December 9, 2021
The most effective, long-term way to make health care more affordable is to pay for health care differently: prioritize appropriate, high-value care and interventions, including prevention, primary care, and identifying and addressing the social determinants of health. When we pay for care this way, patient outcomes improve and costs go down.And when payers and providers work together, coordinating care and aligning payment incentives, value across the system improves even further. As we drive toward a value-based health care system, here are five things Washington can do in the new year to ensure affordable, high-quality coverage and care for all.
The Medicare Advantage program is in the spotlight – for good reason. CBO projects that a majority of eligible seniors will be enrolled in MA by 2023 and will reach 60% in next decade. Considering its popularity among a diverse group of seniors, now is the time to take it to the next level.
- Allow health plans to account for audio-only encounters in risk adjustment during the pandemic to ensure patient acuity is accurately and appropriately documented and the needs of these patients continue to be met.
- Raise the bar on quality to include more accurate health outcome metrics that help better meet the needs of seniors choosing MA.
2. Commit to telehealth, making permanent telehealth flexibilities afforded under the PHE
Americans safely and conveniently accessed telehealth in record numbers in 2020 and 2021, clearly indicating that this method of care delivery is here to stay.
- Congress can move Cures 2.0 and make permanent current telehealth flexibilities – specifically removing geographic restrictions – and prioritize a consistent telehealth experience across all federal programs.
- The Administration can incent value-based benefit design that supports telehealth.
Washington must ensure that every American maintains access to affordable coverage and care, particularly post-public health emergency.
- Congress must make permanent the increased subsidies available to supplement coverage costs on the individual market.
- The Administration must streamline the cumbersome Medicaid redetermination process and expand independent navigators and other enrollment assistance.
4. Make meaningful and targeted investments in underserved communities
With a significant focus on health equity, Washington can make a difference by removing obstacles to equitable care.
- Congress must advance the maternal health provisions included in the Build Back Better Act as well as bipartisan mental and behavioral health initiatives targeting improved access and care.
- Incenting and standardizing health data collection across federal programs will help us understand and analyze care gaps as well as inform targeted interventions to improve health equity.
In the short-term, it’s critical that Congress pass and oversee implementation of the Build Back Better Act provisions targeting drug pricing.
- Congress and the Administration can move forward on bipartisan ideas that encourage innovation, improve transparency, stem anti-competitive practices and reform the broken drug patent system.
- Both removing obstacles to generics reaching the market and allowing formulary flexibility will improve affordability of out-of-control prescription drug prices.