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Health insurers and health-care providers are going to be pushed to change their way of doing business faster.
That’s the gist of remarks Health and Human Services Secretary Alex Azar made March 5 to for-profit hospitals, and he’s likely to push even harder on health insurers March 8. “We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests,” he told the Federation of American Hospitals (FAH) March 5.
This is Azar’s first signal to the health-care industry of the initiatives that will be his priorities. Azar, who was president of the U.S. division of drug company Eli Lilly and Co. before taking over the HHS in January, is making the point that innovations in payment and delivery systems that the U.S. health-care system has relied on for decades are lagging too far behind scientific innovations in drugs and other therapies. Azar is speaking March 8 to America’s Health Insurance Plans (AHIP).
At both the March 5 FAH conference and the AHIP conference, Azar is addressing value-based transformation in America’s health-care system, an HHS spokesman told Bloomberg Law in an email March 5.
“It seems like every other week that [the Food and Drug Administration] is approving some novel therapy, or [the National Institutes of Health] announces a finding that revolutionizes how we think about a key piece of biology,” Azar told the FAH, which represents for-profit hospitals.
“But innovation in payment and delivery systems is simply not proceeding at the same pace,” Azar said.
A shift from fee-for-service, which is roundly lambasted throughout the health-care industry as encouraging providers to perform a high volume of services rather than get better value for patients, began in the 2000s, he noted.
“Yet here we are today—more than a decade later—and value-based payment is still far from reaching its potential,” he said.
Centers for Medicare & Medicaid Services Administrator Seema Verma and Jared Kushner of the White House Office of American Innovation will be making announcements March 6 at the Healthcare Information and Management Systems Society conference in Las Vegas regarding regarding actions the administration will be taking to give patients access to health records, Azar said.
“Too often, doctors and hospitals have been resistant to give up control of records, and make patients jump through hoops to get something as basic as an image of a CT scan,” he told FAH.
“Medical science is rapidly moving towards precision treatments at the level of an individual’s genes,” Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, told Bloomberg Law March 5. “Yet our ability to provide these amazing innovations is in the stone age. I call it Star Wars science and Flintstones delivery.”
Azar’s message will be even more important to insurers, Joe Antos, a health-care policy expert at the free market-oriented Washington think tank American Enterprise Institute, told Bloomberg Law March 5.
“The list price on the hospital is basically irrelevant to everyone,” he said. “The part about what am I going to have to pay after the insurance company has paid [is] where he’s going to hit the insurers pretty hard.” Only health insurers can tell people that, Antos added.
Azar called for giving consumers greater control over health information through health information technology; encouraging transparency from providers and payers; using experimental models in Medicare and Medicaid to improve value and quality; and removing government burdens that impede the change to a value-based system.
The Medicare and Medicaid programs, which accounted for a third of the country’s health spending in 2016 at just over $1 trillion, must play a “key role” in transforming the health system, Azar told the FAH. The Center for Medicare and Medicaid Innovation “vests HHS with tremendous power to experiment with new payment models,” he said.
Azar trod carefully on the subject of demonstration projects. In November 2017 the White House scrapped extensions of two mandatory bundled payment models proposed during the Obama administration but announced a new voluntary bundle in January. “Aggressive models have not always worked out, so appropriate guardrails will always be essential,” he said.
“I don’t intend to spend the next several years tinkering with how to build the very best joint-replacement bundle,” Azar said. “But make no mistake: We will use these tools to drive real change in our system.”
“We want to look at bold measures that will fundamentally reorient how Medicare and Medicaid pay for care and create a true competitive playing field where value is rewarded handsomely.”
He also called out accountable care organizations, which were created under the Affordable Care Act to try to better coordinate patient care. “The results have been lackluster,” he said.
To contact the editor responsible for this story: Brian Broderick at firstname.lastname@example.org
HHS Secretary Azar's speech to the Federation of American Hospitals is at http://src.bna.com/wOb.
Information on AHIP's National Health Policy Conference is at https://www.ahip.org/events/national-health-policy-conference/#d=all.
Copyright © 2018 The Bureau of National Affairs, Inc. All Rights Reserved.
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