Authored by: Austin Burt, Joshua Livingston, Patrick Saale, Taylor Weis
What are the most pressing healthcare issues today? How is our nation currently addressing these challenges? And what can we, as healthcare leaders and citizens, do to improve outcomes within our communities and across the country?
The Nashville Health Care Council’s 2022 Leadership Health Care Delegation – a group of nearly 50 healthcare leaders from Nashville – recently visited Washington, D.C., to hear from health policy experts and explore these questions and more. Here are our top takeaways on the most pressing issues in healthcare today.
Telehealth
Telehealth continues to be a priority within the industry, expanding access but requiring policy changes.
- Telehealth provides excess capacity for a system that often fails to meet the needs of patients. The widespread adoption of telehealth during the pandemic demonstrated how safe, effective, and convenient this mode of healthcare delivery can be – but only when patients have reliable access. Locally, communities can work toward ensuring that underserved patient populations have broadband internet and that rural health facilities get the technology and resources they need.
- Although policy lags telehealth capabilities, regulatory changes are on the horizon. The need for waivers during the pandemic has impelled legislators to reexamine antiquated telehealth regulations. Emergency waivers will expire at the end of 2022, and regulations regarding licensure across states and virtual prescription of controlled substances will need to be extended. Currently, the Advancing Telehealth Beyond COVID Act of 2022 (R. 4040) is on the Senate floor. The act would extend telehealth regulatory flexibilities through December 31, 2024.
Interoperability
Interoperability is still a key challenge for providers, payors, and policyholders. TEFCA may help.
- The healthcare industry is facing mammoth challenges regarding interoperability within health information systems. Electronic health records (EHR), health information exchanges (HIE), Internet of medical things (IoMT) and other health I.T. tools are rife with incompatibility problems. While there has been bi-partisan support for interoperability initiatives, there has not been agreement on implementation.
- TEFCA may help. The Trusted Exchange Framework and Common Agreement (TEFCA) was established on January 19, 2022, by the U.S. Department of Health and Human Services to create a universal floor for interoperability across the nation. TEFCA is a critical development toward the goal of achieving interoperability, but time will tell whether TEFCA’s implementation and adherence to its framework are successful.
Community-Based Care
Health systems, public health organizations, policymakers, health leaders and local entities are increasingly focused on the importance of community-based care.
- The industry is beginning to meet patients where they are to improve health outcomes. Many organizations are generating out-of-the-box solutions to expand access to care. Examples include programs that provide free transportation to clinics and vaccination sites, health navigators who assist with patient education, health literacy and care coordination, and providers who offer wellness outreach and vital signs checkups at local barbershops.
- Health systems and public health organizations are becoming involved. For example, Kaiser Permanente has an integrated delivery system (IDS) designed to help patients access vertically integrated holistic care, offering improved quality and better outcomes at reduced costs. Moving forward, health systems and public health organizations can collaborate to further community-based care.
Social Determinants of Health
Addressing social determinants of health (SDOH) and overcoming racism are critical for achieving health equity.
- Only 10-20 percent of what affects health outcomes is medical care, while 80-90 percent is social determinants of health. To improve outcomes, our nation, the industry, and local communities can focus on factors outside of the clinical setting, such as health-related behaviors, socioeconomic issues and environmental factors. In addition to improving wellness, taking a more comprehensive view of healthcare should also drive longer-term cost savings.
- Institutional racism within the healthcare system is still a key obstacle we must strive to overcome. Racism leads to poor health outcomes and lower quality of life. Healthcare organizations and leaders can work to promote policies which drive diversity, inclusion and equity. We can educate ourselves, challenge our environments, gain exposure to diverse experiences, and change our culture, thoughts, and actions.
Value-Based Care
Innovative solutions are needed to achieve actual value-based care.
- While most policymakers have bought into the idea of value-based care, there is risk of it becoming merely a buzzword. Our nation’s healthcare system promotes value; however, it is currently a complicated and inflexible system. Patients, providers, healthcare organizations, insurers and policymakers aren’t aligned on what constitutes value.
- Opportunities exist to drive real savings and better outcomes, but it will take innovative solutions. For example, interoperability can help accelerate the success variables of value-based care. This is because interoperability connects systems, improving data, which can be used to gain population health insights.
Medicare and Social Security
Both Medicare and Social Security will face solvency challenges in the near future.
- Medicare and Social Security face financing shortfalls. Current estimates show Medicare Part A being insolvent by 2028 (org) and Social Security only being able to pay old-age and survivors’ benefits until 2034 and disability benefits until 2057 (ssa.gov). Further, as individuals continue to live longer (outside of COVID), this will continue to drive costs. The nation will have to face difficult conversations around how to fund these programs sustainably. CMS will need to continue shifting care into lower cost savings without compromising quality of care.
- Innovative solutions are in the works. Medicare Advantage is one of these solutions likely to continue growing and innovating. Increased creativity around plan design and shifting sites of care will allow for better outcomes at lower costs for the Medicare population.
Price Transparency
Price transparency efforts are underway, but there’s still much work to be done.
- New policy initiatives have been implemented, but health systems and payors have pushed back. These entities have questioned the efficacy and feasibility of the current approach and are seeking a “step-back” to ensure the implementation and governance is realistic and achievable.
- There has been bi-partisan support for price transparency but not on the methodology for implementing it. The industry and regulators see value in transparency for consumers, especially individual care cost estimates. Opportunity exists in developing ways to approach transparency with reasonable timelines and practical, user-friendly solutions.
Politics and Policy
Politics is continuing to drive policy.
- Trends in politics continue to have a significant impact on which policy initiatives get prioritized. Additional challenges result from politicians passing along what they believe constituents want to hear in efforts to get reelected.
- Achieving clinical, social, and regulatory change requires efforts at the national, state and local levels. Specific sectors of the ecosystem are continually overlooked. However, organizations like Nashville Health Care Council and Leadership Health Care provide opportunities for local health leaders to hear updates from federal and state legislators and bring ideas back to their organizations and communities.
Our Charge: Develop Innovative Solutions for Today and Tomorrow
Nashville is a central part of the current legacy healthcare system, but the Nashville healthcare ecosystem will need to continually evolve to help solve tomorrow’s challenges. As leaders and citizens, we must work to explore nontraditional partnerships, generate innovative ideas, keep all patients top of mind, and consider solutions beyond the walls of the healthcare setting.
About Leadership Health Care and the LHC Delegation to Washington, D.C.
An initiative of the Nashville Health Care Council to nurture the talents of future leaders, Leadership Health Care (LHC) provides members with unique educational programs and networking opportunities. With a membership of nearly 800 up-and-coming health care industry leaders from 300 organizations, LHC is the foremost organization for emerging industry leaders in the field.
The LHC Delegation to Washington, D.C., is an annual trip to our nation’s capital with a focus on healthcare policy and politics. During the sessions, delegates hear from legislators, gain insights, build connections, collaborate and develop ideas to bring back to their own workforce and workplace to effect change within their communities.
2022 LHC Delegation Speakers
Alexis Apple (American Telemedicine Association)
Todd Askew (American Medical Association)
Julie Barnes (Maverick Health Policy)
Marsha Blackburn (U.S. Senate)
Jim Cooper (U.S. Congress)
Tollie B. Elliot, M.D. (Mary’s Center)
Amy Gyau-Moyer (Kaiser Permanente)
Bill Hagerty (U.S. Senate)
Josh Hopson (TEAMHealth)
Ann Mond Johnson (American Telemedicine Association)
Paul Keckley (Keckley Report)
Michael Rhein (Institute for Public Health Innovation)
Molly Smith (American Hospital Association)
Jeanette Thornton (AHIP)
Eric Ueland (U.S. Domestic Policy Council)
Amy Walter (Cook Political Report)