Shifting Roles and Expectations in Health Care Policy

 According to PEW Research Center, reducing health care costs is a top issue for the American public, second only to strengthening the economy. 

At a recent policy discussion with some of the country’s most powerful health care trade association leaders we learned of their priorities in Washington and what they are anticipating in the current political environment.

Guest speakers included Matt Eyles, president and CEO, AHIP; Chip Kahn, president and CEO, Federation of American Hospitals; and Tom Leary, senior vice president and head of government relations, HIMSS. The discussion was moderated by Melinda Buntin, PhD, Mike Curb professor and chair of the Department of Health Policy at Vanderbilt University School of Medicine.

Here are four issues that were central to the discussion:

1. Improving Health Equity

Most health care sectors say health equity is an important focus. Associations, health systems, payers and tech innovators are all trying to creatively approach the problem of inequity in different ways, but most agree that a multilayered, long-term approach is necessary. 

“There is no silver bullet to addressing equity. Solutions must be multifaceted. For example, with the recent Medicare Advantage rate notice, they’re including a health equity index to measure how health plans are addressing equity. The concept is good, but how do you actually implement this? It will take a while before all of this is sorted out. But it is a starting point,” said Eyles.

Eyles also noted that health insurance providers are leading many different approaches to improve equity in their communities.

The American Hospital Association recently announced plans to facilitate health equity by providing capital and support to investment funds specifically serving health care startups led by women and people from racial and ethnic minority communities. As for the Federation of American Hospitals, Kahn said the organization has been working with the administration and Congress to assess the areas of health care policy that could remove social and structural barriers to improve health.

On a final note, both Leary and Eyles emphasized that lack of sound data is a major hurdle in addressing inequity.

“As an industry, we want to find ways for technology to support health equity. But what we are lacking is data modernization. You can’t have quality data when you’re still using paper and fax machines. We need a strong investment from the government to get us to a place where we have a good baseline to measure efforts,” said Leary.

 2. Strengthening Public Health Infrastructure and Worries About the End of Pandemic Relief

Covid-19 brought to light the importance of effective public health care policy and infrastructure. From data collection to vaccination distribution, contract tracing to public communication, the system’s weaknesses were revealed, inspiring investment and new strategies. It’s vital to take learnings from the past two years and use them to strengthen the country’s public health program for the future.

All of the panelists expressed concern that an abrupt the end of CARES Act funding, which kept the health care system from collapsing from the weight of the pandemic, would wreak havoc on a system that is still struggling. Through the CARES Act, Congress appropriated $100 billion in emergency funding for eligible health care providers and loan availability to businesses confronting the pandemic. Medicare and Medicaid reimbursement for COVID-19-related services was augmented, testing and treatment coverage was expanded, and rural health care providers obtained regulatory flexibility.

“I hope there is a glidepath to the end of this relief. Though we are getting to a better place, Covid is not going away completely. Luckily, uninsured people were able to get care during the pandemic thanks to effective health care policy. We don’t want to leave physicians and patients out in the cold,” said Kahn. 

“During the pandemic, providers were able to use technologies like telehealth and remote patient monitoring more easily because emergency health care policies were put in place. Now, we have millions of Medicare patients using these regularly. We do not want to go back to 2019, when using these technologies was cumbersome,” said Leary.

3. The No Surprises Act

The No Surprises Act (NSA), which went into effect on January 1, 2022, establishes new federal protections against surprise medical bills, which arise when insured consumers receive care from out-of-network hospitals and providers they did not choose. Studies by Kaiser Family Foundation and others have found that this happens in about 1 in 5 emergency room visits, posing financial burdens on consumers. The federal government estimates that the NSA will apply to about 10 million surprise medical bills a year.

NSA implementation has been closely watched by industry stakeholders. To implement the key provisions of the NSA, the Biden administration has issued several interim final rules, one proposed rule, and several rounds of guidance. Displeased with implementation of the federal Informal Dispute Resolution (IDR) process, health care providers—doctors, hospitals, and air ambulance companies—have sued the Biden administration over the two interim final rules.

“The law’s fate is in the court’s hands,” said Kahn. “We think the administration misinterpreted the law, weighting the IDR toward insurers. This makes it an existential issue for providers, as our entire negotiation system could be affected by this. It gives insurers tremendous leverage and could undermine providers’ ability to provide sufficient care,” said Kahn.

“As payers, we think the ban on surprise billing is great for patients. We’ve filed many briefs in support of the government’s rule, and we hope it passes through the court,” said Eyles.

4. The rise of health care consumerism

For years, health care pundits have predicted the rise of health care consumerism, and that someday, people will be able to shop for health care products and services in the same way they do in every other industry. Today, we are closer to that vision than ever. Retail and tech companies such as Amazon, Google and Walmart are investing a great deal in the health care space, hoping to fill care gaps and improve Americans’ health by offering convenience and services such as telehealth, primary care and prescriptions.

“Consumer expectations are now sky-high regarding access to care technology. We saw a 40% increase in telehealth use at the height of the pandemic, and now this is something patients expect, along with other services such as remote patient monitoring. Now we are challenged with making sure these technologies are available to those who need and want them. Health care policy will play a huge role in this effort,” said Leary.

The Council’s “Trends and Influencers” series is presented by BlueCross BlueShield of Tennessee. Supporting sponsors include Bass, Berry & Sims, Cressey & Company and LifePoint Health. For more information about the Council and upcoming events, visit www.nhccstaging.wpenginepowered.com.