Former U.S. Senate Majority Leader Tom Daschle recently spent time in Nashville to discuss health policy and innovation within the industry. In addition to being part of the Nashville Health Care Council Panel discussion on the 2016 presidential election and the future of healthcare, Daschle also participated in an executive roundtable with the American College of Healthcare Executives of Middle Tennessee in his role as an Accumen Health Care Advisor.
Daschle, who also served as a member of the U.S. House of Representatives for eight years prior to his tenure with the Senate, is a highly respected expert on health policy. He is the founder and CEO of The Daschle Group, A Public Policy Advisory of Baker Donelson, and co-founder of the Bipartisan Policy Center. In addition, Daschle sits on numerous public and private boards, including the board of directors for Accumen, one of the nation's leading lab transformation companies.
Sen. Daschle graciously agreed to an exclusive Q&A session with Nashville Medical News to take a deeper dive into several key issues facing healthcare.
NMN: This month, U.S. citizens head to the polls to elect a new president. Calling on your deep experience, how do you think healthcare could be impacted, and what should the new president's top priorities be?
Senator Tom Daschle: The next president needs to look for opportunities to reset the debate over the Affordable Care Act, maintain the consumer protections, continue efforts to improve value for patients and taxpayers, protect America's tremendous innovation machine, and allow states to construct solutions through waivers.
Much depends on the tone the president-elect sets following the election and who controls the House and Senate in January. A key factor is the individuals the president-elect chooses to appoint or nominate for key positions. Other factors many often underestimate include the culture of the next Administration, the degree of delegation to cabinet members and agency heads, and how the president uses the Office of Management and Budget to enforce the Administration's objectives.
It will be important to allow a cooling off period following the election and for whoever is president-elect to reach out to experts beyond the Beltway, particularly innovators and thought leaders in the private sector and the states.
Secretary Clinton brings considerable experience in health policy and in how Washington works. She likes to learn about issues in-depth, observe, and then take action. I think her top priority for healthcare will be initially getting a handle on fixes needed in the Affordable Care Act and perhaps new drug price controls. Mrs. Clinton is likely to see her Administration as an opportunity to move beyond coverage expansion and may focus more on containing costs for consumers, taxpayers, and employers. Secretary Clinton as president is likely to take a more active role in framing strategy for health policy in her Administration. She'll have less of a learning curve, and she will be surrounded by many with policy experience in the Obama Administration or from think tanks and academia. That is invaluable, but she will need to take advantage of the expertise and solutions of those outside the Washington Beltway.
Mr. Trump, as a businessman who would be new to public office, may be expected to set a much broader tone to issues, selecting a few key policy objectives and delegating the rest to be defined and negotiated between agency heads and Congress. Mr. Trump works more instinctively, and his staff will need more time on the details. As businessman, he is more likely to reach out to the private sector for ideas and appointees, but he may tap some of Washington's experienced conservative health policy gurus.
NMN: Given the current climate in Congress, is consensus ... or at least less gridlock ... possible? Are there areas where compromise might be reached to transform healthcare to meet the triple aim of improved patient experience, outcomes, and cost efficiencies?
TD: There are several areas of potential consensus for the next Congress and Administration. Four come immediately to mind.
Innovation - innovation in diagnosis, treatment, and prevention and innovation in how healthcare is delivered - is essential to achieving the triple aim. Federal policies must be aligned to support innovation, remove barriers, foster competition, and avoid imposing new controls that may look good on paper but severely harm patients and taxpayers.
Virtually everyone agrees with the quest for higher value. This is playing out through payment and delivery reforms across Medicare, Medicaid, and the private sector. To work, this must be a truly collaborative effort among the federal government, states, employers, health systems, clinicians, consumers, insurers, life sciences innovators - everybody. The new Administration and Congress will have an opportunity to work to together with the private sector, the provider community, and states to continue the transformation.
Like innovation, one of America's historical strengths is states as laboratories of reform. In recent years, we have moved away from this, and we need to reinvigorate this in healthcare. One way is through waivers. States should be encouraged and supported in requesting waivers to craft state-based health reforms and innovate in how healthcare is financed. The state innovation waiver authority under section 1332 of the ACA starts on Jan. 1, 2017 and offers many possibilities, and may be coupled with Medicaid reform waivers.
The Affordable Care Act has been instrumental in protecting Americans and eliminating ages old discrimination against those with cancer, diabetes, and other costly, life threatening conditions. Meanwhile, the ACA is imperfect and in need of reform. A possible area of compromise is to recognize that these consumer protections should be maintained but that also the ACA needs some state-based and market-based reforms to stabilize and sustain the health insurance exchanges and cover more of the uninsured.
NMN: Where do you think there are opportunities for the private sector to help us move towards that triple aim and how does that mesh with government regulations and processes?
TD: The government needs ideas. It needs solutions. And it needs real-world expertise. This can only come from the private sector and the states. Federal policymakers and regulators understand this but the day-to-day demands of their roles all too often distract them. The private sector and states are eager to lead and help if given the opportunity. The new president and Congress have the ability to work together to make this happen.
NMN: I know you have discussed the transformative possibilities of technology, but healthcare seems to still be mired in issues surrounding interoperability. How do we get to a place where innovative technologies can actually work across the continuum of care?
TD: Health systems are moving in the right direction with the foundations taking shape in many areas of the health system ecosystem. For example, starting next year, hospitals and practices will have to report some of their quality metrics electronically. If done right, with one vision and one EHR platform, you begin to create the rigor and discipline around metrics that can cascade across and up through a health system, improving the continuum of care.
In the hospital lab, the reporting of quality and service metrics has long been reported. Using one module of an EHR, commonly referred to as the Lab Information System (LIS), laboratories have lead the way because of the significant role lab information plays in an individual's EMR (upwards of 80 percent of an EMR is lab data) and more importantly in a physician's patient diagnosis (~70 percent of a physician's diagnosis is based on lab information).
NMN: What were your impressions from your recent trip to Nashville? How might the industry here play a role in changing the cost/quality trajectory of healthcare in this country?
TD: Nashville is the home of some of the finest healthcare institutions in the U.S. They have an opportunity to leverage their size, experience and expertise to pursue a new standard of excellence for health. The healthcare landscape is changing, new companies are forming that are driving transformational change, which has been necessary for many years. However, it is evident that regulation is not moving at the speed of innovation. The industry needs to be enabled to continually drive high quality and better access while reducing costs.
NMN: What are you passionate about when it comes to the future of healthcare in this country?
TD: Our healthcare system is undergoing transformational change, and we need new ways of delivering healthcare that are high performance, high value and provide quality care for all. Despite recent advances (e.g., big data, predictive analytics, new payment models, wellness approaches, and coordinated care), we face challenges in moving the system toward a new standard of value, and countless aspects of it need improvement.
For example, I can tell you from my work with Accumen, a healthcare transformation company, the hospital lab is an area that is often overlooked in our health system. The lab is at the heart of everything the health system does and is crucial to their ability to serve their community and support new models of healthcare delivery. Accumen is helping to transform the healthcare system by helping hospital labs evolve to operate at peak performance. Accumen helps the health system as a whole, improving patient care while saving hospital partners tens of millions of dollars annually and ensuring they are meeting the highest standards of operational excellence.
Transforming the lab is one example of how a health system can perform better and save money. As we've done in the lab, health systems need to continue to find practical solutions and innovative ideas that improve care while keeping costs in line.