The first two plenary addresses at HM17 are focused on policy at a time when the dynamically evolving U.S. health care delivery system may seem daunting, opaque, and labyrinthine.
Some might view the health care landscape as hopelessly confusing. Yet both of the keynote speakers use the same word for what they hope to leave their listeners with: optimism.
“Though it feels uncertain in the headlines, the reality is that the health care world feels pretty united in that we need to continue the progress we’ve made on moving away from the fee-for-service model and to let people practice medicine the way they want – to work better as teams and focus on patients and outcomes,” said Karen DeSalvo, MD, MPH, MSc, former acting assistant secretary for health in the U.S. Department of Health and Human Services (HHS) and former national coordinator for health information technology.
Patrick Conway, MD, MSc, MHM, deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation, is also optimistic, despite concerns about the rollback of the Affordable Care Act and what that could mean for access to care.
“I would view it as an opportunity as well,” said Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends in greater Washington, D.C. “I think the pieces are coming together. Everything from data, to new payment models, to the MACRA Medicare Physician payment legislation, really suggests a time of positive change.”
Dr. DeSalvo, a former political appointee, joined HHS as the national coordinator for health information technology in 2014 and soon thereafter assumed the acting assistant secretary role. Dr. Conway has attained one of the country’s highest-ranking public health care jobs since joining CMS in 2011. He retained the top post at CMS while President Donald Trump’s nominee to lead the agency, Seema Verma, awaited a confirmation hearing before the U.S. Senate. Dr. Conway’s prior title was principal deputy administrator and CMS chief medical officer.
Dr. DeSalvo, who will speak about “Rethinking Health: The Vital Role of Hospitals and the Hospitalist,” says that despite the current tumult, hospitalists are well positioned to drive the discussion about health care reform. But she said that conversation need not bog down in insurance-coverage issues that, while important, are more the purview of bureaucrats and wonks than of physicians.
“I don’t want people to lose sight of the fact that there’s this entire care system that everybody’s working and innovating in every day, trying to find more efficient, effective ways to get better outcomes,” she said. “Hospitalists, quite frankly, have been leading that for their entire existence. They really understand in great granular detail what it takes.”
Dr. DeSalvo believes that the progress of the past 5 years has established a path that must be followed. The public sector move away from fee-for-service has combined with emerging technology platforms to create a new age where physicians and insurers can judge, in real time, how well care is working.
“We’re now in a feedback loop where we can say – ‘When we’ve built a care system like this or when we pay this way, we are actually seeing improved outcomes’ – and change doesn’t take as long,” Dr. DeSalvo said.
Dr. Conway, whose working title for his speech is “Health care System Transformation,” said hospitalists should be encouraged by how well the field has already adapted to the proliferation of accountable care organizations (ACOs), value-based purchasing (VBP), alternative payment models (APM), and the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. He noted that, as innovations lead to better and more coordinated patient care, hospitalists, patients, and hospitals would all benefit.
“I want to leave people with the idea that value-based payment innovation and delivery system reform will continue to be critical aspects of improving our health system,” he said. “I also want hospitalists to continue to stay engaged with these new payment models, help lead them, and provide better patient care as a part of them.”