Modernizing Medicare and Medicaid: A Conversation with CMS Administrator Seema Verma / HealthChoice

00:00

[Music] i'm ruth katz co-director of aspen ideas health and executive director of the health management society program here at the aspen institute i'm delighted to welcome you to another aspen ideas health 2020 virtual event while the kovic pandemic has prevented us from gathering in person we are delighted to be able to continue to host informative and inspiring

00:42

conversations with leading health practitioners advocates artists scientists innovators and policy makers and we couldn't be more excited about today's program a conversation with sema verma administrator of the centers for medicare and medicaid known as cms an agency within the department of health and human services as cms administrator seema verma oversees a one trillion dollar budget representing 25 percent of the total federal budget

01:12

administers health coverage programs for more than 140 americans and oversees the quality and safety of all hospitals participating in medicare a huge portfolio indeed sema will be in conversation with alan weil editor-in-chief of health affairs a leading american health policy journal previously allen was executive director of the national academy for state health policy and held a cabinet position as executive director of the colorado department of healthcare

01:42

policy and financing the state's medicaid agency allen's a good friend of the aspen institute he also serves as director of the aspen health strategy group co-chaired by former hhs secretaries kathleen sebelius and tommy thompson with that thank you both for taking time from your incredibly busy schedules to join us for what undoubtedly will be a very interesting discussion and of course thanks again to all of you in the audience for joining us today we look forward to seeing you soon for

02:12

our next aspen ideas health event with that alan the aspen stage is all yours thank you again both thank you ruth seema it's great to have a chance to talk with you uh we don't have a lot of time so i'm gonna jump right in uh more than 60 million americans rely on the medicare program i'm curious what you view as the biggest challenges confronting that program and what you've done during your tenure to try to address those well thanks for having me today alan it's great to be with you

02:44

so when it comes to medicare i think we've been delivering on the promise that the president make to always protect the medicare program but if we look at not just the medicare program but the medicaid program and really health insurance for americans and and the uninsured the big issue that we face in our country is the cost of health care you know we have one of the best health care systems in the entire world obviously that's evidence with the great progress that our providers have made around covid treatments but the issue in our health care system

03:15

is around affordability and so when i look at medicare and medicaid what we're trying to do across the board is make health care more affordable because when it's more affordable then it's accessible to every single american in the country and that's important for the sustainability of the medicare program of medicaid and all of the programs that we have if we can make health care more affordable then you know we assure that these programs are sustainable over the long term and that we are delivering high quality

03:45

care you know seniors have paid into this program their entire lives and they deserve high quality care from our perspective we've been working on a range of policies that are focused on lowering the cost of health care that's why you hear us talk about drug pricing that's why you hear us talk about price transparency interoperability we're trying to solve problems across the health care system that will not only help medicare but that will also have an outsized impact on the entire health care system in medicare in particular i think our policies have worked

04:16

we're just about to start open enrollment and we've had great news with president trump's tenure we've actually seen premiums go down on average of 34 percent in some areas of the country i was just looking at the data this morning north carolina 44 michigan over 50 percent so seniors are actually seeing their premiums decline very significantly and the same thing that we're seeing in the part d program where premiums have gone down 12 percent we're offering a new insulin program where seniors can get

04:47

their insulin for 35 dollars a month what's also interesting here is while we have dropped premiums we've actually increased the number of choices that seniors have they have more choices of plans and we're actually adding more benefits we've given more flexibility to our health plans across the medicare advantage program and they're offering things like home care transportation meal services things that are going to keep seniors independent and keep them healthy so the president's policies i think in medicare

05:19

are working and then we've done a lot to lower out-of-pocket expenses for our seniors we've also just made some changes to make the medicare program work better for our seniors we have an initiative called e-medicare which is a lot of online tools price transparency tools updating the plan finder so it just makes it easier for our seniors to compare between the traditional program and medicare advantage they can look at the quality of the providers they see we've updated all of our quality compare

05:50

websites so it's just easier for our patients and our beneficiaries to make decisions about their health care so there's a broad consensus i think that affordability is a key challenge for americans under the affordable care act medicare started a number of experiments designed to improve value to to put incentives for providers to deliver high quality care at a lower cost and to keep some of those savings if they were successful trump the trump administration has been very

06:20

uh has continued this tradition of experimentation i just wonder if you could talk about your sense of what's working and not working at the at the experimentation level well i think that there's been broad consensus around the concept of value-based care and what that means is that instead of paying doctors for every service that they do what we call a fee for service system to pay for pay doctors and providers based on what they achieve the outcomes that they produce the quality metrics that they

06:52

achieve and actually setting some benchmarks or financial targets for them and that's been sort of the premise of value-based care i think that's that's enjoyed bipartisan support what we've done at the agency is fix a lot of the programs that were geared towards value-based care fortunately many of them were not working and we saw that taxpayers were losing money wasn't a great return on investment and so we've structured restructured a lot of those programs to provide more skin in the game for

07:22

providers and we're seeing great results there as well you know our aco program which is a value-based program for hospitals has produced over a billion dollars in savings uh in just the past year so we've had to restructure some of those programs but i think that trying to move to a different system where we're paying providers based on what they achieve the outcomes that they achieve and then as part of that we've also tried to push a lot of other reforms that are going to put patients back in the driver's seat of their health care

07:53

we're trying to push on price transparency for example and that goes alongside with value-based care you know if patients have more information about price transparency and quality transparency they're going to pick providers that are delivering better care and lower costs and we want to create a competitive atmosphere where providers are competing for patients on the basis of cost and quality so as we learn i think we would expect all these programs to evolve i do wonder you you gave the impression

08:25

that there are things that were failing and costing a lot of money and i wondered what it is you've sort of dispensed with that you would have put in that category sure well i think one of the best examples of that is the aco program um you know we were giving a lot of flexibility to providers waiving a lot of the medicaid regulations and rules and yet what we were seeing is that providers were taking advantage of those flexibilities but a lot of them weren't saving any money and they were actually costing the money more costing the whole system more money and so we changed a lot of those rules

08:56

we required providers that were participating in the program to take on risk to have some skin in the game and i think that's made all of the difference we actually see now that they are delivering better outcomes higher quality and lower cost for patients let's turn to uh an important change you made quite recently in the wake of uh kovid which was expanding the availability of payment for telehealth my question to you is do you think this is a permanent shift

09:26

the growth that we've seen in telehealth and if so what are you doing in your seat to try to make it permanent or is this just something that will pass as people's willingness to go to a physician's office returns let me be very clear as and and i think the president's been clear on this issue we think that telehealth is very important um it's a tool in the toolbox for our providers and that this is something that should continue when we look at our health care system given where we are in terms of high costs issues with

09:57

accessibility we want to do everything we can to improve the health care system and telehealth really offers and addresses several health care problems that we're having so for example accessibility i mean sometimes it's just hard to get to the doctor you need health care services in covit in particular it was a lifeline for many of our patients they could receive care safely in their homes and it was better for providers too because it allowed them to save personal protective equipment and they were still able to provide

10:27

health care services effectively now it's not going to replace inpatient or in-person care but i think what it can do is it can solve a few problems and let me go through those number one for mental health services we know often that there's a lot of stigma associated with mental health services and in our country there's been a growing demand and need for these types of services and so even though we've seen a lot of in-person services return we're still seeing high rates of telehealth use for mental health services also across the country in rural areas

10:58

in particular but even in some urban areas we know that there's difficulty accessing certain specialists and sub-specialists by allowing for telehealth we can actually increase access to higher quality healthcare services if you're able to connect with the specialists i think that can also save our money our money for the whole health care system down the line if we're able to provide timely care to patients i also think that there's just a convenience factor for patients it's just easier for them to get health care services they're

11:29

going to take better health care or better care of themselves if it's just easier to get services the other thing that we hear from providers is that you know again it doesn't replace inpatient or in-person services but it also gives them a view into the patient's environment i was talking to a pediatrician that treats special needs children and he said you know i was able to see the patient in their home their environment i was able to touch base with a lot of their caregivers that i would not necessarily see during a visit so i

12:00

think there's there's definitely a role for it and why wouldn't we want to do everything we can to make health care more accessible and affordable for for americans across the country so those are great reasons to be in support of telehealth traditionally payers have been nervous and we've published some of the research on this that that remote visits can actually add costs that people instead of uh not going to the doctor for something mild will say well it's easy to pick up the phone or easy to get on a video chat

12:31

or they'll start an interaction uh telephonically or uh or over a video and it'll lead to an in-office visit so there will be two visits where there would have been one so how do we overcome the concerns that this is actually going to drive up cost it may be convenient it may be great care but payers you started by saying we're concerned about cost how do we assure that that's not a barrier that gets in the way of sustaining these efforts well first of all this is why i think the transition to value-based care where you're paying doctors for outcomes and

13:02

you're not necessarily paying them for each and every services that they provide but you're paying them in a lump sum i think that also addresses the issue you know with any service that we provide in the medicare program we always to be worried about fraud and abuse and over utilization so we're going to be looking at how we pay and reimburse for telehealth taking those things into consideration i think those are are certainly important issues um and i would say they're valid issues but i think those are things that we can try to address those are things that we can

13:33

overcome it shouldn't be a reason to not offer telehealth services let me turn to the other major program under your leadership which is medicaid i know from your work uh before you came to this position you've been a long-standing supporter of work requirements for medicaid recipients we've published a number of pieces in health affairs that suggest people don't always understand the requirements may not be aware that they exist and recently

14:03

it didn't seem to show any effect on the level of work and of course the economy is going through this major shift now with particularly low wage workers under uh pressure and and higher unemployment rates just wonder if you're thinking about work requirements and the role they play in the future of medicaid has changed at all in this environment or or what it is you're looking for moving forward sure alan i'm not sure you you characterized my views on this well first of all let me start at a

14:33

uh uh start at a high level with the medicaid program i mean this is this is a a program which is a lifeline for for many people um some of our most vulnerable population are working poor pregnant women children individuals living with disabilities this program is also one of the number one budget items for states and you know for the people that rely on this program it's important that we deliver high quality care that's accessible so

15:04

let me start with that what we have seen in the data is that medicaid quality hasn't necessarily hasn't always produced that there's many great examples of what the medicaid program has done that being said there's a lot of questions about the quality that it produces from my standpoint it's time for change changes in the way we deal with the medicaid program and part of that is empowering states i think that states are on the front lines they're running this program they're closer to the people that we

15:34

serve and decisions shouldn't be made in washington d.c they're funding this program significantly and yet the federal government holds all the cards is making all the decisions about this very very important program and as you know every state is different every delivery system is different um the people that are being served by the medicaid program may look different in every state so it's important that they're empowered to make decisions about their programs when it comes to work requirements or community engagement i'm supportive of states making

16:05

decisions about their programs about deciding what's going to work best in their state so we had a lot of states come to us you know really over 20 states a lot of interest in this program to be very clear this program was not geared at the traditional medicaid program it was aimed at sort of what we call uh working non-disabled individuals people that are not dealing with acute health care issues or substance abuse uh people that um you know folks felt were able to contribute to the community in some way whether it

16:37

was volunteer work or going to school what i heard from governors across the country is that they wanted to do more than just hand out insurance cards they wanted to help people rise out of poverty help them be independent nobody wants to be dependent on a government program to be on the medicaid program they need help they need help with their health care and what we also saw in the data is that people that are engaged in work have better health care outcomes we've known that for many years

17:08

and so as we talk about the social determinants of health you know just giving somebody a medicaid card isn't going to solve their problems and many states wanted to experiment with community engagement requirements and this required individuals you know to have some sort of minimum requirement about engaging in either looking for a job volunteering or you know participating in some type of educational program so at the end of the day our country has struggled with poverty for so many years despite all of these

17:40

programs and so i support innovative efforts by governors that are trying to help people trying to lift them out of poverty um and find a path forward okay we pitch this as an opportunity for the audience to ask questions and we don't have much time but i do want to get a couple of those in before i know you have to go one of the questions that's coming from the audience is the note that preventive care has really dropped during the pandemic and that's quite uh concerning given the potential long-term benefits of

18:13

prevention yes so the question is how do you in your role think about a response to this so that we don't suffer terrible health effects down the road due to people not getting needed care well i think you're absolutely right we have seen preventative services drop off not only for our medicare population but even for kids this is something that you know i think could give rise to a second public health crisis if if communities across the country

18:43

don't start addressing this you know in children in particular we've seen that vaccinations have dropped off health care screenings that are routinely provided in schools vision screenings hearing screenings are just not getting done and you know when it comes to kids i think this is really important i you know have my own personal experience where my son went through a routine vision screening when he was just four years old and they detected an abnormality and we were able to treat it but had it gone undetected he would have lost vision

19:14

permanently in his eye in that particular eye so you know i can't stress enough how important it is that you know we're not only dealing with the immediate issues around covid and trying to reduce transmission and keep people safe but we have to find a path forward to make sure that people are getting those preventative services in the medicare program we're starting to see a little bit of an increase and rates are starting to get back to where they were before but we know that millions of americans are afraid to get health care services

19:44

um and we're concerned because we're hearing from let's say oncologists that are saying we're seeing people show up with very advanced cancer because they were afraid to come in and i think healthcare providers across the country are taking precautions they have plans in place to make sure that when patients come in that they're safe the doctors are safe and the patients are safe and so really i think this is just a call to action for communities across the country to come up with plans to ensure that children are getting the needed services that they're getting

20:14

and really every american is not forgoing essential preventative healthcare services okay last question before you have to go your the programs you oversee uh reach the most vulnerable americans uh were anticipating at some point a vaccine for covid what are you doing to prepare to make sure that the most vulnerable are the ones at the front of the line as the vaccine rolls out well we've already seen some of the recommendations from the advisory committees in the cdc that

20:46

obviously we're going to be prioritizing those that are most at risk and what comes top of mind for me is our nursing home residents they've been hit particularly hard by this and our seniors just in general one of the things that we're doing at cms is that we want to make sure that people across the country have convenient places to go that our providers across the country are ready to provide these immunizations that we're providing the appropriate reimbursement for administering these vaccines and also just getting out

21:17

the word you know there's a lot of fear around vaccines um i think we've been very clear that you know any vaccine that comes out is has to be safe and effective and there's not going to be any shortcuts you know unfortunately there's just been you know a lot of people trying to suggest that this vaccine isn't going to be safe and unfortunately i think that could have an impact on people's willingness to take the vaccine but you know rest assured there are no shortcuts when it comes to safety and efficacy for the american people

21:47

around these vaccines well thank you for taking time out of what i know is an incredibly busy schedule to answer some of our questions and some of the audience's questions wish you the best of luck in uh the important responsibilities that you have and once again uh to the audience thank you for watching sema a pleasure to talk to you and uh that's it for today thank you alan [Music]

Modernizing Medicare and Medicaid: A Conversation with CMS Administrator Seema Verma

Table of Contents

More in Lectorium

SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE