9 minute read
TRENDS
from REP June 21
Biden’s Healthcare Agenda
Affordable Care Act, telemedicine, home-based care intended to promote healthcare equity and accessibility
If anyone had doubts about the Biden administra-
tion’s plans for healthcare and payment reform, those doubts were dispelled just eight days after his Jan. 20 inauguration, when Biden issued his “Executive Order on Strengthening Medicaid and the Affordable Care Act.”
Of course, even the best laid plans can get derailed. The courts could disembowel the Affordable Care Act, or natural disasters and global political turbulence could divert the administration’s time and resources. But the guiding healthcare principles of the Biden administration can be summed up in three words: Quality. Cost. Equity. For those in the healthcare supply chain, that means more patients are likely to enter the system.
Affordable Care Act
In Biden’s American Rescue Plan, signed into law on March 18, the administration pledged to reduce the cost of healthcare coverage for 9 million consumers currently receiving financial assistance. As spelled out in the plan, one out of four enrollees on Heathcare.gov will be able to upgrade to a higher plan category that offers better out-of-pocket costs at the same or lower premium compared to what they’re paying today. What’s more, an additional 3.6 million uninsured people will become eligible for healthcare coverage savings.
As if to underscore the administration’s determination, the Department of Health and Human Services was allotted $50 million to fund advertising to bolster the Special Enrollment Period outreach campaign, which was scheduled to run through August 15, 2021.
If the Affordable Care Act were indeed to be fortified, what difference would that make to the industry? If history is any guide, the results will be mixed for providers, suppliers, payers, patients and caregivers. In February 2020, Commonwealth Fund researchers reported that the ACA:
ʯ Reduced annual increases in payments to hospitals under traditional Medicare as well as Medicare Advantage plans (which most likely contributed to a slowing down of increases in Medicare expenditures). ʯ Implemented value-based payments for hospitals, including the Hospital Readmission Reduction Program, the Hospital-Acquired Condition
Reduction Program and the Hospital Value-Based
Purchasing Program. ʯ Encouraged the formation of accountable care organizations, that is, voluntary organizations of providers that agree to take responsibility for the quality and costs of care for a population of patients (generating modest net savings of up to 2% for
Medicare while maintaining or improving quality). ʯ Implemented bundled payment programs, giving providers a single, prospective payment for treatment of a surgical or medical condition. (The program for hip and knee replacements appears to have reduced spending, but those savings may not have exceeded administrative costs, according to the Commonwealth Fund.) ʯ Launched a number of experiments to strengthen the nation’s primary care infrastructure. (While most of these experiments produced mixed results, the Independence at Home Demonstration, which provides intensive primary care for homebound patients, had the most promising results, according to the Commonwealth Fund.
Emergency department and hospitalizations were down, patient and caregiver satisfaction were up, and Medicare expenditures were down.)
Lasting improvements in payment and delivery systems will require persistent effort on the part of public and private stakeholders, concluded the researchers. Repertoire readers can bet the Biden administration intends to make that effort. Telemedicine will probably be a key component of it.
Telemedicine
Prior to Jan. 20, the Trump administration promoted efforts to expand telemedicine as a way to cope with COVID19-related lockdowns. Before the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries per week received a Medicare telemedicine service. Under a special waiver for the PHE in March 2020, Medicare was authorized to pay for office, hospital, and other visits furnished via telehealth, including those originating in patients’ places of residence. Between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees received a Medicare telemedicine service.
Services added to the Medicare telehealth list in the 2021 Physician Fee Schedule included “domiciliary, rest home or custodial care services,” home visits with established patients, “cognitive assessment and care planning services,” and “visit complexity inherent to certain office/ outpatient evaluation and management (E/M).”
On March 30, 2021, the Federal Communications Commission voted to adopt a $249.95 million federal initiative that builds on a $200 million program established as part of the CARES Act. The FCC said its COVID-19 Telehealth Program will help healthcare providers serve patients by providing telecommunications services, information services, and connected devices. FCC Commissioner Geoffrey Starks sees telemedicine and increased broadband access as essential responses to historical inequities in healthcare.
“Telehealth can make a difference for all Americans, particularly low-income communities of color,” he said in a statement in March. He pointed to Rush University Medical Center, which is located in a majority Black neighborhood on the West Side of Chicago (“the city with the largest gap in life expectancy in the United States – nearly 30 years”). Between April and May 2020, Rush received more than 600 patient transfers from surrounding safety net hospitals, most of whom were COVID-19-positive, and many of whom were either uninsured or on Medicaid, he said. In response, Rush invested in telehealth technology that allowed doctors and staff to monitor and communicate with COVID-19 patients from the patients’ homes.
“Communities of color have been affected in many ways by the COVID-19 pandemic, not only with disproportionate losses of employment and businesses, but also with higher rates of infection and death,” he continued.
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“Yet these same communities lack equal access to mental health and substance abuse resources. Telehealth has proven it can be a valuable tool to connect our most vulnerable with the resources they need to receive treatment and stay in touch with counselors and other support.”
Home-based care
Much has been written about the growing need for healthcare assistance for an aging population. The Biden administration sees home-based care as a big part of the solution.
The clearest indicator of its intentions lies in the American Jobs Plan, released on March 31, which calls for expanded access to long-term-care services under Medicaid. “President Biden believes more people should have the opportunity to receive care at home, in a supportive community, or from a loved one,” said the White House in a statement. “[His] plan will expand access to home- and community-based services and extend the longstanding Money Follows the Person program, which supports innovations in the delivery of long-term care.”
As with telehealth, the Biden administration considers home-based care to be a tool to promote equity – for patients and caregivers.
“Caregivers – who are disproportionally women of color – have been underpaid and undervalued for far too long,” according to the White House. “Wages for essential home care workers are approximately $12 per hour, putting them among the lowest paid workers in our economy. In fact, one in six workers in this sector live in poverty.
“President Biden is … calling on Congress to put $400 billion toward expanding access to quality, affordable home- or community-based care for aging relatives and people with disabilities. These investments will help hundreds of thousands of Americans finally obtain the long-term services and support they need, while creating new jobs and offering caregiving workers a long-overdue
raise, stronger benefits, and an opportunity to organize or join a union and collectively bargain.”
Equity
Biden believes his approach to COVID-19 is another example of his administration’s concerns with inequity.
“Equity is at the center of the Administration’s COVID-19 response,” said the White House in a statement about the American Rescue Plan. “The President has set up federally run community vaccination centers in hard-hit areas; sent vaccines directly to local pharmacies and Community Health Centers that disproportionately serve vulnerable populations; launched hundreds of mobile clinics to meet people where they are; and created the COVID-19 Health Equity Task Force.”
The plan includes a $6 billion investment in community health centers to expand access to vaccines, testing and treatment for vulnerable populations in underserved communities. But it also sets the stage for future work to address inequities. The Health Resources and Services Administration was authorized to provide funding starting in April to nearly 1,400 centers across the country. Community health centers serve one in five people living in rural communities, according to the White House. More than 91% of health center patients are individuals or families living at or below 200% of the Federal Poverty Guidelines, and more than 60% are racial or ethnic minorities.
On the very first day (Jan. 20) of his presidency, Biden addressed healthcare inequity and discrimination on the basis of gender identity or sexual orientation. Rescinding a one-year-old executive order by the prior administration, Biden’s “Executive Order on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” stated that “People should be able to access healthcare and secure a roof over their heads without being subjected to sex discrimination. All persons should receive equal treatment under the law, no matter their gender identity or sexual orientation.”
In another nod to equity, on Feb. 2, Biden signed the “Executive Order on Restoring Faith in Our Legal Immigration Systems and Strengthening Integration and Inclusion Efforts for New Americans.” The order directed the Secretary of Health and Human Services and other agencies to review an August 2019 executive order, Inadmissibility on Public Charge Grounds, which allowed officials to deny admission to the U.S. for people whom they believed may receive non-emergency Medicaid in the future.
