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Putting the Puzzle Together for Health Care in 2017 and Beyond

Published on 12/5/2016

Meg Marshall, senior director of public policy for Cerner, develops and oversees Cerner’s legislative agenda and represents the interests of Cerner and health care IT collaboratives in working with government officials and industry partners.

If the future of government’s role in health care and health IT is a puzzle, a few key pieces were revealed last week.

Let’s start with how President-elect Donald Trump’s health team is shaping up. Most significantly, Trump named U.S. Rep. Tom Price as his nominee to head the Department of Health and Human Services (HHS)

As a practicing orthopedic surgeon, Price has extensive experience in health care delivery. As a member of the House Committee on Ways and Means, he has been closely involved in the oversight of Medicare reforms, including the EHR Meaningful Use Incentive Programs and MACRA. A strong advocate for physicians, he spearheaded efforts to ensure regulations encouraged patient access, choice and quality, without unnecessarily burdening providers.

Price has been a longtime opponent of the Affordable Care Act (ACA) and was one of the first legislators to draft a proposal to simultaneously repeal and replace ACA, H.R. 2300 “Empowering Patients First Act of 2015.” This plan outlined repeal of the expanded Medicaid coverage to: 

  • Offer fixed, age-based tax credits for individuals to purchase insurance policies in the private market;
  • Prohibit denial of coverage based on pre-existing conditions, provided the individual had 18 months of prior continuous coverage;
  • Expand use of health savings accounts;
  • Provide grants to states to insure high-risk populations;
  • Limit the employer tax exclusion for providing health insurance to $8,000 a year for individual policies and $20,000 for families;
  • Allow for intrastate insurance policies;
  • Eliminate mandates for insurers to include a standard package of benefits.

Republicans have signaled the ACA could be repealed under the budget reconciliation process as early as January. The path for its replacement, however, is not yet clear. Sen. Lamar Alexander, chairman of the Senate committee on Health, Education, Labor, and Pensions, said he would like to see a replacement plan outlined before the repeal is voted on. On the other hand conservative think tank Heritage Foundation, published a recent issue brief suggesting Republicans immediately repeal ACA, then take short-term actions to stabilize the 2018 plan market and have replacements in place staring with the 2019 plan cycle. The latter strategy became the more likely choice last week when Trump selected Nina Owcharenko to join the HHS landing team, as Owcharenko was the brief’s co-author and current head of Heritage’s Center for Health Policy Studies.

Another significant announcement was the nomination of Seema Verma to lead the Centers for Medicare and Medicaid Services (CMS). Verma advanced Indiana’s Medicaid program, which under Vice President-elect Mike Pence’s leadership was one of the few Republican-led states to expand Medicaid. Called Healthy Indiana 2.0, it may provide a blueprint for ACA replacement strategies, as a federal waiver allowed implementation of conservative strategies focused on personal responsibility, such as requiring a small monthly payment and contributions toward health savings accounts from its enrollees, encouraging employment through a state-funded incentive program, and requiring enrollees to pay copays for unnecessary trips to the emergency room. 

Widely considered to be one of the preeminent examples of a market-based Medicaid transformation, Indiana's state Medicaid program includes six goals: 

  1. Reduce the number of uninsured low income Hoosiers and increase access to health care services. 
  2. Promote value-based decision making and personal health responsibility. 
  3. Promote disease prevention and health promotion to achieve better health outcomes. 
  4. Promote private market coverage and family coverage options to reduce provider and network fragmentation within families. 
  5. Facilitate HIP member access to job training and stable employment to reduce dependence on public assistance. 
  6. Assure state fiscal responsibility and efficient management of the program. 

Verma’s consulting firm is said to have worked with other Republican-led states to evaluate similar strategies, such as Iowa, Ohio and Kentucky.

21st Century Cures

Another significant event from the past week is the House passage of the 21st Century Cures Act, a bipartisan effort over two years in the making. 

As one of the most impactful provisions related to health IT, the act aims to improve EHR interoperability through information blocking provisions that outline enforcement authority and civil penalties, and streamlining of standards development. This provision seeks a “trusted exchange framework” to ensure full network-to-network exchange of health information based on a common agreement. 

This act establishes a $6.3 billion medical innovation package targeted to accelerate the discovery, development and delivery of new cures and treatments and provide new funding for the National Institutes of Health (NIH) and Food and Drug Administration (FDA). The bill provides for $4.77 billion over 10 years to the NIH for the Precision Medicine Initiative and other research initiatives such as Cancer Moonshot. Additionally, $1 billion in grants will support state efforts to improve opioid abuse prevention and treatment, including better prescription drug monitoring programs. While not every member of Congress is a fan of all parts in the bill, the Senate is expected to vote to approve this week with no amendments.

At approximately 1,000 pages, the legislation addresses policy issues of importance to research institutions and life sciences, pharmaceutical and medical device companies, as well as several important provisions for health IT suppliers, hospitals and providers, which seek to achieve administrative simplification of federal health IT programs.

Other notable provisions include:

  • Consolidation of the existing ONC advisory committees on standards and policy into one to create a more streamlined HIT Advisory Committee to specifically address issues related to interoperability, privacy and security. Eight of the 25 members are to be appointed by Congress.
  • The addition of health IT developers to the confidentiality protections afforded to Patient Safety Organizations to help improve the safety of HIT products for patients.
  • Requirement for the Government Accountability Office to conduct a study on methods for security matching patient records to the correct patient.
  • Encouragement to reduce regulatory or administrative burdens – such as documentation requirements – relating to the user of electronic health records (EHRs).
  • Authorization for ONC to create a voluntary certification program for medical specialties.
  • Exemption of EHRs, fitness trackers and certain clinical decision support from FDA regulation, with some exceptions.
  • Exclusion for a period of time ambulatory surgical centers from EHR Meaningful Use penalties and Advancing Care Information domain scoring under the MACRA MIPS for professionals who practice primarily in ASCs. 

A saying from philosopher Sun Tzu, “In the midst of chaos, there is also opportunity.” This is certainly a busy time in the health and health IT policy space. In this golden era of health care, Cerner remains committed to advancing a favorable policy environment for continued innovation and our clients’ ability to improve the lives of millions of Americans. As the future of health care in the U.S. continues to be an important debate, we look forward to working with the new government as it reflects upon lessons learned to sharpen its focus on advancing the nation’s health care system, protecting the role of health IT as fundamental to achieving high quality, low cost care for Americans.