National Health Policy Conference 2014

If you haven’t been following my Twitter feed (@PolicyRx) you may have missed that I recently traveled to DC for the National Health Policy Conference sponsored by Academy Health. And if you missed the conference itself, don’t worry, I’m writing this review to catch you up on all that happened.

The Administration’s Health Policy Priorities

Jeanne Lambrew, from the White House Office of Health Reform, opened the conference with a few indications that the administration with double down on delivery system reforms. The Obama administration will start to focus on private sector collaborations and possibly aligning incentives with the Medicaid and Medicare programs.

Focus on State Coverage Activities

A panel of experts from different states (Kentucky, Illinois, Maryland, and Mississippi) discussed reform efforts. In Kentucky, Audrey Haynes stated that expanding Medicaid was a “no brainer.” They were the 44th sickest state in the country and couldn’t imagine leaving so much federal money on the table while not improving health. In Mississippi, where Mike Chaney of the Mississippi Insurance Department described health policy as akin to  “tap dancing on razor blades” all observers can expect is a SHOP exchange but no further action on the Affordable Care Act.  In Maryland, Josh Sharfstein indicated that Maryland remains full-steam ahead with the Affordable Care Act and will even try to maintain the Medicaid bump-up rate for primary care physicians. Overall, the experts made four important to-dos from the national perspective: (a) contain costs while delivering quality, (b) focus on public health, (c) examine health care as a right, and (d) fix the politics that stifle action.

Physician Payment Reform

This breakout session discussing the SGR was extremely popular, with a standing-room only crowd. Physicians finally see the holy grail of healthcare lobbying (i.e. SGR repeal) materializing on the horizon. Off the record comments from the congressional plenary session the following day would confirm that both the Seante and House (Republican and Democrat) are heavily invested in making SGR repeal a reality this time.

The group most cautious about SGR repeal was that of the Medicare beneficiary advocates – the Medicare Rights Center. They want to make sure that paying for SGR repeal does not fall on the backs of seniors through higher cost sharing. They also want patient experience metrics to be incorporated into Medicare quality measures.

One of the important themes in the physician payment reform session was that of alignment of incentives. That theme would resurface throughout the conference and should inform future negotiations between payers and providers. 

Meanwhile, in a simultaneous session comparing implementation of the Affordable Care Act, participants noted the polar opposite approaches of states like Maryland and Texas.

Shannon Brownlee: The Coming Transformation in Healthcare and Health

Shannon Brownlee, a reporter who popularized the concept of over-treatment in health care, headlined the lunch plenary. She had some great insights such as noting that “if we go one industry, one specialty, one choosing wisely campaign at a time, we are going to go bust.” Noting that the hospital and physician sectors are overwhelmingly large sectors of the U.S. economy, she described the relative neglect of social determinants of health such as education and social services.

Brownlee challenged physicians to be like Virchow, who stated that  Having felt thoroughly trounced by her negative connotations of emergency care earlier in her speech, I and many other physicians, took to the microphone during the Q&A.  I reminded the audience that there are a group of physicians who attempt to embody Virchow’s words. We, the Evidence-Based Health Policy® experts at Policy Prescriptions®  are just that group.

Price Transparency

The next break out session discussed price transparency, which is a tool for purchasers and policy makers but could become one for patients. Transparency sheds light on price variation but requires an all-payer database, standardized cost and quality measures, and a lack of gag clauses to be effective.  It also requires about how much their own services cost.  Dolores Mitchell of Group Insurance Commission of Massachusetts noted that these price transparency tools are useless when nobody uses them.

Mitchell also noted that different prices are paid by patients of different circumstances (i.e. insurance statuses). If fact, she went on to claim that differential pricing might even be immoral. One prominent attendee suggested that maybe Medicaid paying less than Medicare was immoral too!

Mitchell: maybe immoral to charge patients different amounts. So, Medicaid paying less than Medicare a moral issue? #NHPC14

— Atul Grover, MD, PhD (@AtulGroverMD) February 3, 2014

Conclusion of Day 1

The closing session for Day 1 of the National Health Policy Conference was by Troyen Brennan, of CVS Caremark. I only mention this because on Monday he regretfully noted the public health problem of selling cigarettes at pharmacies and by Wednesday CVS made the decision to pull tobacco products from their shelves by October 1, 2014. I don’t know if the policy wonks at the conference had anything to do with it (I seriously doubt it), but why not take credit anyway for such an important public health victory. Click here to read my summary of Day 2 of the National Health Policy Conference.

by

Cedric Dark, MD, MPH