During AcademyHealth National Health Policy Conference, held February 4-5, in Washington, DC, healthcare stakeholders joined together at the nation’s capital to provide insight into the latest updates in policy and care delivery that are shaping the future of healthcare.
During AcademyHealth National Health Policy Conference, held February 4-5, in Washington, DC, healthcare stakeholders joined together at the nation’s capital to provide insight into the latest policy and care delivery updates that are shaping the future of healthcare. Here are 5 things to know:
1. Tackling the drug rebate system
Opening up the conference, HHS Secretary Alex Azar doubled down on the administration’s efforts to tackle the current drug rebate system. He emphasized President Trump’s proposal to make a significant change to the antikickback safe harbors, which exempts rebates from antikickback laws. Starting January 1, 2020, the rebates that circle through the drug pricing system each year will be passed directly to the patient at the pharmacy counter, he said.
According to Azar, this will also take away the incentive to increase the list price of drugs each year. The reason for these price hikes is that high list prices result in larger kickbacks to the drug plans, which ensure the drug’s placement on the formulary.
2. Other efforts to address healthcare costs
Unsurprisingly, a major focus of the conference was healthcare costs. During a session on tackling these costs, panel members discussed what works, and what doesn’t, in achieving this mission. The panel highlighted the move from fee-for-service to paying for episodes of care, which allows stakeholders to see if the care is medically appropriate, if it’s done well, and if the patient is getting better.
Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab at Harvard Medical School, who serves as co-editor-in-chief of The American Journal of Managed Care®, noted that while the savings are not in the 30% range that many were hoping for, there are savings, and there is evidence that points to improved quality of care with alternative payment models. He also emphasized that with any payment model, there will always be tradeoffs, so you have to be willing to take them.
The panel also discussed vertical and horizontal integration. Gail R. Wilensky, PhD, senior fellow at Project HOPE, noted that while vertical integration has potential, horizontal integration creates monopoly pricing.
3. Health policy and the elections
Reflecting on the recent midterm elections, a panel of health experts tried to make sense of the role healthcare played and implications for the year ahead. What Melinda Buntin, PhD, professor in the department of health policy at Vanderbilt University Medical Center, found was that voters largely wanted healthcare to stay the same. Rather than wanted big change in healthcare policy, voters wanted Medicare benefits to stay the same and for people to be able to keep their insurance regardless of a pre-existing condition.
As the rest of 2019 unfolds, the panel members agreed that states will continue to play an emerging role in addressing the needs of their populations. Grace-Marie Turner, president of the Galen Institute, noted the adoption of Medicaid work requirements, more flexibility with 1332 waivers, and the expansion of short-term limited-duration health plans. States have also pitched the idea of importing drug from other countries to address high prescription drug prices.
4. Innovation in delivery of care
The conference also put a focus on innovative strategies being put forward to shape a new wave of care delivery. A panel discussion recognized the increasing role and importance of social determinants of health in addressing a patient’s well-being. Bechara Choucair, senior vice president and chief community health officer of Kaiser Permanente, discussed housing specifically, outlining Kaiser Permanente’s $200 million impact investment to address housing instability and homelessness.
The panel also discussed digital health, with Naomi Fried, PhD, founder and chief executive officer of Health Innovation Strategies highlighting the importance of virtual health, clinical-grade digital information that collects information from the patient that their provider can act on, and digiceuticals that use software programs to improve patient clinical outcomes. The panel ended the discussion with the potential of data to inform and improve payment models.
5. Health challenges facing rural communities
Despite an abundance of innovation being introduced, there are groups of patients that still struggle with adequate access to care. A panel discussion at the conference gave a comprehensive look at the health struggles facing rural communities, in particular. In 2016, rural health populations had a 16% increased rate of mortality compared with metropolitan areas and continue to be sicker, older, lower-income, and unemployed.
Providers in the communities also struggle, with many rural hospitals closing or switching to outpatient care due to a lack of workforce, harder to treat patients, patient safety concerns, and poor management. In addition, rural health clinics continue to concert from independent or physician-owned practices to provider- or hospital-owned clinics as a result of financial challenges.