On Wednesday, January 20, Inauguration Day in the U.S., Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Blair Childs, senior vice president of public affairs at the Charlotte-based Premier Inc. Childs, who has been involved in federal healthcare policy issues for many years, spoke of the exceptional moment that the healthcare delivery system is in right now, as the biggest focus of policy development and execution will necessarily be connected to helping the nation overcome the COVID-19 pandemic, which has killed over 400,000 Americans and sickened more than 24 million.
When it comes to the federal government’s support for shifting the U.S. healthcare delivery system from volume-based payment to value-based payment, Childs believes that for the moment, very little new value-based-related legislation will be introduced into Congress in the first few months of 2021, following the passage of H.R. 7791, the Value in Health Care Act of 2020, which was passed as part o the package of legislation passed by Congress in December to address the economic impacts of the COVID-19 pandemic.
That legislation, introduced back in July by Reps. Suzan DelBene (D-Wash.), Peter Welch (D-Vt.) and Darin LaHood (R.-Ill.) “amends many of the program parameters of Medicare’s Alternative Payment Models (APMs),” according to a press release published by Rep. DelBene’s office on July 24. That press release stated “The Value in Health Care Act makes the following changes to the APM and ACO [accountable care organization] parameters,” among them: it “encourages participation in the Medicare ACO program by increasing the percent of shared savings beginner participants receive”; “modifies risk adjustment to be more realistic and better reflect factors participants encounter like health and other risk variables in their communities”; “removes barriers to ACO participation by eliminating arbitrary program distinctions so all participants are playing on a level playing field”; “supports fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care”; “provides greater technical support to ACO participants to cover the significant startup costs associated with program participation”; incentivizes participation in Advanced APMs by extending the annual lump sum participation bonus for an additional six years”; “correct[s] arbitrary thresholds for Advanced APM qualification to better reflect the existing progress of the value-based movement and to encourage bringing more patients into this model of care”; and “addresses overlap in value-based care programs so that APM overlap within markets complement each other rather than cause confusion.”
More broadly, Childs believes that there will be greater calm in Congress in terms of healthcare legislative activity, as the fact that the Democrats now have control of the White House, the House of Representatives, and now the Senate, there will no longer be any threat to the stability of the Affordable Care Act (ACA). As a result, he believes, there will be greater stability in terms of intuiting the broader direction of healthcare legislation in Congress. Nonetheless, later in the year, he expects some potential new legislation around value-based payment, and also anticipates potentially new directions at the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), once the new CMS Administrator is nominated. That individual will have a particularly key role, as former California Attorney General Xavier Becerra, the new HHS Secretary, who had been among the leaders of the state attorneys general collaborating to defend the ACA to the Supreme Court, has a legal background but not a healthcare operations or public health background. Thus, much remains to be learned in the coming weeks about the factors that will help shape the development of federal healthcare policy in this year.
Below are excerpts from Hagland’s interview with Childs.
Looking forward into 2021, what do you anticipate in terms of changes to federal healthcare policy?
My expectation is that we’re going to start seeing a lot of executive orders coming out of the new administration, to reverse a lot of the policies of the old administration. That’s the thing that can happen fastest and most clearly and expeditiously, and it will happen. And you have to the notice and comment process. But that will begin the process. There will be a lot going on, on a policy basis, that we’ll be hearing a lot about.
On the congressional side, I think it’s going to be really interesting to see how it unfolds. And I don’t want to spend a lot of time talking about the impeachment process, but that process could definitely create even more tension in Congress, which might slow down the passage of legislation. That has to do with the divisive nature of things in Washington and in our country overall. I have not paid as much attention to it in terms of where things are on the impeachment process.
Do you have any idea of who the new CMS Administrator might be?
No, I really don’t. And from the congressional vantage point, everything is going to be about COVID-19 for the next six months. Now, there will be efforts to extend Medicaid coverage in states that have not yet expanded Medicaid. We’ll see what comes forward; but everything will be wrapped into COVID. So whatever gets done, gets done because it’s in the interest of addressing COVID. And in terms of the movement to value, I think it’ll be on hold in the short term, because of the intensive focus on COVID, and I don’t anticipate that tying into the COVID discussion. We got legislation passed in the end-of-the-year legislation around keeping the thresholds from increasing, that would have made it difficult for physicians to achieve their five-percent bonus. We played a driving role in that. That was a positive thing. But I don’t see much more occurring for the next six months, as for these first several months, we’ll all be focused on vaccines, testing, contact-tracing, the things necessary to get COVID under control.
How might CMS change?
I definitely think this will be much more of a reboot of what was in the ACA, which was about making a competitive marketplace move to value and APMs, but much more about brining providers along. The Trump administration was very focused on the payer side. The latest MA call letter that just got released on Friday, that was astounding, honestly, in terms of how it advantaged the payers. And I don’t want to sound anti-payer. I think this administration will focus more on bringing payers along.
And once we get COVID under control, there won’t be the distraction around whether the ACA comes or goes. I think the Supreme Court will uphold the ACA, and even if they didn’t, Congress could take action to deny it being found unconstitutional. They can strip out the individual mandate. And I bet you’d get the Republicans to support stripping out the individual mandate.
What would you advise the leaders of patient care organizations to do right now, as they reflect on potential federal healthcare policy developments during 2021?
If we’re looking at an era where there’s less question and turmoil, so to speak, in healthcare, and relative calm when it comes to the ACA, which is what I’m anticipating, I think you’re going to see very aggressive actions in the marketplace, and it’ll be potentially disruptive. There will be more disruption coming out of the pandemic than we’ve ever seen, because we’ve accelerated this movement towards virtual health, which people will want available. So the way we deliver care will change, and a lot of people will be getting into healthcare, because there’s less confusion. The ACA is here to stay, its elements will continue, and it will become a very competitive marketplace. And the policy is bipartisan, and because there’s less turmoil, things will accelerate fast.
