We all see it coming: the repeal and replacement of the Affordable Care Act – a key position for Donald Trump during his presidential campaign. With his impending inauguration just two weeks away, we now have an opportunity to rethink healthcare. As policy changes are considered, one thing that both parties can agree on is the continued need to improve quality, reduce costs and build on existing successes, such as the move toward a value-based care delivery and payment system.
Here are three focus areas for the Trump Administration that will help capitalize on the gains we’ve already achieved.
1. Creating incentives for delivery system changes
The Medicare Access and Chip Reauthorization Act (MACRA) has clear incentives for providers to move toward value-based care and alternative payment models. However, current models need some work to better balance risks and rewards, and clear away any legal and regulatory barriers that can discourage participation. For providers to succeed, key policy changes are needed, including:
- Choices and flexibility among the alternative payment models – Healthcare providers need additional options and greater incentives to participate in value-based payment models, such as accountable care organizations (ACOs) and bundled payments.
- Preserving an infrastructure for innovation – It’s difficult moving away from the antiquated and broken fee-for-service system on which our healthcare system is built. Healthcare providers and clinicians are accustomed to it, but its payer-led model undermines healthcare provider innovation and accountability. We need a means to learn our way to a new model, which requires an infrastructure to innovate and voluntarily testing of new care models that can be scaled nationally.
- State flexibility to assist providers to measurably improve quality and reduce costs – States should be able to implement innovative payment and delivery models that will lead to better coordination, reduced costs and improved care.
- Informing consumers – Consumer engagement is key to MACRA’s success and can be improved by increasing transparency of quality and cost information and providing flexibility around benefits to incent the right behaviors.
2. Empowering providers and consumers with greater access to healthcare data and interoperable technology
Successful quality improvement by healthcare providers and a more empowered consumer requires effective use of clinical, pricing and other data, as well as patient access to their own medical information through interoperable, secure information systems. Patient data should be able to be accessed closer to real-time to help providers improve quality, and electronic health records should move from being closed systems to interoperable medical records that make it easy for providers and patients to exchange information.
3. Bringing down costs through pharmaceutical competition
A greater federal focus is needed to create a more competitive market for pharmaceuticals. As Susan DeVore recently discussed in Modern Healthcare, we need to implement solutions that will drive competition and keep costs down, including:
- Faster approvals from the FDA;
- More biosimilar approvals;
- Ending pay-for-delay; and
- Relaxation of closed distribution networks.
We recently shared these suggestions in a letter to the Trump Administration, along with our Delivery System Transformation Roadmap which provides a more detailed account of our recommendations. We look forward to being able to continue to partner with our members and Washington to transform care delivery and improve America’s healthcare system.
To learn more about Premier’s advocacy efforts, CLICK HERE.