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Conversation with Bill Geary of Flare Capital Partners on Value-Based Care

Eric D. Hargan
Flare Capital Partners
April 25, 2019
Boston, MA

When people are actively involved in the management of their health, they have better outcomes. The first step to empowering consumers is providing them with information, specifically, information on the price and quality of the healthcare services they receive.

Q: Please give us a quick overview of the 4 priorities on which you’re focused to accelerate healthcare innovation.

A: Well Bill, as you know I am hosting DSIIS: which stands for the Deputy Secretary’s Innovation and Investment Summit (DSIIS). DSIIS is a quarterly meeting between healthcare innovation and investment professionals and HHS personnel who will discuss the innovation and investment landscape within the healthcare sector, emerging opportunities, and the government’s role in facilitating more investment and accelerated innovation. So far we have had two meetings and we at HHS have heard a number of issues, which are:

Parallel review: This is a mechanism for FDA and CMS to simultaneously review submitted clinical data to help decrease the time between FDA's approval of a premarket application and the subsequent CMS national coverage determination (NCD). We are examining how, if at all, HHS can create more certainty in the investment space to enable more innovation.

Value-based Care: This is one of Secretary Azar’s 4 priorities for the Department as we continue to promote the shift away from fee-for-service, and as you could imagine, a topic that industry leaders are willing and eager to discuss.

Consumer Empowerment: Investment and innovation leaders want to know how HHS leverages patient’s data to help them empower patients and HHS has an interest in helping the private sector get patients more involved.

Data interoperability: DSIIS participants want to discuss the government’s involvement regarding regulations about how data move between providers in a secure way.

Q: The shift from FFS to value-based care is a central driver to lower costs and improve outcomes . . . from drug pricing undertakings through to new primary care models just announced . . . please go a little deeper as to the importance of the transition to value-based care.

A: Americans deserve better, cheaper and more accessible healthcare options, that’s why HHS is working to transform our system from one that pays for procedures and sickness to one that pays for outcomes and health. To do that HHS is focusing on four areas:

  1. Maximizing the promise of Health IT.
  2. Boosting transparency around price and quality.
  3. Pioneering bold new models in Medicare and Medicaid.
  4. Removing government burdens and barriers, especially those impeding care coordination.

Part of that effort is my Regulatory Sprint to Coordinated Care (#RS2CC) , which is examining four sets of regulations relating to the Stark Law, Anti-Kickback Statute, HIPAA, and 42 C.F.R. part 2.

Each of those words is deliberately chosen – it’s a sprint because we want to gather the necessary information and then move to rulemaking as soon as possible.

It’s about coordination of care – understanding how regulations are impeding coordination among providers that are capable of delivering better, lower cost patient care, and then reforming these regulations consistent with the laws and their intents.

Fundamentally, it’s about care – we are determined to deliver better access to the highest quality care at the lowest possible cost for American patients.

Two of the regulations deal with partnerships and affiliations. We want to enable providers to be able to affiliate and create value without potential criminal violations and huge fines. The other two laws are about information-sharing, which is also crucial to coordination.

Q: What are some of the best ways to engage and empower consumers?

A: When people are actively involved in the management of their health, they have better outcomes. The first step to empowering consumers is providing them with information, specifically, information on the price and quality of the healthcare services they receive. The way our healthcare system is currently structured, people have no way of knowing what their healthcare services cost—total cost or out of pocket costs. This not only results in “sticker shock” at the pharmacy counter and surprise bills from doctors, but it makes it impossible to shop for services. So the first step the Trump administration is taking is to create price transparency for healthcare services. We want Americans to know how much their medical services are going to cost up front, so that we can unleash the power of the market and allow patients and their families to make informed choices.

Of course, knowing price is only half the equation. You have to know what you’re getting. So the Trump administration is undertaking multiple projects to make healthcare quality transparent as well. Which doctors and hospitals are best? What nursing homes are safest? We are working to increase transparency in the health space to better enable patients to choose the providers and services that is best for them.

Technology is revolutionizing every aspect of our lives. We think healthcare should be no different. That why we are working to restructure the regulatory framework around drug and device approval, and around care delivery. We want new technologies to be brought to market, paid for, and given to patients so that patients can better manage their own health. Implantable and wearable technologies, as well as online visits are just the beginning. Government has to keep up with innovators, and we in the Trump administration are committed to doing so.

The administration released two draft rules, from CMS and the Office of the National Coordinator for Health IT, aimed at ensuring patients and providers have access to interoperable health information. We want to dictate the what, not the how, in health IT. We aren’t going to micromanage exactly how providers, payers, and innovators make health IT interoperable and patient-accessible – we’re just going to say it has to happen, and let private actors determine the best way to get there. Last August I hosted

PETS (Patient Empowering Technology Summit). The summit included entrepreneurs and health providers for the purpose of exchanging facts and information so the department could better understand technological innovations that could benefit Medicare and Medicaid beneficiaries. Not only does this technology empower patients, but it personalizes our digital health and makes it accessible and understandable to doctors, providers, and patients themselves. FDA has also released a Digital Health Innovation Action Plan that lays out their vision for fostering digital health innovation while continuing to protect and promote the public health

Q: What is your outlook for Medicare Advantage?

A: This year, we expect that 37% of Medicare beneficiaries will be enrolled in the program, and this proportion is only expected to grow. Beneficiaries clearly appreciate the freedom of choice and additional benefits which MA offers them. They clearly appreciate the knowledge that they are protected from the burden of catastrophic medical expenses through MA’s maximum out of pocket limits. This Administration has worked to free beneficiaries to select plans customized for their individual needs. Thanks to the changes we’ve made, the Medicare experience is more customizable than ever before. That’s the future.

Content created by Digital Communications Division (DCD)
Content last reviewed on April 25, 2019