Washington, D.C. hardly seems like a town on suicide watch.
As November turned to December, from the venerable Old Ebbitt Grill near the White House, to Charlie Palmer Steak at 101 Constitution and over to The Capital Grille at 601 Pennsylvania, revelers abounded, in both food and drink.
At the Capitol Hyatt on New Jersey Avenue though, some contrasts were evident. While contestants from the Miss World 2016 pageant moved in and out of the upper lobby to awaiting buses, in the lower-level meeting rooms, also from November 30 to December 2, the mood was hopeful optimism meets whistling past the graveyard.
There the Jefferson College of Population Health summit brought forth Andy Slavitt, Michael Leavitt, Farzad Mostashari, NCQA President Peggy O’Kane, former advisors from the George W. Bush and Obama administrations, officials from Johns Hopkins, the Henry Ford Health System, Brookings, Deloitte, AMA, AHA and the American College of Physicians and many more to dissect MACRA and ponder “population health strategy under the new administration.”
The consensus on where value-based care (VBC) is heading?
Wait and see.
The predictions? The Cadillac tax will go the way of the DeSoto. Medicare Advantage payment models will increase. The overriding attention on ACA insurance will back-burner VBC changes buffered also by MACRA. Track1+ will itself be the savior of MACRA. And looming large is whether Medicare will become a voucher or premium support model.
Voices of hope and optimism, sometimes bordering on defensiveness, could be heard, all as the bipartisan 21st Century Cures bill moved toward law a few blocks away.
Mandatory bundled payments will be killed. Wait a minute; bundled payments have returned nearly 3% to the Medicare Trust Fund, versus .02% by ACOs. Tom Daschle, like Tom Price, was once a shoe-in as secretary of HHS. VBC pilots preceded CMMI. Value preceded ACA. Well, most federal payment models will just be renamed or rebranded, beginning with the term physician.
Former HHS Secretary Michael Leavitt sought calm. “CMMI will be challenged, but the analytics it provides are important to maintain … we need to find the balance between provider readiness and the speed to change between providers and payers … the GOP is not in lockstep … the bottom line is we don’t know.”
As a prelude to his standing ovation, outgoing CMS Administrator Andy Slavitt called for the continuation of lifetime limits, coverage for pre-existing conditions and those up to age 26 be maintained on parental policies.
PTAC to the rescue
Given much attention at the conference was a so-far overlooked element of the MACRA law, the establishment of the Physician-Focused Payment Model Technical Advisory Committee (PTAC).
Amid speculation that the new regime at HHS will, again, decry mandatory bundled payments, shrink MACRA, lay siege to EHRs (which took its lumps from many quarters) and roll back the movement to VBC or quality reporting payment models seen as onerous to physician workflow, PTAC was seen as a potential fresh start.
Its mandate is to assess and put forth new physician-focused payment models, done by a committee of 11 already appointed by the GAO; a committee that includes six MDs. Already nine letter-of-intent proposals have been submitted, and PTAC is to refer winning payment model proposals to, yes, the new secretary of HHS by the spring of 2017.
These new payment models can be APMs, A-APMs, bundled payments; you name it. The criteria for them includes the use of health information technology, risk-level flexibility, value over volume, integrated care coordination and cost-quality metrics.
Physician Heal Thy Future
In the end, Bob Margolis, MD, Duke-Margolis Center for Health Policy, took a more direct position. Physicians should take the debate out of Washington and into their own hands, and realize a future without a government single payer with price controls and salaried doctors.
How? Establish their own care plans around predictive modeling and population analytics. Consider a global capitated population health approach stratifying patients into appropriate treatment plans. Realize that EHRs are not tools for analytics and that BI tools are needed on top. And then, assessing risk-based payment models can be a holistic approach. He reminded the attendees that PCPs and their aligned specialists control 85% of the healthcare spend. In Washington, D.C., that’s called power.
Outside on the newsstands, Washingtonian magazine featured a wistful cover shot of the Obamas for its December issue, headlined “How They Changed Our City.”
Past nightfall, as visitors gathered around one side of the White House to view the Christmas tree, scaffolding was being erected on the other for the upcoming inauguration.
What’s clear throughout the town is that while pockets of the country fume, Washington, D.C. is ready to take change in stride again.
Greg Fulton is industry & public policy lead for Philips Wellcentive