Election Year Politics and Ongoing Transformation of Healthcare: A Recap of the LHC Delegation to D.C.03.16.16
Yesterday, we wrapped up a two-day visit inside the Beltway with Leadership Health Care’s annual D.C. delegation. In an election year, it’s easy to imagine that D.C. is focused on who will be the next U.S. President. Hearing from presenters, however, the contrary is true. There is a lot happening in our nation’s capital to advance healthcare and other federal initiatives that impact those of us in Nashville and beyond.
We kicked off day one hearing from Politico reporter, Jake Sherman, who covers the Republican side of the aisle in the House. His view is that politicians, particularly Republicans, have overcommitted to the American people and have set expectations that cannot possibly be met. As it relates to healthcare, Jake thought that while there’s been a lot of talk, any real effort to repeal the Affordable Care Act (ACA) is untenable. The Republicans have not put forth an alternative plan but have voted to repeal more times than one can count. Buying insurance across state lines has been a key focus for them, but they haven’t issued a comprehensive strategy or plan, according to Sherman.
Next, we heard from Darin Gordon, the director of TennCare and Matt Salo, executive director of the National Association of Medicaid Directors, in a discussion about Medicaid from a national and state perspective. Key points covered in their conversation:
- The position of state Medicaid director is in flux. The median tenure is 17 months and the majority have been in office less than 12 months. Gordon has been in office for 10 years, making him very rare. The short time in office means most state Medicaid directors are still in ramp up mode.
- Currently, Tennessee is working on other payment reform efforts that will move away from siloed and fragmented fee-for-service world and determine how we deliver and pay for care. As Tennessee has stabilized managed care, it has not yet stabilized the relationship between payors and providers. Now, Gordon and his team are trying to get people rowing in the same direction, primarily through incentives.
- Tennessee is one of a few states that’s practically all managed care for Medicaid. Is it the right answer for all? Gordon said “the opposite of managed care is unmanaged care…and that’s not a good option.” But, Gordon stated, just because it’s managed doesn’t mean it’s done well. Trying to do this under a budget crises and expecting quick results is a mistake. There will be learning lessons and tweaks that need to be made before you get it right and see strong results.
- Gordon emphasized the idea that making people healthier isn’t all about healthcare delivery. Sometimes lack of services, access to housing, and other factors weigh heavily on health. Gordon wasn’t ready to say that TennCare should step in to address those issues, but he did say that Medicaid programs can serve as a hub to coordinate those resources.
Turning to Medicaid expansion, Gordon discussed the variety of models being implemented in the 30 states that opted for expansion. Gordon emphasized that in Tennessee, all discussions around expansion are informed by the 1994 expansion of TennCare, which wasn’t sustainable and had to unwind. In 2015, Tennessee had negotiated a plan similar to Indiana’s voucher-based program and gotten conditional CMS approval. Unfortunately, because any expansion requires legislative approval in Tennessee, the plan was not implemented.
Later in the day, we heard from a panel of experts comprised of those working to improve interoperabilityamongst IT vendors, providers and payors. According to Dr. Vindell Washington, Principal Deputy National Coordinator of the Office of the National Coordinator for Health Information Technology, interoperability is not the end game – what we’re truly driving toward is better care. He discussed how Meaningful Use spurred a lot of the advancements occurring today. First, we needed providers to adopt EHRs, and currently we are at 96% adoption by hospitals and around 75% for physician practices.
But the industry still hasn’t figured out how to achieve true interoperability of information systems to support the overarching goal of delivering patient-centered care. Why are we not further along? Jitin Asnaani, executive director of CommonWell Health Alliance, believes the many decades of clinical specialization has negatively impacted coordination. Another barrier is culture and the shift from older physicians – who are slow to adopt technologies – to younger physicians, who are comfortable with data driven care and information sharing.
From the viewpoint of hospitals, Kerry McDermott, vice president of public policy and communications at the Center for Medical Interoperability in Nashville, explained how the Center is working with health systems to develop a platform that will serve as the blueprint for how medical devices should connect to share data. Prior to the Center, health systems did not have an active voice in the interoperability conversation.
After this informative discussion, and a delegate photo, we heard from Kristen Soltis Anderson, author of “The Selfie Vote”, who discussed the role of millennials in politics and the upcoming election.
On Tuesday, the discussion shifted much more to the political climate in D.C. We heard from Tennessee’s two senators, Bob Corker and Lamar Alexander, and Representative Jim Cooper of Nashville. The members of the Tennessee delegation provided updates on the current state of affairs in D.C. and how that impacts Nashville and the healthcare industry. In addition we heard from Representative John Yarmuth (D-KY). Representative Yarmuth focused on ACA fueled Medicaid expansion in Kentucky and recent efforts to roll back that expansion.
Next, we heard from Jeff Cohen, the Federation of American Hospitals, and Kate Spaziani, New York Presbyterian Hospital, who discussed legislative and regulatory developments of particular interest to hospitals and other healthcare providers.
Finally we heard from Dr. Meena Seshamani from the Department of Health and Human Services (HHS)’ Office of Health Reform. Dr. Seshamani spoke to the delegation last year and discussed the expansion of the ACA and efforts to enroll new beneficiaries. She talked about that again this year, comparing the results of third open enrollment for the ACA to the two previous ones. Dr. Seshamani was upbeat, focusing in particular in the growth of enrollment of younger – and presumably more healthy – beneficiaries during this year’s open enrollment period. Like many of the speakers, Dr. Seshamani also touched on the growth of quality-based payment methodologies.
The delegation concluded with a panel of delegates recapping some of the highlights of the trip. With that, we closed out another successful Leadership Health Care Delegation to D.C.