HIMSS19, the Triumph of Federal Policy, and the Hurtling High-Speed Train of Change

Feb. 17, 2019
Federal healthcare policy issues dominated discussions at HIMSS19—for very good reason

I have participated in 28 HIMSS Annual Conferences, and every single one has been fascinating in its own way. But this one was, in its way, the most interesting yet, as the issues of policy and payment at the federal level dominated practically every conversation.

Of course, the presence of federal healthcare officials seemingly everywhere at HIMSS19 in Orlando itself served to focus attendees’ attention Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), in particular, seemed to be nearly everywhere, appearing three times live, and once in the press briefing following the release of twin proposed rules by CMS and by ONC (the Office of the National Coordinator for Health IT). Meanwhile, Donald Rucker, M.D., the National Coordinator, also appeared at least a few times. And Adam Boehler, Director of the Center for Medicare and Medicaid Innovation (CMMI), and also CMS Deputy Administrator and Senior Advisory to the Secretary of Health and Human Services, met with journalists for a first-ever HIMSS press availability on Wednesday, Feb. 12. Meanwhile, though he was unable to attend in person, Secretary of Health and Human Services Alex Azar did speak to attendees via a video presentation that preceded Administrator Verma’s closing keynote speech on Tuesday, Feb. 13. And CMS and ONC officials fanned out across the Orange County Convention Center, addressing attendees questions and concerns in a variety of settings, including in a listening session held on Thursday, Feb. 15.

Even former HHS, CMS, and ONC officials got involved in all the activity. The opening keynote session on Tuesday, Feb. 13 featured not only Administrator Verma, but also former HHS Secretary Mike Leavitt, former National Coordinator Karen DeSalvo, M.D., and Aneesh Chopra, former CTO in the Obama administration, in a wide-ranging policy discussion moderated by HIMSS president and CEO Hal Wolf.

In other words, it was really, really hard to miss the senior federal healthcare officials flooding the site.

And what’s interesting is this: this HIMSS Conference represented the peaking of a wave that began about six years ago, when senior HHS, CMS, and ONC officials more or less “discovered” the great potential that the annual HIMSS Conference offered them as a stage for important federal healthcare and healthcare IT policy announcements, and more broadly, for creating policy presence at the healthcare IT world’s industry-dominant conference. It shouldn’t be surprising that HIMSS—which this year counted more than 43,000 attendees and more than 1,400 vendor booths—could provide such a felicitous environment for federal healthcare officials. And yet, until about six years ago, the senior federal healthcare official presence was relatively light on the ground at HIMSS. No longer: the top healthcare officials have “discovered” the annual HIMSS Conference, and they’re not going to let go; nor should they.

And with the releases of the proposed CMS and ONC rules on Monday, we’ve reached an inflection point—an important one. With the U.S. healthcare delivery and payment system heading towards a cost cliff—as Seema Verma noted in every single instance in which she was present this week, within seven years, “one in five dollars in the U.S. economy will go to healthcare”—there absolutely is a burning platform for fundamental change in healthcare; everyone knows it. And senior federal healthcare officials are savvy in turning to the HIMSS Conference to make use of the platform—where else can one get the in-person attention of an entire industry sector, within the space of a few days?

So the focus on policy and payment was everywhere at HIMSS, touching on issues of interoperability, health information exchange, patient engagement and consumer empowerment, population health, care management, and even data and IT security. And the second-most talked-about element this year—artificial intelligence and machine learning—had a clear connection to the policy and payment element. After all, all those in the know in U.S. healthcare these days fully realize that the transformation that will need to take place in order to accelerate the shift from a volume-based healthcare delivery and payment system to a value-based one, will absolutely be impossible without the ability to leverage AI and machine learning to turbocharge the analytical and performance improvement aspects of clinical and operational transformation in healthcare.

Now, the fact of the clear directionality of federal healthcare policy does not mean that all the contradictions have been worked out; they haven’t. Take for example my exchange with CMMI Director Boehler on Wednesday. As I reported on that day, “After laying out his vision for CMMI, Boehler responded to questions from the journalists gathered at the briefing. In response to a question from Healthcare Innovation related to the question of whether recent comments by CMS Administrator Seema Verma, and rules changes requiring the parameters around participation in the Medicare Shared Savings Program might cause some organizations to leave the MSSP, Boehler said, ‘What Administrator Verma is doing, which I’m 100 percent in support of, is trying to eliminate a [kind of payment] purgatory. It’s very difficult to have a foot in fee-for=service and a foot in risk. And it’s OK if some people decide it’s not right for them,’ he said, referring to the possibility that recent moves intended to accelerate progress by pushing accountable care organizations faster into downside risk in the Medicare Sharing Savings Program. ‘What you want is the right folks, not everybody. And it’s been seven years’ since the MSSP was first created, he pointed out; “there’s never going to be a good time. And it’s time to make a decision, you know? It’s time to commit. And it’s incumbent on us to give predictability of model, and to simplify as much as possible; we’ve heard that from the participants quite a bit. I understand that need, and we’re working on that need.’”

Such issues will remain problematic for some time; indeed, there is a real chance, per the question I posed to Boehler on Wednesday, that Seema Verma’s hard push on forcing accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) to quickly transition to downside risk inside MSSP, could abandon the program, putting its future viability in jeopardy. What’s more, the contradiction between an emphasis on “market-driven” consumer empowerment in healthcare, yet with that empowerment requiring intensive federal agency pressure on payers, providers, and vendors to become fully birthed, is one that continues to strike me, as I wrote in a blog about Verma’s statements.

Still, one thing stood out this year amid the usual crazed swirl of activity at HIMSS: more than ever, healthcare IT leaders, at every level, have the gift of directionality; it is very clear which way this train is headed, and it is equally clear that senior federal healthcare officials feel a sense of urgency about all of this—as they should. The next year should be fascinating to observe and participate in, as the U.S. healthcare industry hurtles forward into the future. Without a doubt, healthcare IT leaders are in an amazing position to be able to step up as real leaders of the entire healthcare system.

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