Healthcare Stakeholders, how will the Administration’s focus on “Choice and Competition” impact your world and our society in general?

A common phrase you hear often in the healthcare world is, “All eyes need to be focused on Washington D.C. and your state capital.” The healthcare sector is greatly impacted by decisions, regulations and payment policies at the national and state levels.

This is why the Trump Administration’s report issued in December of 2018 titled, “Reforming America’s Healthcare System through Choice and Competition” cannot be taken lightly.

This document identified some major recommendations to Congress and the States that, if implemented, would have a major impact on all of the healthcare sectors, but especially the hospital world. In addition, a number of these recommendations are already being implemented within the various federal departments and agencies to varying degrees.

As I discussed in my blog titled, “Trumpcare? A review of the Trump Administration’s recent proposal to reform healthcare,” the aforementioned report was co-authored by the U.S. Departments of Health and Human Services, Treasury and Labor.  I believe that U.S. Department of Health and Human Services’ Secretary Alex Azar II played a key role in the report recommendations and should be considered the Administration’s key healthcare influencer.

Health Economics

As you know, I have utilized health economic concepts extensively in my blogs (see “Health Economics is not just for Nerds” and “Why we have high healthcare costs”) as a tool for better understanding of the complex issues embedded in healthcare.

So when I read this report, I have to admit I was impressed with its comprehensiveness and overall appeal through its utilization of health economics concepts to both identify the challenges we are facing in healthcare and to evaluate potential solutions.

All of this does not mean that I agree with all of the conclusions and recommendations identified in this report, but I will admit it was very thought-provoking.

I have been fortunate to have worked in multiple sectors in my 35 years in healthcare, including both the payer and provider side. While I may have my own personal issues with President Trump, I will not allow them to distort my evaluation of any healthcare related proposals that come from his Administration.

I believe that the issues surrounding healthcare are too important to not seriously evaluate all potential solutions or ideas that could benefit our society. We cannot blindly follow an ideology (right or left) that limits our ability to have an open and honest discourse on opposing perspectives.

          Warning: Depending upon your political view, you may need to ignore the bashing of the Affordable Care Act (ACA) which is sprinkled through the report. Don’t allow ACA bashing to prevent you from focusing on the issues identified and the related recommendations that are noted in the report. Depending upon the issue and the recommendation, I believe there is the potential for cross-party agreement. 

Will the market approach work in healthcare?

This is a good question, since despite what I hear from some people, we do not have a competitive market in healthcare today. As noted in this report, there are barriers on both the supply and demand side of healthcare which are not allowing the market to work.

 These barriers, some of which are regulatory and some of which are embedded within the healthcare world, are subjects for debate themselves. We will address some of these barriers and the associated recommendations at a high level in this blog and in future blogs.

 The open question still exists: What if we unleashed the power of market forces on both the demand and supply side of healthcare by removing these barriers as this report recommends; how would it impact the healthcare stakeholders and our society in general?

 This report emphasizes the importance of choice and competition in healthcare markets. As noted in this report, “Economists recognize free-market competition produces the most efficient production and distribution of goods and services. When consumers have choices, the incentives and information needed to optimize value, firms have incentive to improve quality and lower costs through innovation. Competitive markets typically raise quality and drive down prices.”

As further noted in the report, “When government policies and regulations suppress competition, producers may use their market power to raise prices, produce lower-quality goods and services, or become complacent in innovating. Hospitals without competition will typically charge higher prices and lower quality. Same applies to insurers.”

While pleasing to the ears from a health economist perspective, is this just wishful thinking as it relates to the societal value that results in having a competitive market in healthcare? While we can eliminate some regulatory barriers to competitive markets at the national and state levels, we still have significant barriers that are embedded in the healthcare world. 

Barriers such as the third-party payment system (health insurance which insulates the purchaser from the true cost of care) and the lack of cost and quality transparency, which are non-existent in markets outside of healthcare are fundamental challenges to a true-market system.

Well, enough of the health economic nerd talk, let us get into some of the issues and recommendations identified in the Administration’s Report. As noted previously, we will be deep diving into some of these issues and recommendations in future blogs.

What criteria should we use to evaluate the Administration’s recommendations?

If we frame the evaluation of the Administration’s recommendations as well as the societal and political debate around the following two goals, we may have different approaches to achieve those objectives, but at least we have identified an evaluation criteria and a common endpoint.

1.   A more value-based and cost-effective health system

2.   The expeditious transition to a true “health” system vs. our current costly “sick-care” system which would positively impact population health

A critical review of the Administration’s recommendations to reform healthcare as stated in the following report: “Reforming America’s Healthcare System through Choice and Competition”: (Note: Given space limitations, I only focused on a few of the key issues and recommendations identified in this report. I would recommend that the reader review the entire document at a high level [it is an easy read] and focus on specific topics that may interest you.)

Healthcare work-forces and labor markets:

1.   Issue as identified by the Administration (Foreign-trained doctors):

·      Restrictions on the ability of foreign-trained doctors to practice in the U.S. may unnecessarily limit the supply of physicians to provide care to Americans.

·      Facilitating the entry of additional foreign-trained doctors would be particularly helpful in alleviating the country’s shortage of primary care physicians (PCPs).

·      Highly skilled, foreign-trained doctors could also be encouraged to practice in under-served regions of the country, where Americans often are unwilling to practice.

a.   Administration’s recommendations:

·      Ease restrictions on foreign-trained doctors

·      ID foreign medical residency programs comparable in quality and rigor to American programs. – Allowed to have residency waivers.

b.   Tom’s perspective:

·      While I am not a clinician, the Administration’s recommendations appear reasonable. 

·      These recommendations would increase access to care especially in underserved areas as well as increase the number of primary care providers.

·      Result: Positive impact on population health.

2.   Issue as identified by the Administration (Scope of practice):

·      State licensing and scope-of-practice restrictions are common components of state licensure statutes and regulatory codes for healthcare professions.

·      Such rules, including restrictions on the appropriate use of telehealth technologies, unnecessarily limit the types or locations of providers authorized to practice, or the range of services they can provide, in contrast to regulations tailored to address specific and non-speculative health and safety concerns.

·      Government rules restrict competition if they keep healthcare providers from practicing to the “top of their license”—i.e., to the full extent of their abilities, given their education, training, skills, and experience, consistent with the relevant standards of care.

a.   Administration’s recommendations:

·      States should consider changes to their scope-of-practice statutes to allow healthcare providers to practice to the top of their license, utilizing their full skill set.

·      Evaluate proposals that would allow non-physicians and non-dentist providers to be paid directly for their services.

b.   Tom’s perspective:

·      I cannot make a blanket statement regarding the scope-of-practice statutes, but I do believe that they have been too restrictive.

·      I believe that states should be biased towards allowing healthcare providers to practice to their top of their license. The burden of proof should fall on those stakeholders who are challenging such a decision.

·      Result: Would have a positive impact on cost-efficiencies of the healthcare system and also increased access to care which, in turn, would positively impact population health.

3.   Issue as identified by the Administration (Telehealth):

·      A variety of regulatory barriers have kept telehealth from reaching its full potential to increase competition and access. State laws and regulations typically require that providers be licensed in the state where the patient is located, thus restricting the provision of telehealth services across state lines.

·      State licensing requirements and variations in scope of practice are barriers for even well-established and natural telehealth services, such as mental and behavioral healthcare.

a.   Administration’s recommendations:

·       States should consider adopting licensure compacts or model laws that improve license portability by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice. Interstate licensure compacts and model laws should foster the harmonization of state licensure standards and approaches to telehealth.

·      States and the federal government should explore legislative and administrative proposals modifying reimbursement policies that prohibit or impede alternatives to in-person services, including covering telehealth services when they are an appropriate form of care delivery.

b.   Tom’s perspective:

·      I agree with the Administration’s recommendations noted above.

·      Result: These recommendations would have a positive impact on the overall cost of the health system as well as increased access to quality care which would positively impact population health.

Healthcare insurance markets

1.   Issue as identified by the Administration: (AWP & Narrow networks)

·      Any willing provider laws (AWP) and restrictions on narrow provider networks) increase costs.

a.   The Administration’s recommendation:

·      Federal and state policymakers should carefully scrutinize the impact on competition and consumers of AWP laws, rules, and proposals, along with other restraints on network formation and selective contracting.

·      The Administration should continue to provide flexible network adequacy standards for Medicare Advantage and other federally sponsored programs and avoid stringent requirements that are not conducive to innovation and modern medicine and that do not allow states flexibility to meet their specific needs.

b.   Tom’s perspective:

·      It can no longer be business as usual. We need to be open to different types of network configurations, especially those that could potentially result in lower costs of care.

·      Quality and access are still very important and this is also why that increased transparency is needed regarding the configuration of the provider network.

·      Advances in technology, including telemedicine, make it possible to provide value-based care even in narrower networks.

·      Risk/value-based care payment methodologies also lend itself to narrower networks (capitation, etc.).

·      Result: Narrower networks will not be appealing to all consumers, but there should not be restrictions that limit it as an option. Narrower networks linked to risk/value-based reimbursement can have a significant positive impact on cost-efficiencies. The increased utilization of risk/value-based reimbursement would also provide financial incentives for providers to keep their population healthy.

2.   Issue as identified by the Administration: (Minimum essential coverage)

·      ACA requirement for minimum essential coverage increases healthcare costs for consumers

·      Forces insurers offering coverage in the individual and small-group markets to offer a mandated set of government-defined benefits.

·      Reduces consumer choice and represents hidden costs on the majority of consumers by forcing them to pay for more coverage and the corresponding expense.

·      Excessive mandates hinder innovation in plan design and greater access to coverage. They also limit public efforts to assure affordability without substantial government subsidies.

·      The ACA also requires insurers to cover numerous preventative services without cost sharing under the premise that a government imposed system-wide increase in “free” preventive care will lower healthcare costs. Studies have shown that in some cases preventive care can save money and in other cases it can increase costs. – Also risk of over-testing and over-treating.

a.   The Administration’s recommendation:

·      Loosen insurance rules and mandates.

·      In June, the Labor Department released a final rule expanding the ability of employers, including sole proprietors without common law employees, to join together to form an association health plan (AHP).

·      In August, the departments of Health and Human Services, the Treasury, and Labor released a final rule expanding the ability of consumers to purchase short-term, limited-duration insurance—much more affordable products that can better serve many consumers’ needs.

b.   Tom’s perspective:

·      Now is the time to take a step back and evaluate some of the different aspects of the Affordable Care Act. One example would be minimum essential coverage benefits. We are in the position to have sufficient data to objectively evaluate each of the essential benefits to determine, from a cost-benefit perspective, if they should continue to exist as is.

·      Result: We should initially take this decision out of the hands of the politicians on both sides of the aisle and identify objective experts from both a clinical and actuarial perspective to evaluate the essential benefits from a cost-benefit perspective.

The answer may not be black or white and there may need to be provisos that would limit some of the advantages of the essential benefits based on income or health issues. I will not say any more on this issue, because I am not one of the experts.

Healthcare provider markets

1.   Issue as identified by the Administration (Provider market consolidation):

·      According to a recent analysis of metropolitan areas that are considered single markets, roughly 77 percent of Americans in these urban markets live in highly concentrated hospital markets.

·      Empirical evidence on the impact of mergers on competition in healthcare markets—based on studies by FTC staff and independent scholars—shows that healthcare consumers benefit from competitive markets and the associated lower prices and higher quality services.

·      Economic studies also consistently demonstrate that reducing hospital competition leads to higher prices for hospital care. These effects are not limited to for-profit hospitals: mergers between not-for-profit hospitals can also result in substantial anti-competitive price increases.

·      In sum, consolidation in well-defined antitrust markets can harm competition and consumers. Retrospective studies of healthcare mergers provide credible examples of harmful consolidation. These studies lend support for vigorous antitrust enforcement to prevent the accumulation of market power in healthcare markets.

a.    Administration’s recommendations:

·      The administration should continue monitoring market competition, especially in areas that may be less competitive and thus more likely to be affected by alternative payment models.

·      The administration should ascertain the impact of horizontal and vertical integration among provider practices on competition and prices.

b.    Tom’s perspective:

·      I am a believer in competition. I believe it promotes efficiencies and value.

·      Activities that stifle competition should be looked at seriously since they have both a negative impact on consumer choice and take away the business incentive for providers to be attractive from a value perspective in the marketplace.

·      All of this does not mean that, depending upon the market, provider consolidation could have a positive impact on cost and quality as a result of economies of scale and pooled intellectual capital.

·      A true test of the value of consolidation would be the willingness of providers to embrace up- and down-side risk/value-based payment methodologies presented to them by both government and commercial payers.

·      The result: As noted in the Administration’s recommendation monitoring of market competition by region should continue. This would have a positive impact on healthcare system costs as well as overall population health.

2.   Issue as identified by the Administration (Fee-for-service payment methodology):

·      This “more you do the more you make” payment methodology incents over-utilization, not value.

a.   The Administration’s recommendations:

·      The government needs to promote alternative payment models in more of an aggressive manner.

·      Medicare Advantage, which has moved away from a fee-for-service model, improved incentives and has generally produced higher value (better care per unit of cost) for patients.

b.   Tom’s perspective:

·      I believe that we need to expedite the transition to risk/value-based payment methodologies.

·      If we truly want to transition from a “sick-care” system to a “health” system we need to embrace payment methodologies that reward providers to keep people healthy.

·      This transition will also require hospitals to look outside their walls and focus in collaborative ways with other stakeholders on a healthier community.

·      Result: On paper, all stakeholders agree with these recommendations, the issue comes down to speed of implementation. As noted above, this transition to risk/value-based payment methodologies will have a positive impact on both the cost of our healthcare system and the health of the population and it needs to be expedited.

3.   Issue as identified by the Administration (Accountable Care Organizations) (ACOs):

·      One-sided financial risk arrangements (no down-side risk) do not promote or incent better value as would two-sided risk arrangements.

·      ACOs can create a non-competitive market.

·      While changes such as ACOs and other alternative payment models (APMs) may hold the promise of improved care coordination and better aligned financial incentives, they may also encourage provider consolidation that increases market concentration, drives up prices, and decreases competition between providers. This may occur as hospitals purchase physician practices (vertical integration), or through mergers between hospitals or between physician practices (horizontal integration).

·      This may be why greater physician-hospital integration has been linked to higher commercial prices for outpatient care and hospital prices.

a.   The Administration’s recommendations:

·      The government should transition to only two-side risk arrangements with ACOs.

·      The Administration should ensure that smaller physician and provider practices are not unduly harmed by delivery system reform and corresponding requirements.

·      Reduce reporting burden on providers

·      The Administration should ensure that these delivery system reform models, which aim to hold providers accountable to a set of population-based metrics and total spending, foster collaboration across systems within a geographic area and do not produce harmful consolidation, particularly horizontal consolidation.

·      Encourage programs like Medicare Advantage.

b.   Tom’s perspective:

·      As I have noted numerous times in my blogs, a healthcare system is shaped by what you pay for and how you pay for it. The “how you pay for it” payment methodology of fee-for-service is a major factor contributing to a high-cost health system. 

·      Result: As noted above, this transition to a risk/value-based payment methodology (two-sided risk) will have a positive impact on both the cost of our healthcare system and the health of the population.

4.   Issue as identified by the Administration (physician-owned hospitals):

·      ACA rules restricting physician-owned hospitals reduce competition.

·      Many studies suggest that physician-owned hospitals provide high quality care, and by competing with other hospitals they also increase quality in the market and lower costs.

a.   The Administration’s recommendation: Congress should consider repealing the ACA changes to physician self-referral law that limited physician-owned hospitals.

b.   Tom’s perspective:

·      As noted previously in this blog and in prior blogs, I am believer in competition.

·      A necessary requirement for true competition would be cost and quality transparency. Based on published studies, physician-owned hospitals have been competitive from a quality perspective but, as noted in recommendations below, it is critical that there be user-friendly cost and quality available to consumers to allow them to make prudent decisions relating to their care.

·      Result: Enhanced competition that is linked to increased cost and quality transparency should have a positive impact on the cost of the healthcare system in total as well as overall population health.

5.   Issue as identified by the Administration (Post-Acute Care) (PAC):

·      PACs primarily focused on recuperation and rehabilitation.

·      PACs include home health, skilled nursing, inpatient rehabilitation facilities and long-term care hospitals.

·      In 2016, Medicare developed prospective payments systems for each Medicare PAC called PPSs.

·      Costs can vary widely depending to the setting for PAC.

a.   The Administration’s recommendation:

·      A unified or site-neutral PAC prospective payment system would base Medicare payment on the clinical characteristics of the patient which would promote increased cost efficiencies with no negative impact on quality.

b.   Tom’s perspective: 

·      While I am not an expert in this world, it appears that linking Medicare payments to the clinical characteristics of the patient instead of the provider setting would promote cost-efficiencies.

·      It is critical that this payment transition also be accompanied by increased transparency from a quality perspective. 

·      Result: This recommendation should have a positive impact on the system’s healthcare costs and potentially promote innovative approaches to improve the health of the population.

6.   Issue as identified by the Administration (Hospital outpatient department):

·      Many of the services delivered by hospital outpatient departments such as evaluations and management visits (E&M codes), endoscopies, and imaging services are also delivered in physician offices and ambulatory surgery centers (ASCs). 

·      The Bipartisan Budget Act of 2015 modified how campus outpatient services are paid. Effective January 1, 2017 services furnished by certain off-campus provider-based departments can no longer be payable under OPPS (which is a higher payment level than would be received by physician offices and ASCs) and would generally be paid under the Physician Fee Schedule. This eliminated hospital incentives to purchase free standing clinics. 

·      However, clinics purchased by hospitals prior to November 2, 2015, or which were located less than 250 yards away from a remote location of the hospital, were grandfathered and continue to have services rendered paid under OPPS at a higher payment level than independent ASCs and physician offices.

a.   The Administration’s recommendations:

·      Congress should establish site neutral payment policies based on the anticipated needs and risk factors of the patient, rather than the site of service. In delivering these reforms, Congress should account for differing levels of patient acuity.

·      State Medicaid programs should embrace site neutrality as a goal and reform payment systems to pay for value.

b.   Tom’s perspective:

·      As noted previously in this and other blogs, I am a believer in competition. A level playing field in the outpatient arena, between hospitals and independent providers should result in enhanced focus on competing for patients with better value being the carrot.

·      Hospitals will have a concern relating to lost revenue as a result of site-neutral payment policies. Hospitals will state, and rightfully so, that they provide needed services in the community (emergency, uncompensated care) that are not adequately reimbursed by poor consumers, Medicare and Medicaid.  

While a valid assertion, the answer should not be to subsidize the outpatient side that distorts the market. Enhanced pressure needs to be placed on government for increased reimbursement for hospitals for needed community services.

There also needs to be enhanced collaboration between providers of care in developing innovative approaches to serve this population in a cost-effective manner.

7.   Issue as identified by the Administration (Quality Report Cards):

·      While value is best determined by private sector interactions, the government can play a productive role in collecting and making available data that patients and insurance companies can use to make more informed decisions.

·      In the past, the government has often failed to establish sensible metrics, creating significant reporting burdens for providers and metrics that are not informative for patients or industry and can easily be gamed when reimbursement is tied to them.

a.   The Administration’s recommendations:

·      Administration (CMS) should streamline and standardize quality measures to avoid duplicating reports and limit the number of measures.

·      The Administration should seek to develop measures that are meaningful to providers and patients and help them assess quality and value.

b.   Tom’s perspective:

·      This is like mom and apple pie - who can argue against increased transparency as it relates to cost and quality?

·      Reporting is critical, but it is also important that it does not become an administrative burden on providers.

·      Result: The key will be user-friendly and the ability to do apples-to-apples comparisons between providers of care and services provided. If implemented correctly, enhanced transparency will have a positive impact on the cost of the health system and overall population health.

Consumer-driven healthcare

?

1.   Issue as identified by the Administration (the third-party payment system):

·      Third-party payment distorts healthcare markets

·      Increases spending and premiums

·      Reduces consumers’ incentives to seek value from their healthcare decisions

a.   The Administration’s recommendations:

·      Expand HSAs and HRAs (realign incentives)

·      Allow any plan with an actuarial value below 70% to be considered an HSA-qualified plan, raising the contribution limit on HSAs, allowing HSA qualified plans to pay non-group premiums.

·      Allow HSAs greater ability to cover preventive low cost treatments for chronic diseases.

·      Increase usability of HRAs.

b.   Tom’s perspective:

·      The devil is always in the detail. Overall, I believe that HSAs and HRAs serve a positive role to incent consumers to be prudent purchasers of healthcare services.

·      A community of prudent purchasers of healthcare services will also help shape a more value-based health system attempting to respond to their needs.

·      Access to care is also critical, and HSAs and HRAs should not be structured in a way to be a barrier to needed care.

·      Result: On the face of it, I agree in general with these recommendations, but I will need to deep dive into them further in future blogs. In theory, if appropriately developed, HSAs and HRAs would promote a more value-base health system. It could also have a positive impact on population health if it incents the consumer to more proactively participate in their own well-being.

The concern, as stated above, is when HSAs and HRAs become a barrier to needed health. We cannot make a blanket statement as to their appropriateness in all cases. This is why there needs to be continued debate on this topic involving experts, not just politicians.

2.   Issue as identified by the Administration (Consumers are mostly passive purchasers of healthcare services):

·      The power of consumers to positively impact the healthcare system by searching for value needs to be unleashed.

·      Empowering consumers with price information and realigning financial incentives to give consumers a greater stake in their healthcare decisions has been shown to lower prices without affecting quality.

a.   The Administration’s recommendations:

·      Payers need to promote reference-based pricing. It places an upper limit on the amount of reimbursement a payer will pay for a medical service (median reimbursement in the area). 

·      Payers need to promote contracting for centers of excellence utilizing bundled payments which will enhance quality and cost-efficiencies.

b.   Tom’s perspective:

·      As I have noted in prior blogs, I am a believer in both reference-based pricing and centers of excellence. 

·      Result: In regards to reference-based pricing, again, the devil is in the detail. The “how,” as in “how it is it setup” is critical. The concept makes sense and it can promote efficiencies, but it cannot be focused solely on reducing costs at the expense of quality care. Centers of excellence should have both a positive impact on cost, quality and overall population health.

3.   Issue as identified by the Administration (Lack of availability of user-friendly cost-quality information):

·      Consumers cannot effectively shop for services since there is a lack of availability of user-friendly cost-quality information.

·      To be effective price transparency efforts must distinguish between the charges a provider bills and the rate negotiated between payers and each provider.

·      One study classified 43% of healthcare spending as shoppable.

·      There is less incentive to shop if someone else is paying the bill (moral hazard).

a.   Administration’s recommendations:

·      Meaningful and timely consumer access to prices can supplement benefit designs to help consumers choose lower-cost, higher-value providers. In a competitive, functioning insurance market, insurers would have an incentive to use such approaches.

·      More importantly, price information may be less useful to consumers if price comparisons do not group, or bundle, services into common episodes of care. An episode of care can include multiple services and fees, which makes it difficult for consumers to obtain accurate price estimates.

Consumers may be unaware, for example, of separate physician and facility fees, resulting in higher than expected prices and surprise medical bills.

By developing a standardized set of services, such as those used in bundled payment approaches, price transparency efforts could better help consumers compare providers.

·      Administration should continue to publically release data

b.   Tom’s perspective:

·      This is like mom and apple pie - who can argue against increased transparency as it relates to cost and quality?

·      Result: The key will be user-friendly and the ability to do apples-to-apples comparisons between providers of care and services provided. If implemented correctly, enhanced transparency will have a positive impact on the cost of the health system and overall population health.

4.   Issue (Health information technology including Electronic Medical Records -EMRs):

·      Limited state of interoperability. Patients have very limited ability to obtain or move their records.

·      Providers have significant barriers to get health information from other providers.

a.   Administration’s recommendations:

·      The 21st Century Cures Act (December 2016) provides powerful tools to increase interoperability of health data and, by extension, market competition.

·      Act defines information blocking broadly and outlaws it.

·      Mandate to create a “Trusted Exchange Framework” and a “Common Agreement” to get the various health networks to share data.

·      Administration needs to enforce the CURES law

·      CMS should champion interoperability across the healthcare sector

b.   Tom’s perspective:

·      This in one of my pet peeves. We talk about patient-centered care. As a result of the lack of interoperability across the healthcare system, patient-centered takes on a new meaning.

·      I need to be the one responsible to make sure my providers communicate with each other. I am the one who has to make copies or push for faxes between providers. I am the one who goes to my primary care physician, the so-called healthcare hub, without having a complete picture of my health be available for my physician.

·      Result: For all of the reasons noted above, I am a strong believer in having the Administration enforce the CURES law to promote greater interoperability.

Concluding comments:

As stated previously in this blog, I am not a supporter of President Trump for a variety of reasons. That being said, as noted in this blog, I do agree with a number of recommendations stated in the report titled, “Reforming America’s Healthcare System through Choice and Competition”

I do believe that “choice and competition” can incent our healthcare system to be more value-based, but it does not need to be done by erecting “barriers” to care for those in need. We do not want to substitute “barriers” to a competitive market with “barriers” to needed care.

That being said, I am impressed with U.S. Department of Health and Human Services, Secretary Alex Azar’s understanding of the healthcare challenges we are facing and his willingness to confront them head on.

I plan to devote a blog or two to some of Secretary Alex Azar’s recommendation relating to the drug industry since, as a former CEO in that world, he is in a good position to look on the covers.

Finally, my next blog will summarize my thoughts relating to how we can potentially reconcile the key elements that are articulated in the “Choice and Competition” report reviewed in this blog and those within the Accountable Care Act. 

A teaser, I am a supporter of Medicaid expansion. More fun to come.

Thomas Campanella is the director of the Health Care MBA and an associate professor of health economics at Baldwin Wallace University near Cleveland, Ohio.

If you are interested in receiving a monthly summary of all of my healthcare blogs, you can respond to me on LinkedIn or e-mail Tom Campanella ([email protected]) with your contact information.

Source of pictures: pixabay.com & pexels.com