Health care policy expert Ezekiel J. Emanuel, M.D., will present a keynote on the future direction of the American health care system on Monday, March 29, the first day of RISE National. Dr. Emanuel, former advisor to President Joe Biden’s transition team on COVID-19, talked to RISE ahead of the virtual conference about the current health care landscape and potential changes that could improve it.
Dr. Emanuel serves as vice provost of global initiatives & Levy University professor at the Perelman School of Medicine and The Wharton School, University of Pennsylvania, and is special advisor to the director general of The World Health Organization.
During his keynote address at RISE National 2021, he’ll offer practical steps that payers and providers can take to transform the health care system to consistently provide higher-quality and lower-cost care.
In a wide-ranging interview with RISE last week, Dr. Emanuel offered thoughts on several issues confronting the industry:
Biden’s health care priorities: While a federal response to COVID-19 is the main priority of the administration, Dr. Emanuel told RISE that he expects that Biden will also address equity and ensuring better outcomes among minority and lower income populations during his term. The administration, he says, will likely take on social determinants of health, such as food insecurity and access to mental health services, as well as end-of-life care.
Medicare Trust Fund insolvency and potential savings: But lawmakers, he says, will also need to address another problem: the impending insolvency of the Medicare Part A Trust Fund, which pays for hospital and other inpatient care. Analysts project that the fund will go bankrupt in the next four to six years and there will be no money left to cover the entire cost of beneficiaries’ health care. Since lawmakers are typically reluctant to raise taxes, Dr. Emanuel says they will likely focus on how to make cuts. One potential savings they may explore, he says, is revising the Medicare Advantage bidding process and moving away from the benchmark to a more competitive bidding model.
Primary care, capitation: Dr. Emanuel also advocates for a greater investment in primary care and shifting to a capitation model in which insurers pay providers a fixed fee per patient they care for, rather than services rendered, with adjustments for quality provided and how sick patients are. Payers must also give providers better, real-time data on utilization, expenses, and where they can save money without compromising quality.
Digital innovation: Real-time data will also be needed to prepare for another pandemic, he says. The current information plans offer aren’t good because they rely on claims that have a three-month run out for monitoring problems. “Honestly, if you want to work with providers you need to get them regular information and help them manage better,” he said. “You need real-time information and the only way to get it is to have much more point-of-care completion of billing and service provision information like they have in other countries.”
He pointed to the success Taiwan had in managing the COVID-19 pandemic due to its innovative digital health infrastructure. In an opinion piece published last spring in STAT, Dr. Emanuel and colleagues noted that every person in Taiwan has a health card with a unique identification number that all providers can use to access online medical records and document care for reimbursement from the Ministry of Health. This information allows the ministry to obtain real-time data on physician and hospital visits and the use of specific services. As a result, the country was able to integrate the health care database with information from immigration and customs to alert physicians about patients that may be at higher risk for COVID-19 based on their travel history, they wrote. They also used the data to identify patients for testing when supplies were limited.
“Every physician interaction with a patient was known that day or the next day. There is not a single plan in this country that can do that,” he says.
RISE National, a virtual live-streamed conference, will include preconference workshops on March 26 and the main conference March 29-30. Dr. Emanuel will discuss the future direction of American health care during his keynote presentation at 10:20 a.m. Monday, March 29. Click here for the full agenda, list of speakers, and registration information.