Amer­i­cans don’t want to go back­ward on health­care; first, sta­bi­lize the mar­kets

Modern Healthcare - - COMMENT - By Ceci Con­nolly

Af­ter a sea­son of health­care pol­icy fits and starts, now is the time for Washington to take a col­lec­tive deep breath and as­sess what we learned and how we as a na­tion can do bet­ter.

I say “we” be­cause if the ob­jec­tive is truly a high-per­form­ing, af­ford­able health sys­tem for all Amer­i­cans, then ev­ery­one has a role to play—pa­tients, providers, pur­chasers, health plans and pol­i­cy­mak­ers of ev­ery stripe.

First, what have we learned? Amer­i­cans do not want to go back­ward. Let’s ad­dress the flaws in our sys­tem, in­clud­ing the far-from-per­fect Af­ford­able Care Act, but let’s not in­crease the num­ber of unin­sured, push up costs or cre­ate chaos in the mar­ket. In­cre­men­tal im­prove­ment—fo­cused on tack­ling un­der­ly­ing costs and driv­ers such as so­cial de­ter­mi­nants of health—offers the best chance for con­sen­sus.

Mar­ket sta­bi­liza­tion is cen­tral to long-term suc­cess. Not-for-profit com­mu­nity health plans are in­vested in the places where they op­er­ate; they don’t pick and choose mar­kets based on fi­nan­cial re­turn. But even not-for-prof­its need ro­bust, sta­ble mar­kets to re­main vi­able and con­tinue to pro­vide af­ford­able cov­er­age. When a Repub­li­can Congress en­acted the Medi­care Part D pro­gram it in­cluded three mar­ket sta­bi­liz­ers—risk cor­ri­dors, rein­sur­ance and risk ad­just­ment—which 14 years later con­tinue to help that pri­vate mar­ket serve mil­lions of se­niors.

Sim­i­larly, mar­ket-based strate­gies are needed to­day and a crit­i­cal first step is for Congress to guar­an­tee the ACA’s cost-shar­ing re­duc­tion pay­ments. Rather than be­ing a gov­ern­ment bailout, th­ese pay­ments help mil­lions of work­ing Amer­i­cans, on av­er­age earn­ing $19,000 a year, af­ford de­ductibles and co­pay­ments.

Well-de­signed rein­sur­ance pro- grams can en­able com­mu­nity-based plans to im­prove ac­cess to care by help­ing states cover the costli­est pa­tients. Giv­ing states flex­i­bil­ity on risk ad­just­ment will level the play­ing field so that smaller, re­gional health plans can com­pete. And to have any hope of a ro­bust risk pool, plans need ev­ery avail­able tool to en­cour­age broad par­tic­i­pa­tion. This in­cludes both car­rots and sticks.

We must also en­cour­age in­no­va­tion to en­sure a 21st cen­tury health­care sys­tem that works for physi­cians, pa­tients and pay­ers. Thought­ful im­ple­men­ta­tion of the ACA’s waiver au­thor­ity will al­low states to tailor pro­grams while main­tain­ing cov­er­age lev­els achieved un­der the ACA. For ex­am­ple, Min­nesota and Alaska will use fed­eral dol­lars for rein­sur­ance pro­grams to off­set the costs of the most com­plex cases—keep­ing pre­mi­ums down for ev­ery­one. Pro­vid­ing cer­tainty to our health plans en­ables them to get back to the busi­ness of im­prov­ing the health of their com­mu­ni­ties, not fret­ting over the next shock wave to come out of Washington.

Any fu­ture ac­tion must main­tain cov­er­age gains and con­sumer pro­tec­tions such as es­sen­tial health ben­e­fits. All health plans should be en­cour­aged to ex­per­i­ment with pay­ment and cov­er­age mod­els that pro­mote value-based care, which is good for the pa­tient and the pur­chaser. Plans should have the flex­i­bil­ity to in­no­vate—for ex­am­ple, through tele­health or ar­rang­ing home-care ser­vices. If grandma can Face-Time with the kids, why not make it just as easy to have a vir­tual visit with her doc­tor?

A ma­jor con­trib­u­tor to ris­ing pre­mi­ums is the out­ra­geous cost of pre­scrip­tion drugs. We can start with trans­parency in pric­ing, in­clud­ing the bi­par­ti­san FAIR Drug Pric­ing Act. Dis­clo­sure of re­search and devel­op­ment costs—as well as ad­ver­tis­ing and mar­ket­ing—is a fun­da­men­tal first step in cre­at­ing a com­pet­i­tive and ef­fec­tive phar­ma­ceu­ti­cal mar­ket. Stream­lin­ing the Food and Drug Ad­min­is­tra­tion’s generic and biosim­i­lar drug ap­proval pro­cesses, along with clos­ing loop­holes now em­ployed by brand man­u­fac­tur­ers, would in­crease ac­cess to valu­able, lower-cost prod­ucts, en­sur­ing af­ford­able al­ter­na­tives are avail­able.

It’s time for our na­tion’s lead­ers to rise above petty pol­i­tics and come to­gether to make last­ing im­prove­ments to our health­care sys­tem.

And it’s time for us as lead­ers in the in­dus­try to play a key role in ad­vanc­ing those ef­forts. Mar­ket sta­bi­liza­tion, af­ford­able cov­er­age, flex­i­bil­ity and in­no­va­tion are all part of the equa­tion. Let’s pri­or­i­tize the health of Amer­i­cans and a 21st cen­tury health­care sys­tem that works for ev­ery­one.

Ceci Con­nolly is pres­i­dent and CEO of the Al­liance of Com­mu­nity Health Plans.

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