'Trump effect' causes trepidation among healthcare leaders

Now that efforts tied to the Affordable Care Act have helped to shepherd in an era of value-based payment, Medicaid expansion and an increased emphasis on consumerism, healthcare leaders fear that a potential repeal by the new Trump administration may cause a host of new challenges.

All eyes will be on Seema Verma, President-elect Donald Trump's pick to head the Centers for Medicare and Medicaid Services. Verma, founder and CEO of a health policy consulting firm, is known for her close ties to Vice President-elect Mike Pence, having designed his Medicaid expansion model in Indiana. She has also advised several Republican states on how to add conservative elements to their programs, such as health savings accounts and employment requirements.

"With the nomination of the new CMS administrator, there's interest in what might happen with Medicaid programs, and there has also been some discussion about some changes that might take place with Medicare as well, although it's tough to tell what those might be on a day-to-day basis," said Sarah Thomas, director of Deloitte's Center for Health Solutions.

[Also: House v. Burwell court order one more way for Trump to end ACA]

Insurers in the individual insurance market will certainly be paying close attention to what happens in the insurance exchanges, but Thomas thinks that a full repeal of the ACA is unlikely.

"The ACA contains a lot of policy," she said. "If you think about it, it actually included a lot of things. It included changes to the Medicare program, and some of those are quite popular, like the closing of the donut hole in Part D. When people talk about repealing the ACA, nobody's really talking about repealing all of it. It would be selected parts, and they would be parts that are the pain points -- things that are politically unpalatable, things that are a challenge."

The last four years in particular have seen healthcare reform centered around care coordination and case management, and how it impacts the revenue of small community hospitals. Robin Hynds, senior director of care integration and transformation at Lawrence General Hospital in Massachusetts, said her facility is dependent on block grants and CMS-appropriated funding to continue servicing the community; it operates in one of the poorest communities in Massachusetts, with a high number of undocumented patients.

"My fear is that these kinds of things could be threatened," said Hynds. "We're a low-cost, high-quality provider here in the Merrimack Valley. We're only 30 minutes outside of Boston, where there's high competition, so we're really dependent on the state and federal government to help support the continued role that this hospital plays for the people who live here. I just hope the work that's been done in really making sure we're not functioning in silos is kept, because that really has opened a lot of doors for patients. And that's allowed us to provide care we weren't able to provide years ago."

Thomas said there's been a lot of concern about healthcare eating up an increasing share of the U.S. economy, and what it means for competitiveness. There's a question about affordability, and whether the country is simply spending too much on healthcare. So broadly speaking, strategies that have the potential to squeeze better value out of the healthcare system are likely to still be of interest to the upcoming administration, Thomas said. That means the shift from volume to value -- which has gained a significant amount of momentum -- will likely survive in some form, though the means of getting there may be different.

[Also: Task force pushes Trump administration to preserve CMMI, push to value-based care]

Consumerism, too, is likely to continue as a trend, said Thomas.

"We've been very interested in the rise of consumers in healthcare, and it's a multi-part trend," she said. "Part of it is using financial signals to encourage people to make healthy choices, make efficient choices, choose high-quality care, engage in some of the shopping behaviors that we like to see, and take more charge of their own healthcare. It's a broader notion of healthcare. … All of that has been a really important trend. I don't see any reason that would slow down. If anything, I imagine that would accelerate," she said.

"If you look at proposals like the Indiana Medicare program, if you look at the legislative proposals, some of the policy recommendations from conservative think tanks, they all point in that direction."

Thomas recommends doing some scenario planning to see how an organization may perform financially if one or more expert predictions come true.

Others, like Texas Health Resources Senior Director Patricia Consolver, are taking a more cautious, wait-and-see approach.

"It's too early to tell what's going to happen," she said. "There are opportunities to improve current legislation and regulations, but exactly what's going to be changed and by how much is anybody's guess."

Twitter: @JELagasse