Recommendation for the Incoming Government from William Fleming

No doubt, the Biden administration and our congressional legislators will be challenged in many ways, given this past year of multiple crises, including a gripping pandemic, widespread social unrest, and significant economic turbulence. Healthcare has been and will continue to be a pivotal piece of the puzzle, especially as 2021 is tackled. 

From that perspective, a couple of things come to mind that I believe the incoming administration should steadfastly acknowledge and support:  

• the value of the Medicare Advantage (MA) platform in improving healthcare quality, cost, and access to care
• the importance of protecting Medicare beneficiaries from high drug costs and ensuring sustainability in Part D
• the role of interoperability to help make things easier for doctors and other healthcare professionals to share and leverage data

Medicare Advantage: Compared to those in traditional Medicare fee-for-service arrangements, Medicare Advantage members, especially those in value-based programs, have the benefit of receiving a more holistic, patient-centric approach to their care, which leads to better health outcomes at a lower cost. Statistics reflect fewer emergency room visits and lower hospital readmission rates, as well as better chronic care management, medication adherence, and preventive care. In addition, CMS Star scores for these MA plans rank higher in five key areas, including quality of care and customer service.

Just as we need to encourage the new administration’s recognition of the progressive “return-on-health” MA plans deliver, we also need to continue pushing for healthcare coverage expansion, potentially using the MA chassis to facilitate. With a substantial need for improved access to care, we should explore such means to accommodate more individuals, including via telehealth, which has proven invaluable amidst our COVID-19 challenges. 

Drug Costs: As many drug costs continue to escalate, we would encourage the administration and Congress to explore policy ideas to modernize the prescription drug benefit. At a high level, this could mean, placing limits on out-of-pocket costs, creating a special funding mechanism for today’s high-cost specialty drugs, or including new flexibility for Part D plan design (e.g., options for beneficiaries on high-cost specialty drugs or dually-eligible Medicaid/Medicare beneficiaries). 

We’d also strongly recommend continuing to evolve FDA and patent policy to create competition: The more competition, the lower the drug price.

Interoperability: It would be a great disservice if I didn’t also mention the importance of pushing forward on this one. While the term in its most literal sense refers to transferring and accessing electronic health information without special effort on the part of the user, its broader definition must include using robust information to inform and empower better decisions.  

I recently wrote a lengthier blog on this very subject, expounding on the importance of integrated real-time tools to enable easier point-of-care decisions for physicians and other clinicians, leveraging pharmacists and technology for comprehensive medication management, and using data analytics to simplify and accelerate prior authorizations.  All of these are important.

Whether we look at healthcare from a 40,000-foot systemic perspective or a more focused individual patient view, one thing is clear: We must all work together to achieve the best results. This means digital platforms sharing data. It means true, bipartisan collaboration to solve challenges together. It also means organizations, regulators, legislators, and healthcare professionals partnering across various boundaries, with consumers at the center, to work toward the greater good, improving health and healthcare.