Reflections from 24 hours in Washington D.C.: Prioritizing what’s urgent and necessary in health care

The smoke from Canada’s wildfires may have brought a haze to the city, but it didn’t stop the important conversations from happening about what’s needed from both policymakers and private industry stakeholders to make health care more affordable, accessible, and digitally driven.

After a whirlwind 24 hours in Washington D.C. last week, there’s no shortage of thoughts on my mind as to how we can improve our nation’s health care system.

Along with a valuable, thought-provoking discussion at POLITICO’s Health Care Summit, I sat down with a number of key policymakers and industry leaders to discuss where health care is headed for the rest of this year and beyond.

Here are three takeaways and asks for policymakers from my time in Washington D.C.:

1. Public/ private partnerships are key to controlling health care costs.

As I shared during my session at the POLITICO Health Care Summit, fiscal and financial sustainability in health care won’t happen unless we control costs. That simply isn’t possible without partnerships between the public and private sectors.

Teamwork between these entities is absolutely feasible, and already happening. For example, in California, we brought together labor groups, employers, providers, health plans, and consumer groups that helped create the Office of Health Care Affordability, which is one of the most comprehensive reforms since the passage of the Affordable Care Act (ACA). This office is empowered by law to limit rising healthcare costs and acts as a forcing function for individual players to provide high-quality care in a sustainably affordable manner.

California is a complex, diverse, and massive state that can act as a blueprint for affordable care in this nation.

2. Transparency is needed in pharmacy value chain.

While we can continue to push for affordable health care in California, we also need help from leaders in Washington. Our nation’s prescription drug reimbursement ecosystem is the poster child of a dysfunctional, inflationary health care system. It’s built to maximize profits for all players in the value chain at the expense of patients.

In our health care system, it is nearly impossible to determine what prescription drugs actually cost. Every player in the ecosystem seems to charge a different price. For example, there is a generic prostate cancer drug – abiraterone – that costs approximately $3,000 a month. We are a founding investor of CivicaScript (a subsidiary of nonprofit CivicaRx), which is dedicated to lowering the price of high-cost generic medications at the pharmacy counter. Through this partnership, we developed a version of this drug that costs just $160 a month.

Despite this much cheaper option for our members, pharmacy benefit managers (PBMs) across the nation are preventing us from being able to offer it to members.

To truly address the root of these well-documented prescription drug pain points, we must expand the public sector’s ability to negotiate drug prices at the federal and state level. In doing this, we can slowly begin to force manufacturers to be more transparent about their pricing models.

All of this begins with our policymakers in D.C. They took meaningful strides last year by allowing Medicare to negotiate the price of a handful of high-cost drugs, now it is time to extend that relief to the majority of Americans under 65 with private health care coverage.

3. What we need in D.C., that we have in California, is urgency.

Innovative policy levers that have been pulled in California, including the aforementioned Office of Health Care Affordability’s spending targets, or even our health care data sharing requirements, should serve as a roadmap for what’s possible, urgent, and necessary across the country.

We must create an industry where patients not only have access to but own their health information. More specifically, we need a federally-mandated Digital Health Bill of Rights that outlines patient data ownership rights and expectations around information access and use. From an industry standpoint, we have the tools and capabilities to make patient data ownership happen; now, we need policy leaders to create the will.?

Thankfully, the transformation we’re looking for can be backed with bipartisan support. I have yet to meet a policymaker on either side of the aisle that wants anyone to receive vital health information via fax or CD-ROM. Our leaders and policymakers now need to feel that same sense of urgency in pushing for this development on a national scale.

At Blue Shield of California, we want a health care system that’s worthy of our family and friends and sustainably affordable. But it’s time we are honest with ourselves in how we get there as an industry.

We need transformations in the healthcare system that will create real-time health records, accountability for costs, and transparency for drug prices. All of this is within reach; we’ve laid the groundwork in California. What we need now is a sense of urgency and action from policymakers to make these transformations happen across the country.?