HealthCare Roundtable e-News – October 9, 2019



Trump Administration Making Final Tweaks to International Pricing Index Plan, Says Grogan, Gottlieg

According to officials, the White House is looking to move forward on releasing a plan to set Medicare Part B payments through an international pricing index. On Monday (Oct. 7), former FDA Commissioner Scott Gottlieb said delays are likely due to the administration making adjustments to the proposal. (InsideHealthPolicy). 

In response to recent inquiries about the pricing index, White House Domestic Policy Council head Joe Grogan said the administration has been slower in the review process but has been “taking its time” to make sure the plan has a solid foundation before its release. Grogan has expressed his support for the initiative in the past, noting that differences in prices between foreign and domestic drugs are “unfair to American taxpayers.” (InsideHealthPolicy). 

Last month, House Speaker Nancy Pelosi (D-Calif,) released a drug pricing negotiation plan that referenced the Trump administration’s proposed pricing index. The President had voiced his support for components of the proposal and has experienced road bumps in rallying the GOP to support drug pricing legislation.

Lawmakers, Insurers Clamor Over Arbitration Compromise in Surprise Billing Proposals

The clock is ticking for members of Congress looking to pass legislation to address surprise billing, but insurers lobbying for the inclusion of arbitration have been unwilling to consider dropping the change from consideration for the bill. At this time, the inclusion of arbitration is one of the more controversial topics around surprise billing legislation, according to officials at the Blue Cross Blue Shield Association. BCBSA officials say that arbitration “would pass costs to consumers through higher premiums, and that such a solution is untenable.” (InsideHealthPolicy). 

When asked about arbitration, BCBSA Senior Vice President at the Office of Policy and Representation Justine Handelman told reporters that “there are proposals on the table that protect consumers and take them out [of the equation]. We don’t want any surprise bills…arbitration does not stop surprise bills.” (InsideHealthPolicy). 

With both insurers and providers lobbying on different sides, there’s been a significant increase in dark money groups attacking lawmakers who don’t support arbitration. The Energy & Commerce Committee passed a bill earlier this year that would prevent arbitration unless the charges in question exceed $1,250, but BCBSA Vice President of Legislative and Regulatory Policy Kris Haltmeyer says that insurers would not support a limited form of arbitration, regardless of whether conceding leads to overall compromise. (InsideHealthPolicy).

CMMI Looking to Shift Fee-For-Service Beneficiaries to Value-Based Care by 2025

Officials at the Center for Medicare & Medicaid Innovation (CMMI) are looking to move all Medicare fee-for-service beneficiaries into alternative payment models by the year 2025, according to remarks by a senior official to the Partnership to Empower Physician-Led Care. CMMI senior adviser Sanjay Doddamani told the group last month where the sector expects to see value-based care increase, citing physicians should not have to split different methods of care between patient groups. (InsideHealthPolicy). 

Where CMS is seeing growth in Medicare Advantage, “having some levers to improve outcomes and reduce cost even in the MA environment are going to be important in terms of alignment, as well as from private payers,” said Doddamani. (InsideHealthPolicy). 

CMS Administrator Seema Verma had also recently addressed value-based arrangements, calling on insurers to act before becoming “obsolete if Medicare for All were to move forward.” Other officials from CMS have confirmed the agency is accelerating the move to value-based payments with the help of a partnership with the Health Care Payment Learning and Action Network. (InsideHealthPolicy). 

A report released last month by the Health Care Transformation Task Force noted that value-based pay accounted for more than half of provider and payer members’ business at the end of 2018. In an effort to reach the 2025 milestone, the task force will look to have 75% in value-based pay arrangements by the end of 2020. (InsideHealthPolicy). 

Trump Seeks to Boost Medicare Advantage Through Executive Order

Last week, President Trump signed an executive order to strengthen Medicare Advantage, enable HHS to establish market-driven rates on traditional Medicare, and bring payments in fee-for-service programs in-line with payments for Medicare Advantage. The administration is also seeking to expand services private plans may offer as a result of the announcement. (InsideHealthPolicy). 

At the signing ceremony in Florida, Trump addressed the improved benefits to Medicare through the order and criticized “Medicare for All,” calling out the Democratic candidates for the 2020 presidential election who have backed the approach and other forms of progressive health policies. The President asserted that Medicare for All would “totally obliterate Medicare” and cut the program to finance “socialism.” (InsideHealthPolicy). 

“Medicare is under threat like never before,” Trump said. “I will never allow these politicians to steal your health care and give it away to illegal aliens.” 

The executive order also calls on CMS to monitor and revisit pay disparities between physicians and non-physicians to ensure that practitioners are reimbursed for work performed, regardless of occupation. (InsideHealthPolicy).