Election Impact on Health Care Sectors

(L-R) Joseph Fifer, Marilyn Tavenner, Patrick J. Geraghty, James L. Madara, Richard Pollack, Halee Fischer-Wright
(L-R) Joseph Fifer, Marilyn Tavenner, Patrick J. Geraghty, James L. Madara, Richard Pollack, Halee Fischer-Wright
(L-R) Joseph Fifer, Marilyn Tavenner, Patrick J. Geraghty, James L. Madara, Richard Pollack, Halee Fischer-Wright
(L-R) Joseph Fifer, Marilyn Tavenner, Patrick J. Geraghty, James L. Madara, Richard Pollack, Halee Fischer-Wright

For the first time ever, leaders of five of the nation’s major health care industry associations joined together in a panel discussion on “The Election Impact on Health Care Sectors,” moderated by Patrick J. Geraghty, CEO, GuideWell Mutual Holding Corporation, Florida Blue’s parent company.  “As the U.S. Congress and President Trump look at the Affordable Care Act (ACA), Medicaid and Medicare, what should we keep and what should be change?” said Geraghty, framing the context for the discussion.

Marilyn Tavenner, president and CEO, America's Health Insurance Plans, said it was important to keep the positive parts of the ACA, including the movement from fee-for-service to reimbursement for quality and patient outcomes. “The Medicare Advantage program, which has received bipartisan support through the years, has shown that it can improve chronic disease conditions.  However, changes to the funding model could be disruptive.”

Joseph Fifer, president and CEO, Healthcare Financial Management Association, looked at the implications for member hospitals, physicians and insurers. “In the mid 2000s, I was an advocate for change,” he said. “In general, I like the experimentation that has occurred with the ACA, looking at new payment models as well as the clinical side. But from the CEO perspective, all this experimentation is frustrating. I would like to see us narrow in on things that work and eliminate the others.”

In contrast, Halee Fischer-Wright, M.D., president and CEO, Medical Group Management Association, whose members include practice managers and executives, said the ACA didn’t change the practice of medicine, but it did add to providers’ regulatory burdens. “The ACA was a good starting place, but we need to work on decreasing the administrative costs that are killing some practices,” she said. “At the same time, we want to continue to increase quality and patient satisfaction and keep our nation’s health care moving onward.”

Richard Pollack, president and CEO, American Hospital Association, said there were “two buckets” incorporated into the ACA: insurance coverage and payments. “Today, that’s what the political debate is all about,” he said. “How do you pay for people who cannot afford coverage? There are 22 million lives at stake (the approximate number of additional Americans covered by the ACA). Maintaining that coverage is critical for patients to get the right level of care at the right time.”

The ACA was a major step forward that now needs some fine-tuning, said James L. Madara, M.D., EVP and CEO, American Medical Association (AMA).  “We cannot afford for people to lose ACA, Medicaid or Medicare coverage,” he said.

The changing role of physicians

Next, Geraghty also asked the panelists about the changing role of physicians. Madara noted that AMA surveys show that for every hour a physician spends with patients, another two hours are needed for data entry. “We have created the most expensive data entry workforce in the country,” he said. “We badly need interoperability between electronic health care records (EHRs) so that data can flow among patients and providers. We also need technology that allows individuals to control their own data, just as they do with the bank accounts.”

Fischer-Wright agreed with Madara on the data entry problem. About 78 percent of physicians now in practice said they were dissatisfied with their burdens, she said, referring to a recent association survey.  She added that $40,000 per physician per year is spent documenting quality. “That interferes with the physician’s ability to build a relationship with the patient, and getting better outcomes largely depends on that relationship.”

Geraghty then asked if changes in medical training improve the delivery of care. “My training 25 years ago helped me understand the importance of teams and organizational dynamics,” said Fischer-Wright. “However, medical students face a very competitive environment at every stage of their education, and that can impair their ability to collaborate.”

Noting the importance of updating the medical school curriculum, Madara said the AMA has invested in an innovative educational program in health system science. “Most of our 850,000 physicians think about public health in the context of their own patients,” he said. “But we also have to look at the big picture – how we can achieve optimum outcomes for all 320 million Americans.”

Hospital-physician relationships

Asked how health plans feel about hospitals owning physician practices, Tavenner said, “Regardless of ownership, we are spending more time with general and family practices. We are also helping providers at all levels build their collaborative skills.”

Pollack said today about 23 percent of physicians are employed by hospitals. “Team-based approaches are needed to deliver better care at a lower cost,” he said. “However, the models will be different for every local community.”

Following up on the financial side, Fifer emphasized the importance of focusing on care for chronic conditions. “That’s where we will change the cost curve,” he said.

Pollack agreed, adding that more coordination is also needed for end-of-life and palliative care. “Medicare’s growth on a per-capita basis is quite manageable, but the overall costs are going up because so many people are turning 65 and living longer. Maybe we should look at synching Medicare coverage to the age when people actually retire.”

However, Madara said better data on patient outcomes may be able to lower costs, as well as be a driver for high quality of care.  “We created AMA tools for pilot studies of hypertension,” he said. “That has helped individuals gain more control of this chronic condition, decreasing strokes and heart attacks. In this case, even marginal improvements can save big dollars.”

Finally, Madara pointed to the importance of measuring outcomes from the patient’s perspective, rather than the provider. “We have extensive data on the input side, such as how many knee replacement procedures are being performed,” he said. “But we need more information on the output of our health care system. Patients with knee replacements derive value from being able to drive a car, walk the dog and get around without pain. So, we need to look at the whole series of health care events that lead to that positive functional outcome, and see where we can improve the process.”

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