Premier outlines healthcare wish list for Trump administration

The Premier healthcare collaborative is welcoming the Trump administration with a list to further build on reforms fostered under the Affordable Care Act, while reducing risks under ACA and eliminating cumbersome and antiquated regulations.

Premier is an alliance of nearly 3,800 hospitals and 130,000 other provider organizations collaborating on policy issues and other initiatives. Premier also offers a range of services to members such has data analytics, supply chain management and consulting.

Topping the organization's wish list is the 21st Century Cures Act, which Premier is pushing enactment by the end of the current session on December 9, says Blair Childs, senior vice president of public affairs. The act is intended to harmonize standards to speed electronic health records interoperability, prohibit data blocking, and use data to advanced better treatment and cures.

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Premier also is pushing for open application programming interfaces (APIs) to make it easier and far less expensive for providers to exchange data.

The organization also expects the Affordable Care Act to get a complete review by the new administration, but not replace the law, Childs adds. “A lot will be tweaked and modified; it will take the better part of a year.”

Public policy changes that Premier recommends include:

• Accountable Care Organizations (ACOs): Refine the Medicare Shared Savings Program (MSSP) to ensure the continued success of ACOs. Reforms like permanent payment waivers, additional shared savings for top performers, relief from sequestration and more flexibility to move up the risk continuum for Medicare ACOs are urgently needed.

• Legal and regulatory barriers to integrated care: Remove the legal and regulatory barriers that thwart providers’ efforts to achieve better care for individuals, better population health and lower healthcare costs by amending fraud and abuse laws and policies such as the site of service regulations. Broad exceptions to the anti-kickback, civil monetary penalties and Stark physician self-referral laws are needed to protect ACOs, regardless of whether those ACOs participate in Medicare ACO programs.

• Data access: Paramount to success, data access should move closer to real-time access of not only Medicare, but timely Medicaid, Veteran’s Administration and Department of Defense data used for healthcare operations, research and commercial purposes that improve care while protecting beneficiaries’ privacy.

• Layered payment model demonstration: As an additional choice for providers participating in alternative payment models, implement a new blended payment model pilot to test primary care capitation coupled with bundled payments within Medicare ACOs.

• Interoperable health information technology: Through use of standards and application programming interfaces, electronic health record (EHR) systems must move from being closed, inaccessible information silos to open, interoperable medical records on which applications may be written, easing the reliable exchange of information among care providers and patients.

• Consolidation of hospital pay for performance programs: Pay-for-performance programs should hold providers accountable on areas within their control without creating duplicative penalties. A single, consolidated hospital pay-for-performance program is needed to replace the five separate, contradictory programs currently instated.

• Critical access hospital value‐based purchasing program: Rural areas must not be left behind, but brought into delivery system reform through tailored programs that work in low-population density areas. A pilot program testing and scaling value-based purchasing incentives with critical access hospitals needs to be created to encourage participation from such institutions that are currently exempt from similar programs.

• Beneficiary engagement: Beneficiary engagement techniques should be embedded in all aspects of each program, such as measurement, transparency efforts, benefit design and payment. New beneficiary engagement tools such as co-pay waivers, transportation vouchers and in-home technologies should be allowable and encouraged.

• Provider-based outpatient clinics: Site-neutral payment policies need to broadly consider how the use of provider-based clinics may help support an overall reduction in healthcare spending and improve the coordination and quality of care to patients. In particular, ACOs that own or operate provider-based clinics to coordinate care across the continuum and manage population health should be exempt from site-neutral payment.