Our virtual winter conference on Tuesday began with an inspiring slide show of our members and government partners. They’re working to save lives and caring for those who’ve contracted COVID-19. They’re also delivering food and sewing facemasks — and investing in the health and wellness of their communities. They’re advancing new protocols, vaccines, and therapies to keep people safe. And they’re continuing to deliver essential on-going health care under uniquely stressful conditions.

 

They fill me with gratitude and awe for their courage and dedication.

 

Against that backdrop we began, Election Results 2020 – Implications on Our Health Care System. Our goal was to analyze how the 2020 election results will affect critical aspects of our health care system and how we can continue driving safety, quality, and affordability in 2021 and beyond. We focused on what the election results will mean for the ACA; the role of states versus the federal government when it comes to funding and regulating health care and insurance; what the health care system can do about inequities and systemic racism; and what regulatory changes the Biden Administration may take to support broader access to health care for everyone.

 

We were honored to have former Congressman Rob Andrews, CEO of the Health Transformation Alliance (HTA) and Quality Institute board member as our keynote speaker. Rob spent 24 years as the U.S. Representative for New Jersey’s 1st congressional district. During his tenure, Rob was one of the original authors of the Affordable Care Act. Now, as the CEO of the HTA, Rob oversees the strategic direction of 50 major corporations that have come together in an alliance to address what is broken in our health care system. HTA has grown to include 50 of our nation’s leading employers, which collectively are responsible for more than seven million employees, dependents and retirees, and an annual health care spend of $26 billion. Through Rob’s leadership, the HTA has launched value-driven solutions specifically designed to improve patient care and economic value through the use of data and analytics, pharmaceutical solutions, high quality medical networks, and robust consumer engagement initiatives.

 

Rob, candid as always, outlined the political landscape ahead and suggested that the election of Joe Biden will not necessarily lead to swift statutory change. The margins for either party in Congress will be too slim. Meanwhile, the focus of President-elect Biden will — and should — be on the COVID-19 vaccine rollout and economic relief for Americans hit hard by the pandemic.

 

President-Elect Biden ran on three ideas about improving health care: dropping Medicare eligibility age; adding a public option to the health care exchanges; and giving Medicare the power to negotiate prescription drug prices.

 

“The chances of getting those three ideas through Congress with the political situation we will have in 2021 are improbable. They’re not impossible, but they’re improbable,” Rob told our audience.

 

But Rob was clear we should not lose hope that we can improve our health care system, and he said the work of provider institutions, payers, employers and catalyzing groups like the Quality Institute will become even more important. The Biden administration can also create significant administrative changes to strengthen the ACA and support health care.

 

Here are three changes Rob said employers want to see more of:

 

• Risk-adjusted, peer-driven, data-validated bundled payment models. “We want to take into account and financially reward higher quality providers rather than only reimbursing based on how often and how many things providers do,” he said.
• Value-based purchasing for drugs. “I’m not suggesting just talking about whether a drug ‘costs too much,’ but rather we need to take into account the value of the drug to the patient,” he said. More payers are adapting value-based purchasing models and pricing strategies.
• Data and price transparency. Rob shared what we all know: transparency is popular in theory but harder to enact. Nonetheless, transparency is essential to achieve greater safety, quality and affordability. He called out The Leapfrog Group for pursuing transparency and “making good trouble.”

 

Rob also shared his view that we’ll need to deliver public health messages through trusted health care providers rather than politicians to rebuild trust in science and public health measures.

 

Following my discussion with Rob, we were honored to hear from two more experts on what we can expect for health care post-Election 2020. The first was Quality Institute board member and former New Jersey Commissioner of Health and Senior Services Heather Howard, JD. Heather serves as a lecturer at the Princeton School of Public and International Affairs and is director of the State Health and Value Strategies program, a Robert Wood Johnson Foundation-funded program that provides technical assistance to states to support efforts to transform health and health care.

 

Heather focused on what New Jersey can learn from the experiences of states that already created state-based health insurance marketplaces. She also credited the Murphy administration for moving forward with its new health insurance exchange, GetCoveredNJ, and encouraged all to consider changes that can be made on a state-based exchange to improve quality and affordability in our regulated markets. Those could include continuing to support subsidies to reduce premiums and creating a state-based public option.

 

“The theory is that you create a health insurance program that would compete and hopefully be more affordable,” Heather said. “Some of the necessary ingredients are there by having a big marketplace.”

 

We also were thankful to hear from Triste Brooks, MS, AASECT, President & CEO of Planned Parenthood of Northern, Central and Southern New Jersey, Inc., which is a member of our Leadership Council and has 17 health centers that cover 18 (of 21) counties.

 

Triste shared that she’s thankful the Murphy administration recognized Planned Parenthood for what it is: an essential service that must remain open during the pandemic. The organization never closed its doors and continues to support families through telehealth and in-office visits. The organization’s providers also recognized the mental health issues emerging in many patients during the pandemic. Unfortunately, many employees contracted the virus. Meanwhile, the challenges of providing care during the pandemic have taken an emotional toll.

 

“When we can, we actually give our employees extra hours off so they can do their shopping, spend time with their kids. … We also instituted a COVID break day. … Sometimes you need a break,” she said.

 

Triste cautioned that even though the Biden Administration will likely make regulatory changes, such as eliminating the so-called “Gag Rule,” which prevents health care providers from giving their patients comprehensive care and information, change will not happen overnight. Meanwhile, STDs are up and the need for comprehensive sexual health is greater than ever.

 

We ended our conference with music from the Lee family musicians from Montclair, New Jersey, which brought needed smiles and joy to all of us.