What a Trump Presidency Could Mean for Population Health

Based on President Trump’s campaign promises, the healthcare industry could experience significant changes. His commitment to “repeal and replace” the Affordable Care Act (ACA) is at the center of the conversation, and raises a number of questions. Can it actually be repealed? What is the impact for value-based programs currently underway such as the Medicare Shared Savings Program, bundled payments and MACRA? What should healthcare providers do now? This post will address these questions and my opinion on what it means for the future of population health.

1) A complete repeal of the ACA faces challenges

President Trump has indicated[1] that he supports some parts of the ACA such as forcing insurers to cover people with pre-existing health conditions and allowing parents to cover children on their plans into their mid-20s, so it is hard to determine this early the full extent of the changes to come. In addition, Republicans support some aspects of value-based innovations. There are about 283 million insured lives in the US[2] including about 20 million covered under Obamacare.[3] Even if the ACA was to be fully repealed, there are nearly three hundred million lives for whom the fundamentals of economics and quality of care necessitate the move towards value based care.

2) Value-based healthcare will continue because it has bi-partisan support

MACRA passed with overwhelming bi-partisan support in both the House of Representatives (392–37) and the Senate (92–8).[4] Bundled payments[5] and ACOs[6] also have bi-partisan support. The reason for this is that both sides of the aisle recognize the clear need for healthcare payment reform. Amongst all the contentious legislative arguments that exist today, there is no debate around the fact that healthcare costs are on an unsustainable growth trajectory. There is consensus that the government has to continue making providers more accountable for reducing costs, improving quality and increasing patient engagement and satisfaction.

3) Expect some changes to the mechanics of value-based programs

While the top-level themes in healthcare payment reform are unchanged, I do think we can expect changes in the mechanics of some value-based programs. Republicans, including President Trump’s choice to head Health and Human Services, Rep. Tom Price (R-Ga), have expressed concerns about the power and budget controlled by The Center for Medicare & Medicaid Innovation (CMMI)[7], so CMMI’s role could be impacted. Specific programs like the MSSP ACO program could be structured differently in the future although that would have to take place after current three-year contracts with the government expire. Republicans could push for new Medicare and Medicaid reform, which would impact beneficiaries and could drive more formation of Medicare Advantage plans or lead to Medicaid ACOs. No one today knows exactly how current programs are going to evolve, but the reality is that programs must evolve to address cost and quality concerns.

4) “No regrets” strategies for healthcare

Although healthcare faces uncertainty, there are certain priorities for organizations that will apply. So-called “no regrets” strategies for healthcare include driving more consistent, efficient and coordinated care, integrating IT systems, accurately forecasting patient risk, lowering your cost structure, and building deeper relationships and loyalty with patients. Everyone needs to operationalize these capabilities now so they can manage large scale Medicare and Medicaid populations effectively in the future. These are capabilities that take years to refine, which is why some healthcare organizations view the building of these best practices as market differentiators that will ensure their long-term success against regional competition.

Population health is already making a difference for patients. Our customers are seeing tangible improvements in patient outcomes and cost reduction through lower utilization while developing deeper relationships with their patients. They’re even benefiting financially through the generation of significant shared savings. This is an incredible time of innovation in healthcare that I believe is going to accelerate even more as healthcare organizations build off their early successes and learnings.

Originally published to https://blog.caradigm.com/2016/12/what-a-trump-presidency-could-mean-for-population-health/ on December 6, 2016.

[1] http://www.nytimes.com/2016/11/12/business/insurers-unprepared-for-obamacare-repeal.html?_r=0

[2] http://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf

[3] http://talkingpointsmemo.com/dc/nejm-obamacare-progress-report

[4] http://www.entnet.org/content/permanent-repeal-sgr-formula

[5] https://www.premierinc.com/premier-lauds-introduction-of-bipartisan-bundled-payment-legislation/

[6] https://www.brookings.edu/blog/health360/2015/03/23/how-early-accountable-care-efforts-shaped-payment-reform-in-the-aca-and-bipartisan-reform-ever-since/

[7] http://www.jdsupra.com/legalnews/will-republicans-embrace-cmmi-s-11849/