Back in February, The Aspen Institute and The Advisory Board Company sponsored the Care Innovation Summit in Washington, DC. With a keynote address from Secretary of Health and Human Services Kathleen Sebelius, the daylong summit featured some of the newest data and research on the rapidly evolving U.S. health care landscape.
Featured speakers such as Jeffrey Brenner of the Camden Coalition of Healthcare Providers and Claudia Grossmann of the Institute of Medicine in addition to others from State and Federal government, insurers, hospitals, and research institutions offered insights on higher-value care and improved health for individuals and populations.
Here are five most memorable takeaways:
1. Health Care Cost Inflation Has Slowed
Perhaps the most eye-catching data trend presented was the dramatic slowing of Medicare spending showcased by Patrick Conway, Director of CMMI (presentation available here). The collapse of annual per capita spending growth is important not only because it implies significant value changes are underway in the provision of ever more services by Medicare, but also because it can further mean many things to many people.
The long-term solvency of Medicare changes drastically if the coming decades follow the inflation of the last seven years, with implications for the ongoing political debate surrounding CMS retrenchment. However, the same trend can be used to illustrate the ongoing presence of post-recession fundamentals in the U.S. economy, and therefore potentially little effective reform in CMS administration at all.
Given the increase in Medicare enrollments as well as their aging, low per capita growth is also an arguable proxy for the restricted provision of valuable care. The reduction of per capita cost growth may spark as much debate at it settles, but clearly something important is happening to the U.S. health care cost curve.
“Live for free or die” was how Tom Scully, former CMS Administrator, light-heartedly characterized the relationship of New Hampshire to its Medicaid payment arrangement. Besides being witty, the comment underlines a legitimate and important financial inconsistency in the foundation of Medicaid funding. The leeway provided to states in the financing and implementation of Medicaid coverage, and the resulting negotiations with federal institutions to provide matching funds, inevitably leads to states acquiring divergent, advantageous arrangements.
Different economic circumstances interact with varying state-level cost loads to make the states inconsistent in their willingness to expand Medicaid, which Medicaid itself continues to treat an expanding portion of the population. This fundamental structural heterogeneity only further complicates the ongoing discussion regarding optional implantation of Medicaid expansion under the ACA.
3. Reform Scaling
Jennifer Wood, Chief of Staff and General Counsel to the Lt. Governor of Rhode Island, had numerous interesting comments to make about the fast developing forces driving health care change in her state. One particularly memorable point was the comment that, in Rhode Island, coordination between diverse payer, provider, and regulatory representatives could be collected in “one room” to discuss changes.
Wood pithily stated that if there’s no IT system, “we can’t do population health,” and unlike some other institutions, “our IT system works!”
Beside other state and federal organizations, the local cohesion and coordination of Rhode Island allowed it so far to quickly hurdle the development barriers that have bedeviled holistic federal and large state efforts to integrate care and accumulate actionable data.
Continuing as the font of quotes, Tom Scully noted that, in a robust health care marketplace, different providers should “hate each other a little bit.” This gets to a major intrinsic conflict in the health care system. Even as restrictive payment methods prompt providers to coordinate care and technology makes this possible, competition in a more circumscribed market continues to disincentivize the same sharing.
Scully’s co-panelist, Peter Orszag, implied that the slowdown in hiring by hospitals was evidence that hospitals are responding to financial squeezing by becoming more efficient across the industry, but their impressions are just reflections of an ongoing debate. If providers go down the road to tight coordination of care provision, is that process anti-competitive or simply effective best practice consolidation?
Numerous presenters and panelists commented on the migration of physicians from small practices to hospitals, with the underlying notion that perhaps population health or quality care might not best be served by a consolidation of industry and market levers to too few centers.
5. Health Care In Flux
Chas Roades, Chief Research Officer at the Advisory Board Company, commented that “health care is always in flux” and that thinking “we’re in a messy transition period” is to misread the constancy of forces for change at work in health care.
“Disruptive” was the preferred term throughout the summit, with “disruptive payment models” and “disruptive technologies” characterizing much of the discussion, but of course, these developments are diverse. Some, such as global payment strategies, have existed in some form for decades. Big data was theoretically always available, but only recently has begun to receive the resources and attention necessary to become a hot topic.
Remote access and personalized health measurement technologies arrived suddenly and from outside health care research nodes. The utilization of these previously unused tools is necessarily disruptive, and while it is easily forgotten, a development timeline in which they are slowly or marginally integrated is arguably a disruptive status quo that inhibits natural health care evolution.