Wednesday, November 16, 2016

What Does the Trump Presidency Imply for Healthcare and Healthcare IT?

Many organizations have asked me to comment on the impact of the Trump Presidency on Healthcare and Healthcare IT.    I served the Bush administration for 4 years and the Obama administration for 6 years.   I know that change in Washington happens incrementally.   There is always an evolution, not a revolution, regardless of speechmaking hyperbole.

What am I doing in Massachusetts?   I’m staying the course, continuing my focus on social networking for healthcare, mobile, care management analytics, cloud, and security while leaving the strategic plan/budget as is.

I have no inside information and no involvement with the Trump campaign/transition team.   From talking to people in Washington and reading publicly available resources, I believe there are 10 themes that will guide us over the next two years.

1.   It’s likely that some corporate and personal taxes will be reduced, possibly increasing the funds available for innovation.

2.   It’s likely that some regulations will be simplified, possibly creating more free time/attention span for innovation.

3.   It’s likely that free market competition will increase and some of the political infighting around issues such as Medicare’s inability to negotiate drug prices may dissipate.  I'm hearing that Medicare may be encouraged to negotiate drug prices in the Trump administration.

4.   As corporate taxes are restructured, we may see repatriation of funds currently sequestered offshore.   The tax cost of bringing such funds back to the US today is 40%.   It may be 10% in the near future.

5.   Although much has been said about replacing the Affordable Care Act, it’s likely that it will simply be amended to reduce the focus on Health Insurance Exchanges.  There will be no “public option” for health coverage.   Private payers will be encouraged to offer products across state lines.   Pre-existing conditions will still be covered.   Children will be covered on their parents health plans until age 26.

6.  Medicaid will be moved closer to the states.   States will have more funds to invest in innovation.   Since states will directly benefit from cost savings resulting from investments in innovation incentives will be aligned.

7.  FDA scrutiny of new products may be streamlined.

8.  FTC enforcement actions may be relaxed.

9.  NIH funding may be cut and projects like the Cancer Moonshot, Precision Medicine, and the Center for Medicare and Medicaid Innovation may be scaled back.

10.  Most importantly, the transition from fee for service to value based purchasing will continue unmodified.   This means that all the work we’re doing to improve quality, safety, efficiency, patient/family engagement, and population health will still be high priorities.

I recently spoke with administrators in Washington and they reminded me that although political appointees all resign on January 20th, career appointees will continue doing the work already in progress.   Regulation can be changed in the medium term, but legislative changes (even with a Republican House and Senate) takes a long time.    MACRA/MIPS is legislation.  The Quality Payment Program is regulation implementing MACRA/MIPS.   The career employees are on track to implement the Quality Payment Program as scheduled  2017-2019.

My advice is to remain agile, keep calm, and assume that many Obama era healthcare IT programs will persist.    Focus on reducing total medical expense, measuring quality across the community, providing stakeholders with tools that are valuable to them, spreading the burden of data capture among teams of caregivers, and enhancing interoperability.

Working together and staying focused, above the fray of politics, we can make a difference.

1 comment:

Brian Ahier said...

I agree with just about all of your assessment and the themes are a very good categorization of the top-line issues.
The one place where I see a nuanced difference in our assumptions is CMMI - it will be starved out of existence in the budget process.
There will certainly be no near term repeal and replacement of the ACA. It would never get through the Senate; however, they will use reconciliation in the budget process to eliminate the portions of the law they find most egregious. Yours is a very good list.
I would expand on the following likely scenarios:
For vendors
- Require transparency of provider service prices

For payers
- Expand use of health savings accounts
- Allow sale of insurance plans across state lines

For Pharma:
- Allow re-importation of prescription drugs
And possibly also allow Medicare to negotiate drug prices (that's a coin toss)