Price not committed to value-based programs, questionnaire answers show

Rep. Tim Price may have said that he would back value-based payment models if confirmed as Secretary of Health and Human Service, but judging by his written answers to the Senate's questionnaire, his support may be more lukewarm than thought.

The Senate Finance Committee released the more than 130-page questionnaire on Monday, and while Price was vague on several issues, the Congressman did share some of his integral views on things like payment innovation, Medicaid administration and the states' role in crafting healthcare policy.

Here are a few of his answers. Price gets his vote in the Senate Finance Committee at 10 a.m. Tuesday.

On value-based programs, CMMI and MACRA:

Question: Do you agree that the traditional fee-for-service payment system -- in which providers are paid based on volume instead of value -- creates incentives for overutilization of health care services?

Answer: Our healthcare system is complex, and we cannot attribute overutilization trends to a single cause. For instance, efforts to curb overutilization in emergency rooms have been unsuccessful. Overutilization is a complex issue that needs to be carefully addressed.

Question: Do you also agree that the successful implementation of the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) will require the continued development of value-based payment models?

Answer: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is built on the principle of encouraging providers to develop Alternative Payment Models (APMs) that can ultimately be adopted by CMS and commercial payers.

Question: Will you commit to supporting the continued development of value-based payment models in Medicare and increasing the percentage of provider payments made through those models?

Answer: We share the goal of improving Medicare by empowering providers to be creative and develop payment models that best suit the unique needs of their patients to ultimately improve patient care.

On Medicaid:

Question: Congressman Price, given that this is an issue you seem particularly concerned about, will you commit to ensuring successful enforcement of the Medicaid Equal Access rule, the Medicaid managed care rule, and other federal standards that help ensure states set appropriate payment rates as required under the Medicaid statute's equal access provision?

Answer: If confirmed as Secretary, I will faithfully implement laws written by Congress and the regulations issued by the Department. This includes enforcement action as appropriate. As a doctor who has actually treated thousands of Medicaid patients, I do care deeply about the Medicaid program and the access of Medicaid patients to actual care, not just a card they can carry with them.

On Medicare balance billing:

Question: Will you commit to the more than 55 million Americans who rely on Medicare that, if confirmed as HHS Secretary, you will advise the President to veto any legislation that would undermine these decades-old protections and allow providers participating in Medicare to balance bill seniors and other Medicare beneficiaries?

Answer: In considering Medicare, it is important to appreciate that the bipartisan Medicare Trustees have told everyone that Medicare, in less than 10 years, is going to be out of the kind of resources that will allow us as a society to keep the promise to beneficiaries of the Medicare program. My goal, if confirmed, is to work with Congress to make certain that we save and strengthen Medicare. It is irresponsible for us to do anything else. If I am confirmed, my role will be one of carrying out the laws Congress passes and as to that I would convey to the Medicare population that we look forward to assisting them in getting the care they need.

On Medicare costs:

Question: Do you believe low- and middle-income seniors can afford to pay more for Medicare services than they currently do?

Answer: In previous legislation, I have proposed giving our seniors more flexibility within the Medicare Program and providing the opportunity to make decisions with their physicians without interference from Washington. The measure would help ensure that Medicare beneficiaries maintain adequate access to health care professionals by increasing the number of physicians who will accept Medicare patients and addressing physician shortages by attracting new professionals to the field of medicine. In addition, the bill provides safeguards to Medicare beneficiaries. More importantly, it would allow a provider to see a Medicare patient pro-bono or charge minimal cost (below the standard fee schedule) without prosecution.

On mental health care and Medicaid:

Question: How do you plan to work with states to expand Medicaid coverage to these individuals?

Answer: Every state has different demographic, budgetary, and policy concerns that shape their approach to Medicaid and Medicaid expansion. That is one of the reasons I devoted so much time working to help identify creative solutions, and why I believe a one-size-fits-all approach is not workable for a country as diverse as the United States. If I am confirmed, I will work with CMS and SAMHSA to help the population of uninsured low-income adults with mental health and substance use disorders.

On preventative care:

Question: As HHS Secretary, how will you guarantee that Americans will retain their current level of coverage for preventive screenings and ensure early detection screenings are preserved?

Answer: I would convey to the Medicare population that we look forward to assisting them in getting the care they need and the caregivers that they need too. As we consider what to do with regards to the Affordable Care Act, my hope is to move in a direction where insurers can offer products people want and give them the coverage they want. Getting to that kind of system requires changes that will inevitably involve working with Congress and considering the tradeoffs of various proposals to achieve our shared objective of the best and highest quality care being available to Americans.

On the Healthy Indiana Plan as a model for state-run Medicaid expansion:

Question: If these types of complicated structures used in a state's Medicaid program is shown to keep eligible people from getting the health care they need, will you disallow it as not meeting the objectives of the Medicaid statute?

Answer: The Healthy Indiana Plan has long been and continues to be a national model for state-led Medicaid reforms pertaining to the low-income, able-bodied adult population. It is important that Medicaid's design helps its members to transition successfully from the program into commercial health insurance plans, as HIP's consumer-driven approach and underlying incentive structures encourage. HIP members are more engaged with their providers, less reliant on the emergency room, and more satisfied with their coverage than traditional Medicaid members. HIP is achieving Indiana's objective to increase access to consumer-driven coverage as well the broader objectives of the Medicaid program, and I support the use of HIP's reforms in future 1115 demonstration requests by other states.

On State Innovation Waivers:

Question: What opportunities do you see for states to use the SIW? Are there particular reforms that you think would enhance access to affordable, quality coverage?

Answer: These waivers present an opportunity for CMS to encourage state innovation and allow for adaptation of national requirements to the needs of individual states. If confirmed, I would work with CMS to enable States to utilize this -- and other -- authority provided by Congress to ensure access to high-quality, affordable health insurance.

Question: How do you envision the SIW working in conjunction with Medicaid and any corresponding Medicaid waivers? What checks would you put in place to ensure that those individuals entitled to Medicaid receive the full benefits and protections afforded them under Title XIX?

Answer: There is a tremendous opportunity to allow states to innovate with respect to the intersection of their Medicaid programs and qualified health plans and the risk pools within each. State fair hearing processes (as well as the Medicaid waiver process and CMS oversight) provide substantial procedural and other protections that would address concerns regarding Medicaid beneficiaries not getting benefits due to them.

Question: What precautions would you put in place to ensure consumers are protected in states that choose to move forward with a 1332 waiver application?

Answer: The statute itself has protections in place relating to the findings that must be made that would protect consumers in states that move forward with a 1332 waiver application. Furthermore, the democratic process in each state, where government is even closer to the people, provides substantial protection with regards to any 1332 waiver application and its implementation. Such protection may well be even more effective than that available to consumers vis-à-vis the federal government.

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Contact the author: henry.powderly@himssmedia.com