Washington is not known, especially these days, as a place of consensus. However, there is at least one area of bipartisan, bicameral agreement: for better or worse, the health care system is rapidly changing.
The changes brought about by the Affordable Care Act, coupled with the demographic shifts caused by the aging Baby Boomer population, and consumer-driven pushes for more information and better quality stemming from social media and crowd-sourcing – to name just a few factors – together are driving the health care system into a new era. Policymakers, payers, and patients together expect better quality and outcomes for a more affordable price. Moreover, doing things the same way they have always been done no longer flies, especially with an up-and-coming generation of kids who someday may never remember a time when people, not computers, drove cars. Just as necessity is the mother of invention – economic and demographic pressure can be the impetus for health care innovation.
The federal government remains the largest payer in the nation – insuring 49 million people under Medicare, 68 million in Medicaid, 9.5 million service men and women in the military including reservists and their families, 10 million in Veterans' Affairs, 2.2 million in Indian Health Service, and 8.2 million in the Federal Employee Health Benefits Program. This is a combined total of 146 million lives and more than $1 trillion each year. This employer/payer wants more from its investment and is leveraging its purchasing power in the marketplace. While an estimated 60,000 hospitals, health systems, provider groups, and other organizations have raised their hands to volunteer to help the federal government test 22 new ways to deliver and pay for care, numerous others are being ostriches and sticking their heads in the sand, hoping that this latest "trend" of accountable care, shared risk/shared savings, and "innovation" will pass quickly and the gravy train of fee-for-service – volume based payment – will continue to chug down the track.
Although some tests and innovations are proving to be less successful than anticipated, federal policymakers and commercial payers maintain a steadfast commitment to continuing to modify the system so that outcomes are better and costs are less.
The providers likely to be most successful during this transition – and into the next generation and iteration of the nation's health care system – are those that embrace change rather than those that shirk it. There are many reasons why some have not yet embraced the "value not volume" approach. Yet, while accountable care might not make sense in a geographically desolate area of the country with a small population, care coordination and leveraging of technologies like telehealth might be the right fit. Before the folks at CMS in Baltimore decide for you what new model you must adopt, it is best for you to be in control of your own destiny and start to adapt.
Think about your patients from the payers' perspective: what could or should you be doing differently to care for the patients for whom Uncle Sam pays the bill? What do you do for commercial patients or Medicare Advantage that should also be done for Medicare fee-for-service patients, if only CMS gave you some flexibility or latitude?
Bring those ideas and solutions to policymakers. And, don't be shy about asking for funding or a waiver from requirements or proposing a pilot to study a new approach. Members of Congress might not be legislating a lot these days but they all have relationships with federal agencies and are eager to advance good ideas before regulatory bodies.
When devising your strategies and proposals, remember to keep your Members of Congress in the loop so they can provide assistance in navigating the federal agency sphere and help secure support for your proposal. Elected officials and agency staff express frustration at the providers who solely advocate "no cuts" and push to "keep the status quo;" both Congress and agency staff will appreciate and welcome providers who want to be part of the solution and legitimately want to work together to improve the nation's system of care.
Ilisa Halpern Paul leads the District Policy Group and has more than 20 years of experience in government relations, advocacy, and policymaking in non-profit, academic, federally funded and government settings. Ilisa's practice centers on advising clients with respect to advancing their federal legislative, regulatory and programmatic policy agendas.
Ilisa Halpern Paul leads the District Policy Group and has more than 20 years of experience in government relations, advocacy, and policymaking in non-profit, academic, federally-funded, and government settings. Ilisa's practice centers on advising clients with respect to advancing their federal legislative, regulatory and programmatic policy agendas.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.