As we previously announced, President Elect Donald Trump plans to nominate Seema Verma, a private health policy consultant, to head the Centers for Medicare and Medicaid Services (CMS). While Ms. Verma likely has a few ideas of her own that should be instituted rather quickly, current CMS acting administrator Andy Slavitt believes that “[t]he person sitting in my chair next isn’t going to have a choice but to make this one of their top two or three priorities,” discussing drug pricing.
Slavitt continued, noting that CMS will need to create partnerships with members of the Medicare Part D community in order to be successful. He believes that the current dialogue on prescription drug pricing is set up between whether to have innovative, expensive drugs, or to have less expensive treatments. Slavitt believes boiling it down to simple terms creates a false choice and is not productive for anyone, least of all patients.
Slavitt compared the current pharmaceutical spending debate to conversations several years ago about rising hospital costs. He noted that we now know how to have treatments that are both innovative and less expensive, and that several years ago, frameworks were created to help make hospital care more affordable. He believes similar frameworks can be created for pharmaceuticals.
Slavitt also expressed his hopes that the new political climate in Washington, DC will not reverse the progress made over the last eight years, including the Affordable Care Act (ACA) and implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which is set to change how clinicians get reimbursed under Medicare.
Slavitt cited the following statistics, in support of not only his reign over the past few years, but over the past eight years under President Obama:
- Today, 30% of fee-for-service Medicare payments flow through alternative payment models, up from essentially none in 2010. And, millions more are covered through innovative Medicare Advantage programs.
- Quality and safety have improved with the rate of hospital-acquired conditions declining by 17%, which has prevented an estimated 87,000 deaths over 4 years. The rate at which Medicare patients are readmitted to the hospital within 30 days after discharge has decreased sharply, resulting in 565,000 fewer total readmissions.
- Medicare provides more access with new prescription benefits and, thanks to the Affordable Care Act (ACA), we’ve closed the Medicare donut hole and with that, 11 million beneficiaries have saved an average of more than $2,000.
- The CMS Innovation Center, which the ACA created, takes best practices from the clinical field and has developed over 30 alternative payment models and initiatives, serving millions of Medicare beneficiaries. The CBO expects the Innovation Center to reduce federal spending by about $34 billion over the next 10 years as we find new and better ways to care of people.
- And, with all of this, we have been spending tax payer resources more wisely with extended record low medical inflation. The ACA extended the life of the Medicare trust fund and has helped deliver $473 billion in savings.
MACRA is not likely to go anywhere with the new administration, but the ACA is under extreme attack. Slavitt noted that he hopes Ms. Verma “build[s] from a foundation of progress, not head backwards. There can be no delivery system reform without building on the foundation of reaching universal coverage.”
Slavitt believes that the CMS Innovation Center, created by the ACA to take best practices and develop alternative payment models and initiatives, is crucial to the success of MACRA, stating, “I’ll say this bluntly: MACRA can’t work as well without a CMS Innovation Center that can move quickly to develop and expand new approaches to paying for care.”
Slavitt ended his talk reminding attendees that “people are the heart of every policy made,” and that “[w]e are on a journey as a nation towards better health for all. Patients. Care givers. Consumers. You know them better than anyone because you care for them. View MACRA as a step in the journey to develop care together.”