Healthcare Policy Leaders: Time to Organize Top Federal Healthcare Policy Priorities
A team of healthcare policy leaders has called for a range of changes and innovations in five key areas, now that a new administration and Congress are in place. Their op-ed article in the February issue of Health Affairs calls on policymakers in Washington to take action in five key areas: healthcare costs and financing; optimizing women’s and children’s health; transforming mental health and addiction services; improving healthcare for seniors; addressing infectious disease threats; and advancing health equity for disadvantaged and underserved communities.
The article, “Vital Directions For Health and Health Care: Priorities For 2021,” introduces readers to five separate articles on those topics. It was written by Victor J. Dzau, president of the National Academy of Science; Mark B. McClellan, a professor of business, medicine, and policy and director of the Duke-Margolis center for Health Policy at Duke University; J. Michael McGinnis, executive officer at the National Academy of Medicine; Jessica C. Marx, a program officer at the National Academy of Medicine; Rebecca D. Sullinger, a research assistant at the National Academy of Medicine; and William ElLaissi, managing director of the Emory Healthcare Innovation Hub.
Referencing a “Vital Directions for Health and Health Care” strategic initiative launched in 2016 by the National Academy of Medicine, the authors note that the conceptual framework established back then provided a foundation for their team’s current work around top healthcare policy priorities.
As the article’s authors write, “During the past four years the US health system has confronted unprecedented challenges and uncertainties. The period began with heated debate about the repeal of the Affordable Care Act of 2010, and the law’s implementation and revision remain active topics of discussion and debate. Then 2019–20 saw the emergence of COVID-19 and the dramatic escalation of public attention to long-standing racial and ethnic disparities in society as a whole, with health care being an arena where those disparities are particularly pronounced.”
In that context, they write, “A persistent and serious challenge has been health care expenditures, with US health expenditures as a proportion of gross domestic product continuing to far outstrip comparable expenditures in other Organization for Economic Cooperation and Development countries. To compound the problem, Americans continue to have worse health outcomes even in the face of such high expenditures, including lower life expectancy, higher suicide rates, and a higher chronic disease burden, with people of color suffering disproportionately.”
Looking at the high costs and relatively poor outcomes of the U.S. healthcare delivery system, the experts write that, “Given the high costs and substandard health outcomes of the US health system, ensuring effective and high-value health care for all Americans must be a top priority for the next administration. There is an urgent need to provide more equitable access to affordable health care in the interest of national public health. To achieve these goals,” they underscore, “will need to develop innovative ways of improving access to coverage, address health provider workforce shortages in areas such as primary care, and reform health care payment methods. Recent shifts to value-based payment have sometimes resulted in significant savings, especially models that move farther away from fee-for-service payment. A continued shift to alternative payment methods, including population-based payment with an emphasis on accountability for addressing health disparities, may decrease future costs while improving care.”
With regard to women’s and children’s health, the authors write that healthcare industry and policy leaders need to adopt a “life-course perspective to assess both causes for and solutions to issues in child and maternal health.2 This framework,” they explain, “underscores the impacts of both positive and negative cumulative health outcomes through multiple phases of life from preconception to adulthood and highlights the interrelatedness of each developmental phase. As the authors of this article express, “Maternal health and well-being . . . may determine the health of the next generation and, ultimately, the health of the nation.”
When it comes to behavioral healthcare, the authors write that, “Although the U.S. has made some strides in improving access to treatment for behavioral health conditions, significant gaps in care remain. Barriers to quality care are particularly high for people of color and people with socioeconomic disadvantage, emphasizing the need for special consideration of vulnerable populations in policies relevant to behavioral health.” They state that, though “Current behavioral health interventions often focus on volume of services and symptom reduction as a benchmark for success… given scientific advancements and improvements in patient-centered care, people with mental illness are increasingly in recovery and able to live full lives despite their symptoms. Thus, it is possible to move beyond symptom reduction and to emphasize everyday functioning and societal involvement in behavioral health care.32 A shift toward prioritizing social context and addressing the social needs of patients with behavioral health conditions will be a vital part of behavioral health care going forward.”
And when it comes to seniors in our aging population, the authors note that, “By 2040, people ages sixty-five and older are predicted to account for 21.6 percent of the US population, and resources will need to be appropriately allocated to ensure that they receive person-centered, high-quality care. The COVID-19 pandemic has further exposed the consequences of fragmented and unequal care for older adults, as well as the enduring impacts of structural racism. To address systemic inequities and to address many of the challenges facing older adults, it is imperative to take a population health approach. By actualizing this vision of population health for older adults, the nation can address many of the outstanding challenges and issues faced by older Americans.” In that regard, they believe that “[I]t will be important that the geriatrics workforce—ranging from specialists to caregivers—expands to meet the increase in demand for care. As of 2018 the older adult population in the US was 49.2 million; however, there were only 3,590 full-time practicing geriatricians.”
In that regard, they note, “Telehealth is an important innovation, especially within the context of the pandemic, to increase access to care. However, barriers remain for engagement via virtual platforms, including limited digital health literacy, unequal access to technology, design barriers, and integration of telehealth with other services needed for effective care. An additional concern for care delivery for older adults is that public health funding is often disease or condition specific rather than population focused, yet the development of age-friendly health systems is integral to promoting healthy aging. Redesigning long-term services and supports is also a critical challenge that must be addressed, especially given that twelve million adults are living with serious illness. Innovative long-term care should provide more support for older adults remaining at home and aging in place. The disproportionate mortality rates resulting from COVID-19, particularly in nursing homes, also highlight the importance of improving care quality in long-term care facilities and other community living arrangements.”
