Major changes to U.S. health care policies will have a profound impact on patients, providers, investors and businesses in South Florida, the nation and around the world, according to experts at the conference, “The Business of Health Care Post-Election,” hosted by the University of Miami School of Business Administration March 3.
“While health care is a national issue, we need to look carefully at the global implications, such as training our medical professionals and preparing for pandemics like Ebola that could jeopardize our national security,” said Julio Frenk, M.D., president, University of Miami. In his opening conversation with Frenk, Ashish Jha, M.D., K.T. Li Professor of International Health, Harvard University, and director, Harvard Global Health Institute, Harvard T. Chan School of Public Health. “In fact, health care is the quintessential example of a ‘glo-cal’ sector where services are delivered by local hospitals, doctors and nurses who are deeply connected with global networks.”
While the new administration wants to “put America first,” Jha noted that every aspect of health care has global issues and components. “Would we be better off by shutting our borders?” he said. “The answer is a resounding no. Instead we must make investments in public health to protect the American people in an interdependent world.”
Anuj Mehrotra, dean of the School of Business, welcomed more than 850 health care executives, physicians, consultants, and students to the school’s sixth annual Business of Health Care conference, which featured two former U.S. Secretaries of Health and Human Services, Kathleen Sebelius, who served under President Obama, and Professor Donna E. Shalala, former University of Miami president and President Clinton’s HHS secretary.
“At a time of great uncertainty over federal and state health care policies, our speakers provided valuable insights on the delivery, cost and quality of patient care, access to insurance coverage, the worldwide health care labor market, and business and investment opportunities regionally, nationally, and globally,” said Steven G. Ullmann, chair and professor, Health Sector Management and Policy, and director, Center for Health Sector Management and Policy, which organized the annual conference.
The sold-out conference – presented by Florida Blue– included a networking breakfast and buffet luncheon with exhibits from conference sponsors and a post-event reception. Attendees paid close attention to the keynote speakers and panelists throughout the day, lining up to ask questions after each session. “I was very impressed by the high caliber of the speakers and panelists, as well as the well-balanced discussions of these health policy issues,” said Dawn Thomas, public health analyst for the U.S. Centers for Disease Control and Prevention (CDC).
South Florida health care consultant Mel Rothberg, CEO, Rothberg Associates Inc., also praised the speakers and topics. “Health care is a very diverse sector that includes the research and development of new therapies, drugs and medical devices,” he said. “This forum was ideal for bringing together the patient, provider and business perspectives on these challenging issues.”
The Impact on Health Care Sectors
For the first time ever, leaders of five major provider associations joined together in a panel discussion on “The Impact on Health Care Sectors,” moderated by Patrick J. Geraghty, CEO, GuideWell Mutual Holding Corporation, Florida Blue’s parent company.
Richard Pollack, president and CEO, American Hospital Association looked at the 2016 election’s implications for member hospitals, physicians and insurers, along with;; James L. Madara, M.D., EVP and CEO, American Medical Association; Marilyn Tavenner, president and CEO, America's Health Insurance Plans; Halee Fischer-Wright, M.D., president and CEO, Medical Group Management Association and Joseph Fifer, president and CEO, Healthcare Financial Management Association.
“We need to keep the positive parts of the Affordable Care Act (ACA), including the movement from fee-for-service to reimbursement for quality and patient outcomes,” said Tavenner. “However, changes to the funding model could be disruptive, particularly for patients with chronic illnesses.”
Policies Under Trump
A session on "Health Care Policies under the Trump Administration" featured Stephanie Carlton, engagement manager/expert, McKinsey & Company, and former health policy advisor to former Florida Gov. Jeb Bush; and Steven T. Parente, Minnesota Insurance Industry Chair University of Minnesota, and former health policy advisor to Sen. John McCain (R-Ariz.)
Noting that neither participant was an advisor to the Trump administration, Parente said many of the concepts of the ACA were embedded in a 1991 Republican bill. “GOP House Speaker Paul Ryan’s plan might include tax credits, guaranteed coverage for pre-existing conditions and for young adults to age 26,” he added. “However, there may be less Medicaid coverage and more people buying catastrophic insurance plans in the private market.”
In debating issues like coverage, costs and quality, Americans should ask, “What kind of health care system do we want as a country?” said Carlton. “If we had greater transparency and a well-functioning market, our system could operate much more efficiently and provide better outcomes at a lower cost for consumers.”
Impact on South Florida
The panel "Election Impact on South Florida Health Care Sectors" brought together Steven Altschuler, Sr., M.D., SVP for Health Affairs, University of Miami, and CEO, UHealth - the University of Miami Health System, moderator, with Carlos A. Migoya, president and CEO, Jackson Health System; Orlando L. Alvarez, Jr., chief strategy officer, Cleveland Clinic Florida; and N. Narendra Kini, M.D., CEO, Miami Children's Health System.
“We all have to make decisions for our institutions in a very uncertain health care environment,” Altschuler said. “But we know that the ability to compete on cost will really be critical for our systems.”
Migoya, Alvarez and Kini agreed, noting that their systems were undertaking capital improvement programs, while focusing on lowering costs and improving care. “The number one way to reduce costs is through patient population management,” Migoya said. “That will create opportunities for Jackson to share risks and revenue, while delivering coordinated care.”
Implications for Business and Investment
Tax reform, a border adjustment tax, immigration restrictions and a loosening of the Dodd Frank financial regulations have global implications for business and investment, according to Richard Clarke, former president and CEO, Healthcare Financial Management Association and current member, Board of Directors, Mercy Health Ministry.
“Capital allocations, merger and acquisition (M&A) opportunities and challenges to global supply chains are among the issues up for consideration,” said Clarke, who moderated a panel on "Election Impact on the Business of Health Care" with Karthic Jayaraman, managing director, The Carlyle Group in London; Brian Kinkead, vice chairman, Global Healthcare Group, Bank of America Merrill Lynch; and Jacques Mulder, global health sector leader, EY.
“We are seeing a move toward global diversification, such as U.S. provider companies investing in Europe,” said Jayaraman. “But only companies with differentiated products or services can cross borders successfully. We look for businesses that can be efficient providers or innovators, but what matters the most is having a leadership team that can manage in a world of global uncertainty.”
While U.S. health care businesses will continue to attract capital due to demographics, Kinkead said political risk is a growing concern for investors. “With the high level of polarization in Congress, the GOP might push a program through now, only to have the Democrats overturn it when they come back into power,” he said. “That makes it a challenge to determine where to invest at the right valuation.”
Insights from HHS Secretaries
In the closing session, "A Conversation with Secretaries of Health and Human Services," Shalala and Sebelius gave their “insider” insights on the ACA health care reform proposals now being floated in Washington. “Repeal is easy, but keep your eye focused on the replace aspect,” said Shalala. “Taking giant steps to change health policy requires certain elements, including a president who is passionate about reform, can avoid distractions, and is willing to use a great deal of political capital to get it passed.”
Shalala added that mixing coverage and cost issues is a recipe for failure. “President Johnson put more money in the budget when launching Medicaid and Medicare,” she said. “In terms of politics, that’s very different than pulling money out of the system.”
After winning election in 2008, Obama saw an opportunity to increase health coverage for millions of uninsured Americans, Sebelius said. “He had seen his mother die at a young age, while fighting with insurers about benefits,” she said. “Health care reform became a personal issue for him, even though the economists said ‘don’t do it.’ In terms of coverage, the ACA worked and 20 million more people now have coverage.”
Sebelius said she hopes the GOP-controlled Congress can come up with a plan to provide better insurance with lower costs. But shifting Medicaid funds to the states through block grants in order to reduce the federal budget would be likely to cut reimbursements for physicians and other providers, she added. “Until we see a Congressional bill, it will be difficult to assess the impact,” she said. “But Americans do share similar values about healthcare, including providing extra support for children and the most vulnerable people. I hope any reform proposal reflects those values.”