On May 15th, the Washington Post hosted an event, titled, “America’s Health Future” featuring David Holmberg, President and CEO of Highmark Health, and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, among others.
David Holmberg prefaced Highmark’s activity by stating that health care is the new retail industry in that it needs to be responsive to customer demands and satisfaction. He supported the Trump administration’s recent Drug Prices Blueprint saying it was a step in the right direction. Holmberg identified fragmented care, such as the process of various doctors prescribing different medications to patients, as an additional major challenge. He said the company is investing in smaller “neighborhood” hospitals that feature an emergency department and primary care physicians, as well as embedding specialists where there is a need. Highmark is also working to increase same-day appointments for both primary care and specialized physicians in hopes of elevating patient satisfaction levels. In addition, the company formed a partnership with Carnegie Mellon University to compile consumers’ health data from their portable devices and claims as a way to treat patients before they have a crisis. A proponent of the power of health care data, Holmberg indicated that Highmark is focused more on identifying keen insights from the statistics rather than simply amassing the information.
Holmberg said the ACA was a costly learning experience with a lot of unmet patient need and that beneficiaries should expect premium rate increases due to a flow of companies moving in and out of the market. He added the stabilization of the ACA marketplace depends on predictable government regulations. Homberg said health care solutions should include jobs and education, and should be scalable.
CMS Administrator Seema Verma discussed the Agency’s community engagement guidance and said it is popular with the public and physicians. She said that CMS is looking at the number of program participants and how many get jobs. Verma identified two Medicaid recipient groups — those who are truly vulnerable and those who are able-bodied — and believes policy responses should be different for each patient population. For example, once the Affordable Care Act was expanded to able-bodied individuals, Verma believes there should have been a path for them to get jobs, which is outlined in the guidance.
Verma also favors Medicaid improving health outcomes and ensuring long-term stability. Currently, Medicaid comprises approximately 1/3 of states’ budgets and CMS wants to limit the fiscal footprint by increasing flexibility for states while simultaneously holding them accountable. Yet CMS rejected Kansas’ Medicaid waiver request that attempted to limit individual benefits to three years and, in general, the Agency does not support the imposition of any lifetime limits. Regarding individuals who are in the coverage gap, Verma replied that CMS will not coerce Medicaid expansion in states that have not embraced this optional ACA benefit.
Following the Blueprint, CMS is trying to create competition by transitioning Medicare part B drugs into part D. CMS is also looking to give new tools to Part D and create incentives for pharmaceutical companies to lower their prices by reevaluating the current rebate system. With respect to FDA Commissioner Scott Gottlieb’s comments that Best Price requirements contribute to increasing prices, Verma said he was referring to the complex rebates. She added that the Blueprint questions whether to base the system on list prices versus rebates. Regarding association health plans, Verma said she supported the plans because they offer a choice for individuals who may only have one option in their state.
The administrator announced the CMS Drug Pricing Dashboard, which will include all drugs paid for by Medicare and Medicaid, will also show the yearly price increase for a particular pharmaceutical. She concluded by saying her goal as CMS administrator is to build more health care efficiency.
American College of Radiology (ACR) members can access the recorded event here.
The ACR’s Government Relations office continues to closely monitor all issues affecting Medicaid and private payers.