Time to Discuss a “Health Equity Moonshot”

March 31, 2021
5:41 pm

This month, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on the health inequities witnessed during the COVID-19 pandemic.  The topics discussed in that hearing warrant our sustained attention.

I’m particularly focused on the testimony of Eugene Woods, the president and CEO of Atrium Health (a Healthcare Leadership Council member), a North Carolina-based health system. Out of the tragedies we have witnessed during COVID-19, which have disproportionately affected racial and ethnic populations as well as areas with high rates of poverty and comparably limited healthcare access, Mr. Woods sees an opportunity to do something significant and transformative.

As he put it, “The COVID-19 pandemic has come at a great cost to the world. We should view this reality as an investment that allows us to emerge stronger.  Through unity and collaboration, government and industry are capable of great things. This has been, and still is, a core tenet of American exceptionalism.”

In his testimony, Mr. Woods offered the notion of a private-public collaboration not unlike the efforts that put astronauts on the moon or the Cancer Moonshot Initiative of a few years ago.  In fact, he referred to it as a “health equity moonshot” and suggested four priorities to address the equity gaps that have existed for too long but were made glaringly obvious during the pandemic.  They are:

  • Extending health coverage access beyond the current Public Health Emergency by utilizing innovative private models and government-based structures.
  • Creating worldwide standards for data collection and full data interoperability to enable real-time analytics.
  • Making broadband available to every rural and urban community in the country.
  • Using technology to support sustained well-being, particularly in underserved communities.

If we truly believe in the goal of accessible, high-quality healthcare for every American, then this is an idea that should receive extensive attention and discussion.  To quote Mr. Woods again, “While COVID-19 and the public health emergency we have faced may fade over time, the health inequities the pandemic uncovered will persist if we don’t take this moment to come together around an ambitious goal.”

The Extraordinary Pandemic Efforts You Didn’t See

March 19, 2021
7:57 am

America is well aware of the heroic work performed throughout the COVID-19 pandemic by physicians, nurses and other front line healthcare professionals, tirelessly handling a rapidly escalating number of cases as the virus spread and hospitals were stretched to capacity and beyond.

But what we didn’t see was the vital work taking place behind the scenes to reconfigure healthcare data systems so that COVID-19 treatment guidelines could be rapidly disseminated, patient data could be made readily available, in-person exchanges could be shifted to telehealth, and more healthcare professionals could have access to critical data as they, too, were forced to work from home as America quarantined.

In an interview with the Wall Street Journal, Mayo Clinic Chief Information Officer Cris Ross described having to make decisions in days and weeks that would normally require months on how to make changes to the Clinic’s information technology systems in order to meet an unprecedented challenge.

He said, “We had to make close to 3,000 changes in our electronic health-records system to recognize rapidly evolving hospital-facility changes and protocols. Clinical guidelines for Covid treatment were developed and made available from within the records system. So, for example, if someone arrives at the emergency department who may have Covid, what are the steps? If that patient is admitted, what’s the next step? And if they’re sent to an ICU, what’s the next step?”

The rapid changes required of Mayo and other health systems when the pandemic struck underscores the importance of better preparing the nation for future health crises. Last year and into early 2021, the Healthcare Leadership Council worked with 100 different healthcare, employer and patient advocacy organizations to develop a comprehensive set of recommendations on how to strengthen private-public collaborations on disaster readiness and response. They include the creation of a 21st century public health data infrastructure that will enable real time access to critical information necessary to get ahead of a rapidly evolving crisis like COVID-19.

Many of the recommendations in this report were included in the recently-passed American Rescue Act, but much more work remains to be done before the next catastrophe strikes.

An Innovative Approach in Minnesota to Close the Gap Between Mental Health Needs and Treatment

February 25, 2021
8:15 am

It has always been important to improve access to treatment for mental health and substance use disorders.  Now it’s imperative.

Even before the arrival of COVID-19, national numbers raised serious concerns.  Twenty percent of Americans reported experiencing depression or an anxiety disorder while also having substance abuse issues. Drug overdose deaths have more than tripled since 1990, and almost 21 million Americans have at least one addiction with only one of every 10 receiving treatment for the condition.  The pandemic has worsened our society’s struggles. According to the Kaiser Family Foundation, in August of 2020, 53 percent of adults reported that their mental health had been negatively impacted as a result of the changes wrought by COVID-19. This, in turn, has caused the number of people with substance use disorders to rise.

Now, more than ever, investments must be made to ensure access to treatment and innovative ideas must be pursued to address these mental health challenges.  One such innovation is taking place in Minnesota.

One clear obstacle patients face is the lag time between the initial request for care and the availability of specialists and treatment programs. While this wait time is occurring, there is a heightened risk of suicide, drug overdose, or a change of heart about pursuing treatment. Recognizing this dilemma, M Health Fairview initiated a new program to bridge this gap. The program is designed to provide same-day access to either in-person care or virtual care with trained providers.  Additionally, the health system has included a mobile unit that proactively brings the support directly into the community. Emergency Medicine Physician and Psychiatrist Dr. Richard Levine emphasized that this program does not replace any type of care, but rather simply provides the stability patients need in their transition from initial treatment to longer-term care.

These are difficult times for so many Americans. Health providers like M Health Fairview are demonstrating innovation and leadership in meeting the urgent needs of those with mental health or substance use disorders.

Health Industry Leader Offers a Medicare Advantage Solution

February 04, 2021
10:27 am

Politically, the notion of “Medicare for All” is a non-starter. Americans have consistently resisted the idea of a major government health coverage expansion that would take away the private plans they currently have and value.  Nonetheless, we’re still faced with the challenge of how to achieve universal coverage, provide all Americans access to high-quality care, and address the health inequities that currently exist.

Dr. Sachin H. Jain, president and CEO of SCAN Group and SCAN Health Plan and a member of the Healthcare Leadership Council, advised in a Modern Healthcare op-ed that the focus has been on the wrong type of Medicare expansion. If this country is going to build upon proven successes, Dr. Jain points out that Medicare Advantage, operated by private health plans, outperforms traditional Medicare with lower annual beneficiary costs, superior health outcomes, and high popularity among seniors. Opening up broader access to Medicare Advantage plans is another way to address the health inequity issues that remain a serious challenge.

Dr. Jain’s full op-ed is provided below.

Medicare for All? The better route to universal coverage would be Medicare Advantage for All

Dr. Sachin H. Jain

President-elect Joe Biden won election with a mandate to continue the healthcare reforms begun by President Barack Obama. On the campaign trail, Biden pledged to protect and build on the Affordable Care Act.

Many people have urged Biden to make good on his promise by implementing “Medicare for All.” That would be a mistake. There’s a better system out there—and for more than two decades, it has successfully relied on public-private partnerships to expand access to care, lower costs and improve outcomes for millions of Americans. What the country needs is “Medicare Advantage for All.”

Under traditional Medicare, the government pays doctors and hospitals for individual services, tests and procedures. Under Medicare Advantage, the government sends capitated payments to private insurers—including not-for-profits—which, in turn, are charged with providing highly coordinated, whole-patient care to beneficiaries.

Introduced in their current form in 1997, Advantage plans have proven wildly popular among the mostly older adult populations they cover. That’s in large part because the plans are able to offer a wider array of health-related benefits than traditional Medicare. They commonly charge no premiums, cover prescription drugs, and include no- and low-cost vision and dental benefits. Many offer gym memberships, acupuncture and chiropractic coverage, as well as transportation options to get patients to their appointments.

As popular as these plans are with consumers, that’s not the primary reason to expand their availability. The fact is, Advantage plans outperform traditional Medicare, producing better outcomes at lower costs for both the government and beneficiaries alike. A recent study, for example, looked at people with chronic conditions and found that Advantage plans performed better on several key quality measures, including avoidable hospitalizations and higher rates of preventive screenings.

Likewise, a separate study found that annual beneficiary costs for Advantage enrollees are about 40% lower than for those in traditional Medicare. And because, by law, Advantage plans come with maximum out-of-pocket limits, beneficiaries are protected from the costs that cause traditional Medicare beneficiaries to purchase private “Medigap” plans to supplement their coverage.

As for the government’s portion of the bill, it’s impossible to know exactly how much any “public option” might cost taxpayers without knowing the details of each proposal (Will there be premiums? How much are co-payments? What types of benefits will be included?). Nevertheless, past practice demonstrates that it costs less to care for Advantage enrollees. Humana, for example, just reported that the cost to care for members in its Advantage plans was 19% less than for traditional Medicare enrollees.

At the same time, it’s essential to note that much of this savings derives from the value-based payment contracts baked into most Advantage plans. And that could present a challenge, because Americans often say they want to see any doctor in any network of their choosing. That vision is incompatible with most Advantage plans, which derive their savings—as well as the cohesion of care they provide—from managed-care networks which, by definition, limit one’s choice of providers.

On the other hand, knowing that the coordinated care these networks provide produces better health outcomes and that the private insurers that administer Advantage plans have proven track records collaborating with public officials to design affordable plans that deliver consumer choice and excellent outcomes would surely appeal to a broad swath of the populace. What’s more, growing Medicare Advantage would not require a massive expansion of the federal government’s role in healthcare, something the majority of Americans consistently say they oppose.

President-elect Biden has said that he wants to offer Americans the ability to buy into “a public health insurance option like Medicare.” The best such option is Medicare Advantage. It’s widely relied upon by our parents and grandparents. And in these times of economic uncertainty, it’s time to make it available to everyone.

Dealing With Disaster: Applying Lessons Learned from a Pandemic

November 30, 2020
1:49 pm

As COVID-19 has maintained its grip on the United States, there has been an increasing focus on learning from emergency response successes and mistakes in order to prepare the nation’s healthcare system for the next local or national disaster. Hospitals and healthcare workers in particular have experienced the chaos, uncertainty and stress of caring for patients while, at times, lacking critical data as well as adequate supplies of equipment.

Recognizing the need for a segment of the healthcare workforce to specialize in healthcare crises, ICAP at Columbia University and the Dalio Center for Health Justice at NewYork-Presbyterian launched the REACH (Responding to Epidemics and Crises in Health) Fellowship. The program is utilizing a mix of education, training and mentorship to achieve a comprehensive approach and will include participants with diverse healthcare backgrounds.

Dr. Steven J. Corwin, President and Chief Executive Officer of NewYork-Presbyterian Hospital emphasized the continued commitment of his staff in addressing COVID-19 and said the lessons learned on the ground will be thoroughly studied within the Fellowship. It is no surprise that one of the first collaborations of this nature has been initiated in one of the early coronavirus hot spots. As more time passes, additional institutions will certainly create similar programs.

Individual actions are vital for progress in handling any form of crisis that affects the healthcare system, however a coordinated approach that brings the industry together is unquestionably a necessity. The Healthcare Leadership Council (HLC), of which NewYork-Presbyterian Hospital is a member, has been working with the Duke-Margolis Center for Health Policy and over 75 healthcare organizations to develop recommendations for a private-public partnership that will include an advanced coordinated plan formed and agreed upon by the healthcare industry and federal officials. Through the National Dialogue for Healthcare Innovation (NDHI), HLC and the Duke-Margolis team have led meetings and hosted a summit of healthcare executives and leaders within multiple government agencies to work out the details on this partnership. A final report will be distributed in early 2021. As this pandemic lingers, we can be sure that new lessons are on the horizon and the path forward is through innovation and collaboration.