HHS has a particular vision for healthcare that we’re working on: creating a system with affordable, personalized care, that is centered on the patient.
So what does executing on this vision look like? We focus on three cross-cutting platforms: reforming the financing of care, delivering better value from that care, and improving health in specific, impactable areas.
As Prepared for Delivery
Good morning, everyone. Thank you for that warm welcome. It’s great to be with you all today.
Being at events like this are a great reminder that the dedicated public servants I work with at HHS are far from the only Americans who are working hard on how to improve our healthcare system: to ensure it’s delivering high quality care at an affordable cost.
From day one, we’ve been determined to build a system that provides the affordability people need, the options and control they want, and the quality they deserve.
HHS has a particular vision for healthcare that we’re working on: creating a system with affordable, personalized care, that is centered on the patient.
So what does executing on this vision look like? We focus on three cross-cutting platforms: reforming the financing of care, delivering better value from that care, and improving health in specific, impactable areas.
Thinking about quality is especially important to the latter two areas: higher quality care means higher value care, and lower spending, higher quality care means tackling some of our key health challenges, like the opioid crisis, rural health, and maternal health.
To drive to this vision, we need a lot of change—and I think we have enough examples of government trying to drive change in a silo. It simply doesn’t work as well as it can if government looks outside its own walls, to recognize how many potential partners we have in achieving our goals.
This is one of the reasons why I launched the Deputy Secretary’s Innovation and Investment Summit, or DSIIS, which brought together for the first time healthcare innovators and investment professionals with federal healthcare leadership. We identified four particular areas of interest within DSIIS: value-based care, empowering consumers and increasing their engagement, liberating data to drive value, and developing best practices for approval and reimbursement of medical products and services.
We took these discussions and injected what we learned into our efforts at HHS. In all four areas of discussion key themes emerged, the most prevalent being: incentives, data, and certainty.
In all our discussions, incentives were a constant in driving value-based care.
We talked about direct financial incentives, and how we’ve rolled out new payment models that will reward better outcomes in primary care, kidney care, and emergency transport.
We also talked about the financing of new technologies and our increased reimbursement for innovative technologies, which we think will create the right incentives to drive towards value-based care and accelerate innovation.
But another key incentive we place before providers, one you all know very well, is how we assess them on quality.
It is convenient that, through DSIIS, we’d already begun thinking about these issues through the lens of cooperating with the private sector, because that is how we’ve gone about responding to the President’s request for HHS to work with the Department of Defense and the Department of Veterans Affairs to develop a health quality roadmap.
It’s worth noting that this request came as part of the President’s broader executive order on bringing honest and transparency to healthcare, which also included a number of measures around price transparency that we’ve been implementing.
President Trump recognizes that in order to have a true market in healthcare there must be transparency for consumers, involving both price—what you’re paying—and quality—what you’re getting.
The President has given us a huge opportunity at an important time to examine the quality measures that govern and, in many ways, shape the American healthcare system. For those of you who followed what he said in the State of the Union last night, you can see that his commitment to transparency and honesty in healthcare runs quite deep. It has been one of our top priorities at HHS.
So, what does it look like when it comes to quality measures and a quality roadmap?
The thousands of quality measures administered by HHS, the Department of Veterans Affairs, and the Department of Defense are important. They help us perform a vital function of government: to protect the health of the American people and promote quality care.
That requires us to periodically examine what we, as a government, are doing and ask if we can do it better. Part of that process is examining the metrics we use to make those determinations, which is what undergirds this effort.
As I’m sure you’re aware, this is a major undertaking—and the first time this effort has ever been coordinated across government. And, while I don’t want to jinx things, I’m pleased to say the response so far has been overwhelmingly positive among the stakeholders with whom we’ve engaged. They are ready for change, aligned, and willing to compromise to see our system updated.
What I want to mention to you today are a few principles that we’re looking toward in guiding our work, areas of interest we’ve seen so far.
One is that we need to reform the governance of these quality measures. As I’ve just been describing, it’s essential that we look at them as an opportunity for public-private partnership—not a set of goals handed down from on high, but an ongoing feedback loop.
Second, as you can tell from the emphasis on transparency and honesty, we want quality measures to be useful and available to the public, as much as possible. This is vital to the vision the President has for healthcare: the patient cannot be at the center and in control unless they have access to data like this, in a useable, useful format.
Finally, I think we can all agree that our measurement systems are in need of reform.
There is a dizzying array of measures that CMS is collecting all by itself, before considering quality programs elsewhere in government. This is a vitally important place for all of you to work with us: help us identify how these measures can be simplified, and which measures are most useful to clinical outcomes.
We believe that a better, simpler set of quality incentives will mean a better experience for patients and providers, and we want to pursue that goal in partnership with both groups.
Before closing, I want to discuss a little more about some other sets of incentives we place on providers—and how they may be getting in the way of higher quality, value-based care as well.
These potential disincentives, these barriers to rethinking quality care, have been a big part of what we’ve dubbed the Deputy Secretary’s Regulatory Sprint to Coordinated Care.
This regulatory sprint is focused on reforming our rules that stand in the way of innovation, and how we can reform them while remaining faithful to the underlying statutes.
One way you can tell we’re serious about engaging the public is that we even have a hashtag for the Regulatory Sprint: #RS2CC.
For now, this sprint is looking at four areas in particular: the Stark Law, the Anti-Kickback Statute, HIPAA, and mental health and substance abuse privacy rules. These roughly fit into two categories: Stark and the AKS, which largely affect financial arrangements and business models and HIPAA and 42 CFR Part 2, which largely affect the flow of information.
We focused on these areas in part because they are often the first regulatory barrier to creative thinking and innovative partnerships.
In the world of healthcare, “Sorry, HIPAA,” or, “not a chance, Stark Law,” is too often an excuse to stifle innovation—at the very least because it means you’d have to call an expensive lawyer to get around it, like, say, me about 5 years ago.
We think we can fix that. We think these laws can prevent fraud, waste and abuse while allowing innovation to thrive. Last October we proposed the first-ever major revision of the Stark Law and the Anti-Kickback Statute with a view toward advancing value-based care, which will finally enable a whole range of commonsense arrangements between doctors, hospitals, and physicians as well outcomes-based payments and allowing incentives to patients for adhering to care plans.
We’ve also proposed reforms to 42 CFR Part 2, and you can look forward to proposed HIPAA reforms in the near future.
I’d be remiss if I didn’t mention that talking about the Stark Law is poignant in light of the recent passing of Pete Stark, the California congressman who helped craft not only the physician self-referral statute, but a number of other key HHS programs. The good news is, in proposing to update these rules, we’re actually being quite faithful to the Congressman’s legacy: In recent years, he came to see the law he’d written as a bit of an albatross, at one point telling the Wall Street Journal, “I have every lawyer in town bowing gratitude to me for the work they got” because the law’s regulations had grown so complex.
Ultimately, Congressman Stark cared about protecting patients, and improving their care—and that remains the ultimate goal of our reforms to the Stark regulations.
As I mentioned, incentives are a driving factor in the discussions we had as part of the innovation and investment summit, but on every topic, data was also key.
Key to driving value, key to research, key to innovation and key to empowering patients. We’ve taken steps like sharing encounter data, and Blue Button 2.0 to share more federal healthcare data but we are really excited about rules coming out that will finally give patients their healthcare data in real time and rules that will increase price transparency.
Through the Office of the National Coordinator for Health Information Technology, we’ve proposed to open up the flow of information, and put patients in charge, with our interoperability rule. Through the tri-agencies and CMS rules, we proposed pricing be published by hospitals and insurers.
If we want patients to be more engaged, and we do, they need access to their data: pricing, clinical records, and data on quality.
We believe there is no reason a patient shouldn’t have access to that data. As just an example, think about how digital health could better serve patients and providers if someone actually had their longitudinal health record or a family member can pull up a relative’s medications in an emergency—or if anyone who needs a shoppable health service, of which there are many, could have access to quality and pricing data in the same spot.
In closing, I want to thank you all again for being here, and I hope what I’ve described to you gives you a sense of the vision that this administration has for healthcare. I think there’s never been a more exciting time to be working in this field: Secretary Azar and I, and everyone across the administration, are really excited.
Our journey has only just begun, but I’m confident we’re headed in a direction that will transform our healthcare system to deliver much higher value, higher quality care, and improve the health of every American.
Thank you again for inviting me to speak to you all today.
