Former CMS leaders see shared pathway to a healthier America
Finding areas of agreement will help feed innovation and establish health equity, they say
- Image Daniel Martinez
Dean Sarah Szanton of the John Hopkins School of Nursing and four former administrators for the Centers for Medicare and Medicaid Services (CMS) discussed practical strategies and guidance for enhancing community health and value-based care in the U.S. during a recent event at the Johns Hopkins University Bloomberg Center.
The discussion focused on working across political and philosophical differences to improve the nation’s health.
Here are three takeaways:
- Get everyone ‘moving in the same direction.’
When working on health inequities that impact millions of Americans, it’s important to evaluate and prioritize the needs of people. Only by measuring the success of implemented solutions can the nation move from fee-for-service to value-based care—a medical system that puts the patient first and treats them holistically.
“What we’ve seen with value-based care is that the way to make change is to get the industry on the same page—all moving in the same direction,” said Nancy-Ann DeParle, managing partner and co-founder of Consonance Capital Partners and CMS administrator from 1997-2000. “When you give that consistent message, people move.”
For value-based care, the panel discussed one challenge that must be overcome: The federal government doesn’t have a standardized process for how to measure and share data between payers. This has slowed the transition to a true value-based system.
“The federal government has to step up and create an infrastructure—we do it for fee-for-service,” said Mark McClellan, director and professor at the Duke-Margolis Institute for Health Policy at Duke University and CMS administrator from 2004-2006. “Why have different measures on whether diabetes is well-controlled? If they’re all national priorities, then we need to reduce the burden on health care providers, especially as we’re implementing these more advanced health data systems.”
A shared set of measurement standards and success indicators are critical stepping stones toward addressing health inequities in the United States, panelists agreed.
- Incorporate the social factors that impact health.
Health issues are often about more than just health. Unmet social needs—whether from inadequate finances, housing, food, transportation, and/or access to traditional public health services—can harm health outcomes. A more inclusive approach to health and well-being is vital to seeing the whole picture and treating the whole person, the panelists said.
A growing number of states are shifting their approach to care by integrating components of social needs and family well-being to enhance community health. North Carolina, for instance, launched the NC Integrated Care for Kids (NC InCK) pilot. NC InCK recognizes that community, social, and educational settings can influence the health of children and their families.
“This model is not only integrating data on health care and social services, but also educational participation and juvenile justice—data that identifies kids and families that are at high risk,” McClellan said.
“In North Carolina, they were smart enough to say, ‘We’re spending money on the juvenile justice system and education. Are we spending it effectively? Let’s create one set of measures on whether we are or not and use all of our resources toward the same goal,’ ” DeParle added. “I do think it’s possible, on the state level, to bring people together and focus in that way.”
States are often incubators for federal programs, and North Carolina InCK might offer a model of what is possible.
- Work across the aisle to get things done.
Those who advocate for the health and well-being of people say that doing so is non-partisan, and taking this approach invites the possibility of progress.
“Most of these issues are not Democrat or Republican issues. They’re non-partisan,” said Thomas Scully, general partner in the Healthcare Group and CMS administrator from 2001-2003. “Just talking about these things outside of a political context is important.”
And there is common ground, McClellan added: “Across both parties, there’s a real interest in getting costs down and showing that health care is making a difference.”
How that happens through the budget process can take time and patience. Consensus on reforms may take several years, but the former administrators say the wait is worth it if a pragmatic solution can achieve a shared goal.
“It’s a slow process. You’ve got to find some trusted folks, whether it’s at the state level or the federal level, that can help champion,” said Marilyn Tavenner, director of Select Medical and CMS administrator from 2011-2015. “You have to be willing to not always get everything you want. There has to be negotiation, some give and take.”