Health Care in 2013: Navigating a Challenging World An Edelman Health Care Salon

January 15, 2013 Washington, D.C. As the country continues the difficult work of implementing the sweeping health care changes mandated by the Affordable Care Act (ACA), business and advocacy leaders in Washington gathered at the Hay-Adams Hotel to participate in a discussion about the biggest problems—and potential solutions—facing businesses, legislators and administrators today. Edelman live-tweeted key questions and The salon was organized by Edelman’s Washington, D.C., responses during the Salon. See those Health Practice and moderated by Peter Segall, managing tweets and more on Twitter under the director of the Washington office and head of Edelman’s handle @EdelmanHealthDC. U.S. Public Affairs practice. Featured panelists were:  Susan Dentzer, editor-in-chief of Health Affairs  Dan Mendelson, chief executive officer of Avalere Health  Caroline Steinberg, vice president of health trends analysis at the American Hospital Association (AHA) Participants discussed a wide range of policy issues facing health industry stakeholders, focusing on the key issues the Obama Administration and Congress must tackle as health care reform takes effect, and how the health care sector can best address the challenges ahead. The panelists agreed that efforts to repeal major provisions of the ACA – efforts that were threatened throughout the presidential election – will likely be unsuccessful. Mendelson said he believes the majority of the ACA will remain intact over the next several years, in part because commercial entities are already moving forward in response to ACA’s passage, such as purchasing Medicare Advantage companies. He noted that as businesses invest more heavily in the essential tenets of the law, the more longevity the law will have. That said, passage of ACA does not mean all decisions have been finalized. Panelists noted that as the country moves to implement the law, hundreds of decisions are still left to be made and rules to be interpreted at both the federal and state levels. Politics vs. Policy Mendelson contended that Congress’ focus on the politics of health care has prevented real health reform progress, despite ACA’s passage. “Can we do something that is actually useful, such as potentially raising the Medicare eligibility age?” he asked. He added that he doubts that lawmakers will be able to agree on any major actions within the next year, and that the public should expect to see more focus on reductions in reimbursements to hospitals and other health care providers.


AHA’s Steinberg said that hospitals must prepare to be pushed in the future and should expect to see increasing Medicare and Medicaid payment cuts. This has already begun, she noted, given that Congress balanced freezing Medicare physician fee levels through the end of 2013 by cutting hospital Medicare payments, among other cuts and reductions. The panelists also expressed concern that budget cuts have and will continue to undermine investment in prevention policies that could have significant long-term public health benefits. Dentzer mentioned potential reductions to the Prevention and Public Health Fund, which was established by ACA to expand and sustain national-level investment in prevention and public health initiatives, as well as improve health care outcomes and quality. And even if the Fund does remain intact, Dentzer said, much of it may be used to offset other cuts in the budget of the Centers for Disease Control and Prevention (CDC). Dentzer also cited a recent Institute of Medicine report that found that although the United States spends more per capita on health care than any other country, Americans continue to die at younger ages than do people in almost all other high-income nations. She wondered how many more years of these reports must come out before either the government or individuals take real action to address the poor health and declining life expectancy of so many Americans. She contended that a major program to prevent diabetes, for example, would cost relatively little but produce savings over the long term. Yet politicians are not yet ready, willing or able to take action in this arena. Today’s Reality vs. Tomorrow’s Future Concern over whether the ACA will be implemented in a sustainable way was another recurring theme at the Salon. For example, Steinberg described how most hospitals are still at the infancy of electronic health record (EHR) usage. As a result, in the face of governmental pressures to institute EHRs, hospitals are focusing on the immediate need to meet meaningful use criteria, too often implementing products that prove to be unusable or incompatible with other systems. The current products available also often focus on the automation of existing processes, instead of truly maximizing the potential for information technology to improve health care delivery. Steinberg said that the promise of HIT— coordinated care, improvement in quality, reduced costs— will take much longer to achieve because of the push to institute EHRs before they have been improved further. Mendelson added that he believed it was a mistake to not mandate interoperability standards for EHRs. Dentzer touched on this, as well, noting that the nation may look back on the HITECH program to spur electronic health records adoption and conclude that, in effect, it came both “way too late, and way too soon,” before the technology had matured. ACA Awareness: The Most Challenging Problem of All? Beyond the structural and political challenges of implementing the ACA, the Salon panelists raised an even more basic barrier: the fact that many people who will newly qualify for health insurance have no idea this benefit is coming. On a related note, many people do not realize they will be required to secure such benefits. While some panelists noted that federal and state governments have their 2 Social Media’s Role in the Future of Health Care Mendelson believes that education on new insurance options under ACA will come not from the government, but from health plans, which will aggressively use social media channels to secure the youngest, healthiest lives possible.

communications work cut out for them, others suggested that it will be stakeholders such as payors who will invest in raising consumer awareness, as they seek to find new “covered lives” that will best suit their business models.

Health Care in 2013: Navigating a Challenging World
Panelists and Moderator SUSAN DENTZER is the editor-in-chief of Health Affairs, the nation’s leading peerreviewed journal focused on the intersection of health, health care and health policy in the United States and internationally. One of the nation’s most respected health and health policy journalists, she is an on-air analyst on health issues with the PBS NewsHour, and a frequent guest and commentator on such National Public Radio shows as This American Life and The Diane Rehm Show.

DAN MENDELSON is chief executive officer of Avalere Health, a Washington D.C.-based strategic advisory company. He founded the firm in 2000, and presently Avalere employs over 160 talented substantive experts focused on commercial strategy issues in health care. Avalere’s client base includes Fortune 500 healthcare companies, startup innovators, financial services companies, government agencies, and major medical foundations. Avalere deploys its intellectual property through products, modeling and structured advisory services offerings that span technology, services, institutional, and government policy concerns. CAROLINE ROSSI STEINBERG is the vice president of health trends analysis at the American Hospital Association, which she joined in 2002 after 14 years in health care consulting. Caroline manages policy research and trends analysis for the AHA. Her work includes modeling the impact of regulatory and legislative proposals, developing issue briefs to inform the development of AHA’s policy positions and tracking key trends in the health care field. PETER SEGALL (Event Moderator) is managing director of Edelman’s Washington, D.C., office and managing director of the U.S. Health Public Affairs practice. He brings to Edelman more than 30 years of experience as a Washington-based public affairs practitioner and issues manager. Peter’s health care public affairs representation includes pharmaceutical manufacturers, insurers, managed care companies, providers, their respective associations and allied health/patient groups.


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