’s Future

On the campaign trail, President-elect Trump also spoke about repealing the Affordable Care Act (Obamacare), which would mark a significant shift in healthcare policy, and would have some implications for health IT, Leary says.

“We know it’s not as simple as pulling the plug on the legislation,” Leary says. “Depending on the outcome of two seats that are still up in the air, it’s still a very tight Senate, so being able to pass a sweeping repeal of Obamacare may not be as simple, procedurally, as the campaign trail might lead people to believe. But I think most importantly, and it’s not necessarily a health IT component, but what is the solution that’s going to cover those 22 million that are now insured, keep them insured, in the new plan?”

When asked about the repealing of Obamacare, Jeffrey Smith, vice president of public policy at the American Medical Informatics Associations (AMIA), says that one of the things that will hit Washington D.C., at some point very soon—if it hasn’t happened already— is a “holy crap, we’re in charge now” realization on the part of Republicans. “What that will do is force people to move from talking points and get into the details of policy. They will find that this is an incredibly tightly wound ball of yarn and we cannot pull on one string and unravel it all,” Smith says.  

Additionally on the potential repeal of Obamacare, Leslie Krigstein, vice president of congressional affairs, College of Healthcare Information Management Executives (CHIME), cautions folks to remember that the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act are two different pieces of legislation, which would keep regulations like Meaningful Use separate. “It would be very hard to just ‘turn it off,’” she says, referring to healthcare policies that are already baked in. “You also have tens of millions of Americans reliant on healthcare. But for health IT implications, it will cause a distraction,” she predicts.

Health IT Implications

With regard to healthcare regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA), Leary does not anticipate any fundamental changes under a Trump administration.

“From a health IT perspective, MACRA was passed on a very strong bipartisan basis to move us towards value-based reimbursement and care delivery, so I fully anticipate that the foundational needs of healthcare with respect to the needs of health IT—to be interoperable so that quality metrics can be reported and patient information on the right patient gets to the right provider at the right time—those are still going to be priorities in any changes to overall healthcare policy, so we really have to continue to deliver on making interoperability more and more of a reality,” he says.

Smith agrees with Leary that larger value-based federal healthcare programs such as MACRA won’t be significantly changed, though certain provisions of the law’s Quality Payment Program could be “re-envisioned” in what Smith predicts “could be a shift towards more de-regulation.” Smith says, “Government policy is traditionally meant to ensure that low performers and bad actors have a floor below which they cannot go. Regulation is generally meant to ensure that the bad actors and low performers are held accountable in a value-based world, and that the performers at the top are not encumbered. A Trump administration will provide a space for people to go back and look at things like the Quality Payment Program. So I could see a ‘rollback’ that would look at MACRA legislation and think about what the minimum necessary requirements are. And if those minimum necessary requirements are deemed too difficult, can they scale the program back some?”

There have been some contentious health IT-related legislative issues this past year, as Republicans in the House have attempted to defund the Agency for Healthcare Research and Quality (AHRQ) and have also been critical of the Center for Medicare & Medicaid Innovation (CMMI) for overstepping its definition in statutes. Will the election results have any likely impact on those organizations, or on funding for the Patient Centered Outcome Research Institute (PCORI)?

“AHRQ funding, from my understanding, is moving forward and last night’s maintenance of the Senate majority keeps AHRQ funding, fully funded, for this year, and I don’t anticipate the election outcome having a negative impact on AHRQ,” Leary says. “And, my sense is that the mission of PCORI is still very much recognized as being needed. The mission around patient-centered outcomes research, and outcomes research in general and its funding has been a bipartisan initiative since the 2003 Medical Improvement Act. It was the Bush administration and Republican Congress that got us started down that road of using outcomes research. So I think the idea of outcomes research helping to improve where we spend our precious healthcare resources will continue to be an important initiative funded by the government and by the private sector.”

Smith, however, says that the CMMI, AHRQ, PCORI, and the Medicare’s Independent Payment Advisory Board (IPAB) are “huge targets.” He says, “For those of us who know what those acronyms stand for, we know they would be big losses.” That’s why, Smith adds, that in the beginning, conversations will have to be about “using only primary shapes and colors.” He explains, “We will have to educate people who have very little understanding for the complexity of the world in which we live in. And that’s not a unique challenge; it happens anytime you get someone new who comes in. Intelligent and well-intentioned people have come in [to the White House] and said, ‘Wow, this is a much bigger challenge than I anticipated.’”

Smith adds that one of the biggest questions for him going forward is what the “brain drain” will look like at federal agencies such as the U.S. Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC). “Any time there is a transition there is a brain drain which includes thousands of political appointees below the cabinet positions too,” he says. “I just can’t imagine a more stark contrast between most of Obama’s Cabinet and political appointees and what will be Trump’s Cabinet and political appointees. It’s not at all clear to me that the same talented and intelligent people will turn up for the job,” Smith says, adding that HHS Secretary Sylvia Mathews Burwell is “a technocrat who understands the complexities and how difficult change is.”

But in the end, Krigstein attests that “health IT is here to stay.” She says that health IT issues have largely been bipartisan, specifically noting a desire from both political parties to: sendoff cybersecurity threats more in the future than today; make sure there is a digital infrastructure to support decision making from clinicians and to empower change; and to continue efforts to dive into usability and optimization of electronic health records (EHRs). “I don’t see many health IT surprises in this space, as there is a recognition that patients and clinicians alike are empowered with the use of technology,” Krigstein says.

To this end, the Charlotte, N.C.-based Premier, Inc. released a statement on Wednesday that said the organization is “looking forward to working with President Trump and the Republican Congress on healthcare transformation.” The statement further said, “There is a great deal to be done to transform healthcare. At the top of the list is achieving interoperability of health IT systems, specifically EHRs, which we encourage Congress to address in the upcoming lame duck session. We also believe more needs to be done to incent providers to move to alternative payment models, such as accountable care organizations. This can be accomplished by eliminating cumbersome and antiquated regulations, reducing the level of risk required in establishing these models, and ensuring competition by creating a level playing field for all healthcare providers seeking to enter these models.”

Moving forward, Krigstein still maintains that there will be a continued drive to improve outcomes. “Regardless of power and party, there is a recognition that there is an opportunity to improve healthcare, and the [government] will still be budget conscious, so I think those sorts of efforts will stick around. We just need more details in place,” she says.


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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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