|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
President Trump vows to protect Medicare from “socialist destruction”
In a fiery speech in Florida on Thursday, President Trump unveiled a new Executive Order on “Protecting and Improving Medicare for Our Nation’s Seniors,” aimed squarely at staking out his position on healthcare, which has emerged as a centerpiece of the 2020 Presidential campaign. The order was original titled “Protecting Medicare from Socialist Destruction”, and Trump’s remarks, delivered to a group of retirees, matched the tone conveyed by that line. Painting “Medicare for All” (M4A) proposals, favored by some Democratic candidates, as an existential threat to the viability of the existing program, Trump called for measures to inject market forces into Medicare, in particular looking to bolster private Medicare Advantage (MA) plans. Among other elements, the Executive Order instructs the Department of Health and Human Services (HHS) to devise new regulations to encourage MA insurers to offer supplemental benefits such as telemedicine, allow MA enrollees to share in savings generated from cost-savings initiatives, and bring innovative care models to market with fewer regulatory constraints. Notably, the order instructs HHS to propose measures to use MA-negotiated rates to set provider prices in Medicare fee-for-service, and to encourage more value-based insurance design in the Medicare program. The order also revisits site-neutral payments as a policy objective, despite a recent court decision that held that HHS’s latest attempt to move to site-neutral payments amounted to regulatory overreach. On the whole, the order reads as more of a political document than a policy proposal, largely composed of a grab-bag of existing efforts already ongoing across HHS. The President clearly intends to position himself as a defender of the Medicare program against “radical” Democratic coverage expansion ideas, a stance made possible by some Democrats’ decision to frame their universal coverage proposals as “Medicare for All” (which is inaccurate—the M4A proposals currently on the table would largely replace, not extend, the existing Medicare program). Look for more fiery healthcare rhetoric on the campaign trail in the months ahead.
Sanders pauses campaign events after cardiac procedure
On Wednesday, Bernie Sanders was rushed to a Las Vegas hospital after experiencing chest pain during a campaign event. Sanders reportedly underwent a cardiac catheterization, which found a blocked artery that was treated with two stents. As of Friday, Sanders was still in the hospital. Cardiologists on Twitter observed that a stay of this length is unusual for a routine stent placement, raising speculation of whether Sanders experienced a heart attack or had other complications. The campaign has been tight-lipped about the status of the 78-year-old candidate, not revealing details or allowing the media to interview his doctors. Given that the President and the three leading Democratic candidates are all over 70, Sanders’ procedure will surely raise questions about his fitness for office and draw additional scrutiny to the health of other candidates. It will also bear watching whether Sanders’ health scare (and likely VIP treatment) affects his healthcare campaign message and “Medicare for All” policy proposals, which are the most aggressive of the Democratic field.
Walmart building low-cost provider networks for its employees
This week Walmart announced yet another new plan to encourage its employees to get lower-cost care. It will send employees to so-called “featured providers”, primary care and specialist doctors who have been identified as providing better care, with the goal of lowering overall employee health benefit spend. Kaiser Health News reported that in return for using those physicians, employees will get a discount on out-of-pocket expenses. The retailer is partnering with startup Embold Health, founded by Dr. Daniel Stein, former Chief Medical Officer of Walmart Care Clinics, to analyze claims data to determine which doctors provide the most “appropriate, effective and cost-efficient care.” According to the company’s website, employers can tailor their networks to meet specific care and cost needs. It’s not clear what metrics the company is using to evaluate doctors, or how Embold’s proprietary algorithms prioritize cost versus quality, or whether providers are evaluated at the individual or group level to form the “bespoke” networks. To begin, the program will be limited to 60,000 Walmart employees in Northwestern Arkansas, central Florida and Dallas-Fort Worth.
Walmart also announced other initiatives this week, including a healthcare “assistant” program to help employees find a provider or understand a diagnosis, and expanded telehealth services, including behavioral health, preventive care, and chronic care management. These announcements come on the heels of the company’s launch of an expansive new clinic model to provide comprehensive primary care and other services in standalone retail locations. Given that Walmart is pursuing both internal, employee-focused and external, consumer-driven healthcare strategies, the provider networks it establishes for employees today will likely be used down the road for referrals from its clinics, and as the network for any future, low-cost insurance offering.