INTRO COMMENTS: Hello and welcome to Modern Healthcare’s Next Up, the podcast for emerging healthcare leaders. My name is Kadesha Smith. I'm your host, and I’m also the CEO of CareContent, a digital strategy agency for healthcare organizations.
So, Election Day turned into Election Week, with the American people waiting a full four days to know the winner of our presidential election. And we’re still waiting to know the results of certain congressional races that will have runoffs in January.
So, what does the new administration mean for healthcare policy?
COVID-19 and the corresponding health disparities have dominated policy discussions for so much of 2020 that it seems like the other issues are distant secondary priorities. As of this recording, we’re in the third spike of COVID-19 infections. The US has reported more than 10 million cases — with the latest million in just the last 10 days — and there has been more than 237,000 deaths. Throughout the country, Black people are dying at 2.2 times the rate of white people.
The new administration will also have to grapple with other issues around hospital closures, accessible care for the uninsured. And this week, the Affordable Care Act will face a newly-conservative Supreme Court in a case brought forth by Republicans who seek to end it. This would affect health insurance for millions of Americans, as well as protections for millions more with pre-existing conditions, including COVID-19.
What is the right mindset for established and emerging leaders in this very uncertain era? The best person for this conversation is Ceci Connolly, President and CEO at Alliance of Community Health Plans. She’s also host of the Healthy Dialogue podcast, and founding member of Women of Impact for Healthcare. She was also the Managing Director of the Health Research Institute from 2012 to 2015, where she advised executive clients on current and emerging issues in the healthcare sector, including ACA implementation and value-based care. Also, in the late ‘90s and early 2000s, she was a national political reporter who covered presidential and gubernatorial elections.
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MODERN HEALTHCARE: Now, let’s get into our discussion with Ceci Connolly, President and CEO at Alliance of Community Health Plans.
MODERN HEALTHCARE: Ceci Connolly, how are you?
CECI CONNOLLY:I am doing just great, how about you?
MODERN HEALTHCARE: I’m doing well. Thank you so much for making time to talk about this very important topic of what our healthcare landscape could potentially look like.
CECI CONNOLLY: Oh, thank you. It really is just a remarkable period in our nation’s history. I guess though, you could say that for all of 2020, but maybe now we’re getting a little bit of clarity about the path ahead.
MODERN HEALTHCARE: First I want to just start with some key data points that set the stage for our discussion.
Number 1 — as people lose jobs due to the pandemic, they’re also losing healthcare coverage. And as of late September, about half of all Americans who had become unemployed because of COVID remained jobless. And this is specifically affecting Black Americans and mothers of school-age children, who are taking the longest to regain employment. So, that’s one fact about our landscape that we’ll touch on.
The winter COVID-19 wave is threatening to overwhelm the United States healthcare system yet again. In the month of October, hospitalizations have already risen from 3,000 to 45,000, and they continue to rise.
And then lastly, the average hospital bill for COVID-19 is roughly between $34,000 and $45,000, depending on age. For someone without insurance, or someone who’s receiving out-of-network care, the cost can be over $70,000.
So, just things to keep in mind as we talk. Before we dive in specifically to COVID and the healthcare landscape, I’m really curious to know what a day in your life was like last week as we were waiting for election results, all probably glued to the news to see what was going to happen.
CECI CONNOLLY: Well, yes. I think so many people were glued to the news. And of course, being a former journalist, 25 years in the business and covering an awful lot of campaigns, I am definitely in the category of “junkie.”
MODERN HEALTHCARE: Uh huh.
CECI CONNOLLY: And my husband is also a Washington Post journalist, so we’ve got professional reasons to be closely monitoring lots of different news outlets simultaneously — on our devices, watching Twitter, TV, you know — skipping around TV channels, not getting a whole lot of sleep.
I will tell you that I knew Wednesday was going to be a very big day for me because we here at the Alliance of Community Health Plans had committed many, many months ago to do a day-after briefing for our members. And so I knew that at 1 p.m. on Wednesday, we were probably going to have about 100 of our members that wanted to know what the heck happened and what it would mean for community health plans.
That was going to mean an early morning on Wednesday, and so, uncharacteristically on Election Night — I’d say around 11:15 or so, when it was clear we weren’t going to have an outcome at that point — I said to my husband, “You know, I’m going to go. I’m going to climb into bed. And I’m just going to have NPR, you know, radio playing softly. It’s kind of like a bedtime story for me. And yeah, maybe that will lull me to sleep.” And sure enough, it did, and so I think I probably got at least a couple of hours of sleep.
But Kadesha, I did awaken to the sound of President Trump’s speech.
MODERN HEALTHCARE: Okay.
CECI CONNOLLY: At 3 in the morning. And so that was a little bit jarring. So, yes. And then a big day on Wednesday with our team here at ACHP.
MODERN HEALTHCARE: Wow. Well, you know what? I admire your effort to get some sleep. I did not take the route. I wish I would have. I am glad to know that this weekend, we had a final result in that we could all now talk about.
So, you know, President Trump will be in office until January 20th. And then at the same time, this is predicted to be an even more deadly period for the pandemic. How do you envision this transition impacting the COVID-19 response and impacting the country?
CECI CONNOLLY: Well, we saw right away Monday, President-elect Biden announcing his COVID-19 Task Force.
MODERN HEALTHCARE: Yup.
CECI CONNOLLY: And a number of those individuals, I know and have known for a very long time. You’ll hear this notion a lot in the coming weeks and months, and it is that Joe Biden — because of his decades of government service — has both a broad and a deep bench to tap. And we certainly see that in the COVID-19 Task Force. It is a very well-rounded, well-experienced — scientists, clinicians, people that have been through pandemics before. And frankly, who have been tracking this from the very beginning.
And so even though they are technically outside of government and during a transition, you worry about when a lot of information and resources are going to be passed from one team to the next. A lot of the COVID information is public, or public enough. And so I think that this team has been not only monitoring, but preparing for more testing and tracing, and a much clearer, singular message around the types of sensible public health measures that everyone can and should be taking. That’s the social distancing, the handwashing, the mask-wearing. You’re not going to have kind of that back and forth — “Well, maybe do it, maybe don’t do it. Do it when you feel like it, do it a couple days a week.” I think it will be very clear, consistent messaging now, coming from trusted clinicians and scientists. And so that in and of itself is going to be very beneficial, I would say.
It’s not the same as when you actually take over the running of government, and you have a lot more tools at your disposal. But I think that, candidly, the media and the health industry will very quickly turn to, and embrace, and amplify, those clear, consistent messages coming out of the transition team and the Task Force. So, I suspect they're going to be getting a lot of air time and attention.
MODERN HEALTHCARE: So, you’ve already mentioned just more clear messaging about protective measures. I kind of want to do a rapid fire round with you of some other ideas and needs and policies, and just get your thoughts on — where do you think these plans will go if we end up with a Republican majority in the Senate and a Democratic majority in the House. Let’s start with the availability of testing. What do you see happening there?
CECI CONNOLLY: I anticipate that there will be an increase in that. We’ve consistently seen it from the House democrats. The Republican Senate has been slower to move on that front. But I think, absent the objections of a Trump White House, you will see increased dollars and availability.
MODERN HEALTHCARE: What about the cost barriers for preventive care and treatment, especially in light of so many people losing their jobs and maybe even losing their coverage?
CECI CONNOLLY: I think this is where you really want to look for the vast public-private sector collaboration. And we had it in the early days and months of the pandemic. Our community health plans and lots of others — they waived all sorts of ...
MODERN HEALTHCARE: Oh yeah.
CECI CONNOLLY: Co-pays, and deductibles, and whatnot. And I believe you will certainly continue to see that from our community health plan members. Just to give an example: You eliminate the co-pay for telehealth. That saves you, in the long run. It saves everybody so much in the long run. And certainly, our community health plans recognize that. And I believe you’ll continue to see that kind of stepping up.
At the same time, we probably are going to need some government assistance here. Because as you rightly pinpoint, so many have already lost their jobs, and I am afraid to say — January, February, March — we could see more layoffs.
MODERN HEALTHCARE: Yes. Okay. What about development of a vaccine? What are you anticipating there?
CECI CONNOLLY: Well, the indications are that a number of companies are making phenomenal progress, in record time. And so I believe that. At the same time, I know that the scientists at the FDA are committed to doing their job. And that may mean that it still takes a little while to really start to reach people. But I think when that vaccine is available, we will have a high degree of confidence about safety and efficacy.
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MODERN HEALTHCARE: Let’s talk about your thoughts on access to supplies — PPE and facilities. What are you anticipating there?
CECI CONNOLLY: Well again, I think this is where the Biden team will fall back on a lot of its existing knowledge and experience. They know a lot about stockpiles. In the Obama Administration, there was, in the White House, an office for pandemics. I think we can anticipate that being reignited, if you will, in short order. They had a pandemic playbook. I’m not saying everything is precisely the same. I’m sure there are going to be some changes. But I do think that again, they ran these drills in the past. And they have been watching the unfolding of this horrible, horrible tragedy for so many months now, that I believe you will see some pretty good, strong plans coming out quickly.
MODERN HEALTHCARE: We recently did an episode with Michael Dowling at Northwell Health in New York City. And he mentioned that one of the things that helped his team be more prepared than a lot of the other hospitals in New York was that they had a plan to at least start discussions. It wasn’t starting ad hoc and a blank page. It was like, “Let’s start with what we know and then pivot from there.”
CECI CONNOLLY: Yes. And I certainly hope, and I do believe, that this Biden Task Force has been in dialogue with so many leaders in the industry. I’ll just give one example here of how things have changed. Our member, SelectHealth, a part of Intermountain, you recall — I believe Modern Healthcare had written about very early in the pandemic — sent a few times of clinicians to New York, in part to lend a hand. But they’ll also tell you — that was to learn very early in the experience. You know, the nation as a whole is smarter about the novel coronavirus than maybe it was 6 or 8 months ago. At the same time, despite all of that learning, we are at record numbers, Kadesha. And that is terrifying.
MODERN HEALTHCARE: Let’s shift now to talk about the Affordable Care Act. Obviously, that is a constant conversation in the healthcare policy landscape. So, assuming the Affordable Care Act stays intact, what is one way that the Biden-Harris Administration’s plan for the ACA could help patients or provider organizations, and how might there be some unintended consequences?
CECI CONNOLLY: Well, I certainly think that the Biden team wants to look at areas such as the ACA subsidies. So, you could make the premium tax credits larger, or you could lower the threshold. That would make coverage on the exchange more affordable for more people.
They need to work with Congress, but I think there’s potential to reestablish reinsurance. A number of states have done it on their own, but a federal reinsurance program would be very smart, and was — way, way, way back in the day — a Republican market-oriented approach. And so, you may have an opportunity to look again at that.
I would think that a Biden Administration would not look favorably on requests for waivers for non-compliant plans, or “skinny plans,” as you sometimes hear about. And probably, you know, and it’s such a tongue-twister here, but those short-term — and I’m putting air quotes here — “short-term” limited duration plans — that the current administration stretched the meaning of “short term” out way too far — that might get pulled back into the range of reasonable.
Probably more money for navigators and other types of enrollment assistance. Maybe additional time in open enrollment season. Perhaps looking at autoenrollment for some uninsured individuals.
So, some of these may sound a little bit smaller, some of them are a little bit grander. But we know that they are proven strategies in the past. And so it would be sensible to return to a number of them.
MODERN HEALTHCARE: In your podcast, Healthy Dialogue — this was just before the election results were announced — you mentioned that the movement toward value-based care began with the ACA. It slowed over time. How do you see that changing under the Biden-Harris Administration, and what does it specifically mean for hospitals?
CECI CONNOLLY: Well, I certainly do know from conversations with healthcare advisors to President-elect Biden, that they are supporters of value-based care. And they understand and appreciate that healthcare in this country is not “affordable.” More of my air quotes for you. However, I don’t want to get anyone’s hopes up for rapid or significant movement toward value. As much as we very much want that at ACHP. But I think that we will all need to be realistic in appreciating the magnitude of the challenge of the pandemic.
The economy, which you have been touching on. And we’ve heard from President-elect Biden — other very big important priorities around climate. Some around ethics. So, this is going to be a very, very jam-packed agenda. And sadly, I suspect the movement to value is second tier.
MODERN HEALTHCARE: Well, and speaking of Biden’s agenda, he said he’s planning on undoing many of Trump’s actions through executive orders. What are the healthcare related ones that we should be looking out for?
CECI CONNOLLY: Well, on day 1 of the Trump presidency, he signed a sweeping executive order that said, “I pledge to repeal the Affordable Care Act, and I’m directing the entire federal government to minimize all regulatory burdens of the ACA.” Sounded very, very dramatic, and certainly did give those departments and agencies encouragement and some latitude to act.
As we know now looking back, what happened — they certainly were able to make some changes and chip away at elements of the ACA. Many of those things did end up in courts and kind of split decisions. The sentiment of that number 1 executive order was probably grander than the reality.
MODERN HEALTHCARE: Yeah.
CECI CONNOLLY: Nonetheless, I wouldn’t be surprised if a President Biden decided he needed to sign one that said the opposite. I certainly think we will see the US back paying its dues to the World Health Organization. And in terms of power — again, through the executive branch — certainly this Biden Administration can require mask-wearing on all federal property and federal buildings. Tougher to do just a flat-out nationwide requirement at private businesses. But that, and even, I imagine you can also do it on travel — airplanes, trains, etc. — through some sort of executive orders is my guess.
MODERN HEALTHCARE: So, to wrap up — you know, if you’re a rising healthcare executive, what policy issues should you be paying attention to but often are not?
CECI CONNOLLY: Before you got to the “often are not,” I was going to immediately jump on my telehealth bandwagon. I do understand everybody’s probably noticing and buzzing about it right now. But certainly in the experience of our ACHP member plans, it’s a cliche now to say that that is a bright spot of the COVID-19 pandemic. It’s a game-changer.
If you wanted one that is overlooked, I’m going to put out there one of my favorites, which is getting serious about low-value, inappropriate, duplicative, and even sometimes dangerous care. You know, the estimates are that up to one-third of our healthcare spending — which, that now means about a trillion dollars in the United States — is going to unnecessary services. It’s a test that you had once and the doctor wants to do it again. Doing surgery when maybe you could have just had physical therapy for your back pain. It’s unproven things, because they’re new and shiny and different. Frankly, it’s c-sections a lot of times.
So, we all as a country need to help educate consumers and patients that in healthcare, more is not necessarily better.
One of the things that’s so disheartening right now are the number of providers that are racing back into offices. The telemedicine really does work. And by the way, the pandemic is raging in every nook and cranny of this country. There is a revenue motivation connected there. And it’s troubling to me. I understand why: It’s our fee-for-service system. We’ve got to tackle it.
MODERN HEALTHCARE: Well we look forward to seeing how that plays out over the next 4 years.
CECI CONNOLLY: [laughs]. It’s going to be as interesting as ever.
MODERN HEALTHCARE: Absolutely. Well, thank you so much for your time. We look forward to maybe tapping you again later on to see what actually did happen in the next few months.
CECI CONNOLLY: It’s my pleasure. Thank you.
OUTRO COMMENTS: Between the continuing COVID-19 pandemic, the new Biden-Harris Administration, and the uncertain future of healthcare policy, we are set to see significant changes in both healthcare delivery and policy over the next few years. But you know what? After this year, I think most of us are like, “Bring it on.” At this point, we can tap into our resilience and the lessons learned in 2020 — and face whatever’s next.
Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their growth goals through digital strategy and content.
We’d again also like to thank this episode’s sponsor, Masimo.
For more information about what’s going on in healthcare policy, go to modernhealthcare.com.
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