Wouldn’t it be nice if, in pursuing [value-based transformation], we had a set of partners that had a track record of delivering quality care at a significantly lower cost? Wouldn’t it be nice if we had partners who had taken the lead in using electronic health records—achieving almost universal adoption? Wouldn’t it be great to learn from providers who excel at coordinating and integrating different levels of care? The good news is that, as you can probably tell, we do have such a set of partners. It’s all of you—America’s community health centers.
As Prepared for Delivery
Thank you for that introduction, Grace [Wang]. It’s a pleasure to be here with you today.
I want to thank all of you for joining us here, and to extend my gratitude to NACHC’s members for inviting me.
I’m excited to be here because the work of community health centers is vital to the lives of millions of Americans, and you all deserve recognition and praise for that.
This is not my first tour of duty at HHS, as Grace mentioned. I worked at the department from 2001 to 2007, and during that time, we were proud to see huge growth in the work done by community health centers.
From 2001 to 2006, the number of patients served by health centers increased from 10.3 million Americans to 15 million. That number has continued to grow since, reaching 25.9 million patients in 2016—a 151% increase from 2001.
The way health centers have grown and advanced their work is well-timed with some particular priorities of this administration and HHS under President Trump.
One of these priorities is transforming our health system into one that pays for health and outcomes rather than procedures and sickness.
The concept of transforming our system to pay for value was another priority during my previous tenure at HHS. It was a top priority for Secretary Mike Leavitt, and it was taken seriously by President Obama’s administration as well.
It has been, at times, a frustrating process—many models we’ve tried have not produced the results we hoped for. But there is no turning back to an unsustainable system that pays for procedures rather than value.
In fact, the only option is to charge forward — for HHS to take more aggressive action, and for providers, payers, and patients to join with us.
This administration, and this President, are not interested in incremental steps. We want to lay down bold new rules of the road, build a system that provides better value to patients, and make real progress on this journey over the next several years.
So today, I want to lay out four particular areas of emphasis that will be vital to accelerating value-based transformation and putting patients truly in charge of their care—each of them relevant in certain ways to the work of health centers.
The four areas of emphasis are the following: first, giving patients greater control over health data through interoperable and accessible health information technology; second, encouraging transparency from providers and payers; third, using experimental models in Medicare and Medicaid to drive value and quality throughout the entire system; and fourth, removing government burdens that impede this transformation.
The shift from paying for procedures to paying for value will not be easy for many involved.
Putting the patient in charge, letting them determine value, is a radical reorientation from the way that American healthcare has worked for the past century.
So in this transition, we’re going to look for models, and for partners.
Wouldn’t it be nice if, in pursuing these objectives, we had a set of partners that had a track record of delivering quality care at a significantly lower cost?
Wouldn’t it be nice if we had partners who had taken the lead in using electronic health records—achieving almost universal adoption?
Wouldn’t it be great to learn from providers who excel at coordinating and integrating different levels of care?
The good news is that, as you can probably tell, we do have such a set of partners.
It’s all of you—America’s community health centers.
We see you not just as vital partners in our movement toward a health system that delivers quality, affordable care for all Americans—we see you as pioneers in this value effort already.
In laying out our areas of emphasis for this value-based transformation, I want to start with information technology, because we’ve taken a real step forward on it just recently.
Since I was discussing this issue around Secretary Leavitt’s conference room table—and believe me, we spent a lot of time doing that—we’ve seen substantial advances in adoption of electronic health records by providers—including, as I mentioned, health centers.
But all too often, this simply meant putting in electric form what had been on paper, at significant expense and burden to the provider.
Useful, but hardly realizing the full promise of health IT—especially when we still have a long way to go toward interoperability of these records.
But most importantly, this shift almost entirely left the patient out of the picture.
It’s not just that the benefits of health IT haven’t always been apparent to patients — it’s that unless we put this information and technology in the hands of patients themselves, the real benefits will never arrive.
We’re not interested in micromanaging how the goals of interoperability and patient usability are achieved. We are much more interested in setting out simple goals: Patients ought to have control of their records in a useful format, period. When they arrive at a new provider, they should have a way of bringing their records, period. That’s interoperability—the what, not the how.
We’re going to have government lead by example. Last week, CMS and the White House Office of American Innovation announced a new government-wide initiative, MyHealthEData, to empower the private sector to put data in patients’ hands.
One initial step was updating Medicare’s system for giving claims data to patients, Blue Button, by announcing that beneficiaries will now be able to connect their data to apps developed by private companies. More than 100 companies, including real leaders in the tech world, are already signed up to be involved. Previously, Blue Button just provided a PDF or Excel spreadsheet of a beneficiary’s claims data, and not much else.
We truly believe these measures can improve quality and drive value.
Better access to patient data has the potential to improve care coordination and follow-ups, for instance—we are excited to see how medical homes can use apps to empower and inform patients and improve outcomes.
The second key piece of the journey to value-based care I want to mention is transparency about both quality and cost.
Community health centers, here, too, have been a model. The Uniform Data System offers a level of detail about populations and outcomes that few other providers offer.
In a little while, you’ll hear from our HRSA Administrator, George Sigounas, who will discuss HRSA’s recent awards for National Quality Leaders and Health Center Quality Leaders.
Awardees should be proud of their work, but so should all health centers: Special recognition would not be possible if health centers in general were not eager to share data on the quality of their care.
HRSA is always looking at ways to advance the use of data about health center performance, both reducing the burden of collecting it and increasing the value we derive from it. You are working with us to experiment with health center controlled networks, for instance, where groups of health centers can work together to bring down the cost of health IT while increasing its usefulness.
Quality data can also identify new opportunities for sharing of best practices among centers, too, something many of you take the opportunity to do here at NACHC’s Policy & Issues forum.
So transparency about quality is one area where health centers are leading. But when it comes to transparency about pricing, health centers do better than most as well.
I’m not sure if you’ve ever tried this, but if you try calling up a major physician group to ask how much a self-pay patient might owe for a typical physical, I have two words for you: Good luck.
The information does not come easy.
Walk into or call up a community health center—and I’m sure many of you are aware of this—and ask the same question.
The answer is often one word: the price—plus, of course, the assurance that what you actually owe will be based on income.
This level of transparency is essential to have across our entire system. When it comes to bigger medical procedures, just about all Americans are looking at significant financial decisions—and yet information about these big decisions can be incredibly hard to come by.
Let me give you an example of just how hard it can be. A few years ago, my doctor wanted me to do a routine echocardio stress test. I figured this could occur within the scope of his practice, which was connected to a major medical center.
Instead, I was sent a few floors down, where I was told to start handing over all sorts of information to a receptionist. Soon enough, I’ve got a plastic wristband slapped on me, and, to my surprise, what I thought would be a simple test in the room next door had resulted in my being admitted to the hospital.
Now, I had a high-deductible plan, so I would be paying for this test out of pocket.
As someone who works in healthcare, I knew that the sticker price on the test had just jumped dramatically by my receiving it within a hospital — something that might never occur to most healthcare consumers.
So I asked how much the test was going to cost, and was told that information wasn’t available. Fortunately, I didn’t just fall off the turnip truck, so I persisted, and, eventually the manager of the clinic appeared and gave me the answer. The list price was $5,500.
I knew that wasn’t the right answer either—what I needed to know was my insurer’s negotiated rate.
That information didn’t come easily either, but eventually, I was told it would be $3,500.
I happened to know of a website where you could search typical prices for such procedures, so I looked up what it would have been if I’d received it outside of the hospital, in a doctor’s office. The answer was $550.
Now, there I was, the former Deputy Secretary of Health and Human Services, and that is the kind of effort it took to find out how much I would owe for a procedure. What if I’d been a busy parent who’d never worked in healthcare, who just trusted the system? Or a twenty-something with a high deductible plan?
This is simply wrong—it cannot continue when healthcare costs are a real burden for so many Americans.
The price-transparency problem is not limited to payers or providers. The same applies for prescription drugs: In both healthcare services and pharmaceuticals, the huge gaps between the list price and the actual price are notorious. We’re committed to greater transparency about prices, and ensuring, to the extent possible, that discounts reach the patient rather than being captured by middlemen.
One example of transparency and fairness in drug pricing we’ve already pursued was our reform to how Medicare Part B pays for certain drugs under the 340B drug-discount program. The program was intended to offer affordable medicines to providers focused on low-income Americans, but has now expanded far beyond the original set of providers identified.
We know 340B is an immensely valuable tool for community health centers, which by definition serve patients in need of these discounts. We are committed to ensuring the benefits of this program flow to its intended recipients—and that means the patients you serve.
The final two areas of emphasis I want to mention are using Medicare and Medicaid to drive value-based transformation across the whole health system, and examining government burdens that may be impeding this transformation.
Federal spending on Medicare and Medicaid amounted to just over $1 trillion in 2016 — one third of America’s total health spending. If we’re serious about transforming our health system toward paying for value, Medicare and Medicaid will play a key role. Providers and payers can innovate on their own, but in many cases, only Medicare and Medicaid have the heft, the market concentration, to be first movers.
We already have a range of tools for using these programs to pay for value, many created by 2015’s MACRA legislation. The Center for Medicare and Medicaid Innovation, alongside these tools, vests HHS with tremendous power to experiment with new payment models.
As you may know, we issued a request for information this past fall regarding the Center, and received feedback from NACHC, other health center groups, and many other stakeholders.
We are taking that feedback seriously—and we are always looking for feedback on other fronts, too, especially regarding HHS rules or other government burdens that may be impeding coordination or delivery of quality care.
Telehealth is one area where health centers have taken the lead, and where we aim to keep payment policies up to date with the innovations we’re seeing.
Community health centers have also been pioneers in care coordination through medical homes, and we are eager to work with you to consider new models that may advance such coordination and deliver value.
Before I conclude, I want to touch on one of our other key priorities at HHS: America’s opioid crisis.
This epidemic of addiction and overdose has reached every corner of America, and the challenge is of immense scale. We saw 63,000 drug overdoses in 2016, and we may see as many as half a million more over the next decade.
This crisis has especially hit under-resourced urban and rural communities, where providers of any kind, let alone behavioral health and addiction specialists, can be thin on the ground.
So I’d put a similar question to you as I did earlier: Wouldn’t it be nice if we had a set of thousands of partners with a long record of providing quality care in both urban and rural communities?
Wouldn’t it be great to have a set of partners who are leading on efforts to integrate physical and behavioral healthcare?
Again, the good news is we have those partners—it’s all of you in this room today.
Health centers have rapidly adapted to the challenge of opioid addiction, becoming hubs for connecting patients to treatment and wraparound recovery services.
This administration has been a strong supporter of that work. In the President’s 2019 Budget, we proposed $400 million in new funding for community health centers to provide substance abuse treatment, in addition to $150 million in funding specifically for underserved rural areas.
The opioid crisis has reminded us that, for all the incredible advances we have seen in healthcare quality, we remain inadequate to many health challenges.
We have a long way to go in building a healthcare system where care is integrated and outcomes justify the costs.
So I want to end by laying out why I’m so optimistic that we can make real progress toward that goal under this administration.
First, the time has simply come — as American healthcare costs continue to skyrocket, the current system simply cannot last.
But it is also because this administration is not afraid of disruption in the way many political actors are.
President Trump is a man of courage and vision. He has seen and heard how the high cost of healthcare is burdening working-class Americans, and he has given us a mandate to do something about it.
So I am determined that we will look back at the years of this administration as an inflection point in the journey toward a patient-centered, value-based system. We are not afraid of the fact that that system might look a great deal different than the one we have today.
Last week, I shared a message with two other major groups of healthcare stakeholders, hospitals and insurers: We want you to join us on this journey toward value-based care.
Health centers have already been a key piece of that journey, and I believe that will continue.
Community health centers as we know them today began over a half-century ago in two very different places: the Delta Health Center in Mount Bayou, Mississippi, and Columbia Point Health Center, not far from the harbor in Boston, Massachusetts.
Those two centers are the forebears of the places where you work today, at thousands of delivery sites across America, using the latest technology to address our newest public health challenges.
I have no doubt you are prepared to adapt to a changing health system, and to continue as innovators and pioneers.
So thank you all for listening today, and for your ongoing engagement with HHS.
Together, we have exciting years ahead of us, years that will finally deliver a healthcare system that delivers quality care and real value to every American, no matter their circumstances.
Thank you very much.