Burwell sends outgoing message: Health reform must endure

HHS Secretary Sylvia Burwell

While not all models have been successful, healthcare reform that rewards for value over volume will and must endure, outgoing Health and Human Services Secretary Sylvia Burwell said Monday in an article published in Health Affairs and shared by the Centers for Medicare and Medicaid Services.

The Affordable Care Act may have been an important catalyst, but the changes it set in motion are permanent, Burwell said.

"Any attempts to reverse or legislate away this progress will have to grapple with the reality of what our nation has already achieved," she said. "This work has gone on steadily for years -- through political turmoil and challenges in the courts. Yet through each challenge, these reforms have endured."

Burwell's comments were aimed at a new administration, one whose leaders - incoming HHS Secretary Tom Price and President-elect Donald Trump - have been vocal in their opposition to Obamacare.

"Although this Administration will conclude in the next month, I have no doubt that the transformation of our healthcare system is larger than any one Administration or any one president," Burwell said. "Rather, it is a transformation guided by the work of actors at all levels and across the country."

A Republican-led House and Senate also threatens CMS's Innovation Center, which some legislators believe has overstepped its authority by issuing healthcare models Congress had no hand in creating.

[Also: CMS Administrator Andy Slavitt tells MACRA summit law doesn't work well without CMMI]

The Innovation Center is needed to advance delivery system reform, Burwell said. It systematically develops, tests, and scales innovative reforms.

Through the Affordable Care Act, 20 million more people have gained health insurance. Nine out of ten people are covered, she said. Growth in both premiums for employer coverage and overall Medicare spending has also slowed, she said. CMS actuaries now project that $2.6 trillion less will be spent over the ACA's first decade than was projected prior to enactment of the ACA in 2010.

"The 20 million Americans who gained coverage cannot lose it again. The more than 129 million people with pre-existing conditions do not want to go back to a time when insurers could discriminate against them, or block them from coverage," she said. "Eleven million Medicare Part D beneficiaries cannot afford to lose the $2,000 they have each saved, on average, from the law's work to begin closing the 'donut hole.'"

Despite political differences, a path forward to a system which puts patients at the center is a vision on which all can agree, she said.

Fee for service fosters a climate in which redundancies have no financial downside nor regard to outcomes.

Instead, HHS has been rewarding value by directly compensating actions that enhance care and drive costs down. It fosters collaborations with private payers and states to test new payment models. And it has improved the access and portability of electronic health records.

[Also: 5 ways Tom Price can quickly alter healthcare policy]

As of January, CMS met its goal of having 30 percent of Medicare payments in alternative payment models.

"Before the Affordable Care Act, Medicare paid essentially $0 through these approaches. Today, we're on track to meet our goal of 50 percent by the end of 2018, which we believe will be a tipping point," Burwell said. "The core of our strategy is this: pay directly for actions that we know drive down costs and improve care; test new payment methods that align financial incentives with evidence-based best practices; and encourage providers to take on the challenge of participating in population-based models, where they are fully responsible for the total cost of their patients' care and a full range of outcomes."

This is being done through accountable care organizations, bundled payments and MACRA, the Medicare Access and CHIP Reauthorization Act. MACRA is a significant step forward in reforming Medicare payments, she said.

[Also: MACRA will move forward largely untouched when Trump steps in, experts say]

"Implementing MACRA has just begun, and we know questions will continue to arise regarding whether we have sufficiently tailored the program to support small and rural practices, or whether there are enough alternative payment models available," she said.
In 2015, Medicare ACOs saved $466 million. Over 100 new ACOs have joined in the last year, bringing the total to 477 serving nearly 8.9 million people, Burwell said.

Similar shifts are happening in the private sector and states. Plans and states are now spending almost a quarter of their healthcare dollars through alternative payment models, she said.

Health information technology goals are to make sure health IT systems are using common standards so that data is portable, to  change the culture around access to information, so doctors and hospitals recognize that their patients have a right to their own electronic health information, and to ensure that rules and regulations reflect the principle that data moving simply and securely throughout the healthcare system is vital for market success.

"Untying the old system is complex work," Burwell said. "Not all models are successful, and we have learned along the way."

Twitter: @SusanJMorse