Group also hears about rise in interoperability, impact of Trump

Editor’s note: This is the first post from the Nashville Health Care Council’s 2016 Leadership Health Care Delegation to Washington. Look for more content in the coming days and click here for other entries from past years’ visits.

Leadership Health Care kicked off its two-day delegation to Washington, D.C., on Monday afternoon with a series of speakers focused on Medicaid policy, the interoperability of health care technology systems and — of course — the 2016 presidential race.

With the presidential primary season heating up, the delegation gathered in the W Hotel, adjacent to the White House grounds, and heard first from Politico Congressional Reporter Jake Sherman, who provided a look at what’s happening on the campaign trail and how members of Congress are responding to the seeming inevitability that Donald Trump will become the Republican Party’s nominee.

“This is probably one of the most surreal, unreal political moments we’ve ever been in,” Sherman said, giving the delegates a recent history of Republican politics to provide some rationale for the rise of Trump and providing an inside look into how Congressional Republicans are positioning themselves ahead of a Trump nomination.

“You’re going to see members of Congress all over the country distance themselves from Trump and (try to) save themselves from losing in what could be a very bad year for Republicans,” Sherman said.

Regardless of who is in the White House, TennCare Director Darin Gordon said he doesn’t see the tension between the federal government and state Medicaid programs changing any time soon. Gordon, who was interviewed by Matt Salo, executive director of the National Association of Medicaid Directors, said Tennessee and all states struggle to get the flexibility they need to be successful within the Centers for Medicare and Medicaid Services’ “homogeneous” approach to Medicaid policy.

With that need for flexibility in mind, Gordon talked about Tennessee’s failed attempt to earn legislative approval for the state’s own approach to expanding Medicaid under the Affordable Care Act.

“Part of what people don’t realize is we expanded (TennCare) in 1994, greater than anybody in the entire country ever has or probably ever will. It was greater than what the ACA contemplated by far,” he said. But the unsustainability of that expansion created an impossible uphill battle for Insure Tennessee, despite the program’s approval by CMS.

He said he thinks Tennessee will eventually join the 30 states that have already expanded Medicaid under the ACA, but “it’s going to be some time before we can get all the stars aligned.”

Later in the afternoon, a panel of experts discussed the state of interoperability of health care systems. Dr. Vindell Washington, principal deputy national coordinator of the Office of the National Coordinator for Health Information Technology, explained how the meaningful use program spurred the rapid adoption of electronic medical records over the past few years — to a point where 96 percent of all hospitals and three-quarters of physician practices have implemented EMRs.

But the industry has not yet figured out how to achieve true interoperability of information systems to support the overarching goal of delivering patient-centered care. Jitin Asnaai, executive director of CommonWell Health Alliance, said one of the several barriers to achieving interoperability is a cultural one — that during decades of moving toward greater and greater specialization, the health care industry hadn’t thought about how data flows between providers. And, perhaps worse, many physicians have come to assume that you just “won’t get the data.”

The nonprofit Center for Medical Interoperability is one of the organizations trying to chip away at this problem. Kerry McDermott, the organization’s vice president of public policy and communications, explained how health systems are working together through the Center to develop a “reference architecture” that is a blueprint for how medical devices should connect to share data. The organization — with board members including leaders from Community Health Systems, Vanderbilt, Ascension Health, LifePoint and HCA — is based in Nashville because the city has the “right culture in driving collaboration,” she said.