C-suite: Keep Obamacare coverage, but not bundled payments

C-suite hospital executives want to keep parts of the Affordable Care Act that protect insurance coverage for patients with preexisting conditions, help support those on Medicaid and give subsidies to consumers to purchase plans. On the other hand, execs are less enthusiastic about ACA mandates to be insured, as well as bundled payments and other alternative payment models.

These were the results of a Vizient survey of C-suite executives taken after the November presidential election.

President Donald Trump and Republican leaders are in the process of repealing the Affordable Care Act and coming up with a replacement plan.

Asked which parts of the ACA should be kept in a repeal of the law, 89.5 percent of hospital executives said protection of patients with pre-existing conditions is number one.

[Also: As he exits his CMS role, Andy Slavitt speaks out against ACA repeal on social media]

This was followed by keeping incentives for expanded Medicaid coverage at 68 percent, and keeping subsidies to help individuals purchase insurance, at 56.4 percent.

Lower on C-suite lists is keeping value-based reimbursements, at 51.7 percent. Surprisingly given the higher percentages of support for keeping coverage in the ACA, only 45.3 percent said mandating insurance coverage for all Americans should be kept.

Lowest on the list, at 40.1 percent, were alternative payment models such as bundled payments.

So it is not surprising that in asking which parts C-suite executives want repealed from the ACA, 38.4 percent said alternative payment models and 37.8 percent said the insurance mandate.

However, 27.9 percent said no parts of the ACA should be eliminated.

[Also: HHS nominee is foe of bundled payments despite data proving their success]

Pharmacy executives were also surveyed, and an overwhelming 96.2 percent wanted to keep from the ACA the protection of patients with pre-existing conditions.

This was followed by 46.2 percent who said they wanted to keep subsidies to help individuals purchase insurance and the 38.5 percent who cited keeping value-based insurance.

Pharmacy executives also listed low, at 15.4 percent, their priority for mandating insurance coverage for all Americans. When it comes to eliminating parts of the ACA, 61.5 percent of pharmacy executives cited the mandate for insurance coverage, followed by 30.8 percent who said the elimination of alternative payment models and 26.9 percent who said incentives for expanding Medicaid coverage.

At 36 percent, both hospitals and pharmacy executives said lower reimbursements were their number one concern, followed by 15.3 percent who said fewer insured and covered patients and 14.4 percent who cited fear of the unknown.

Another 11.3 percent said a change in policy may make investments spent transforming care delivery, irrelevant.

[Also: Tom Price refuses to say he supports Medicaid block grants, privatizing Medicare]

The greatest influence over hospital mergers under a Trump administration are reimbursement from Medicare and Medicaid, health policy direction, market conditions, the number of insured and covered patients and insurer consolidation.

Priorities for 2017, in order, are reducing clinical variation across care delivery, migrating towards value-based care and the integration of existing technology systems. On the bottom was technology innovation.

Of survey respondents, 33.3 percent were CEOs, 15.3 percent CFOs and 12.6 percent were pharmacy executives, followed by other  C-suite executives.

To stop the price spikes in pharmaceuticals, 55 percent want the Trump administration to work with the FDA to fast-track competitive drugs to market, 41 percent want to eliminate the pay for delay practice of branded pharmaceutical companies, and 35.6 percent want to allow for the importation of foreign pharmaceuticals.

Twitter: @SusanJMorse