Why: With the Biden administration implementing sweeping policy changes across the board, the new CMS administrator will be tasked with building a forward-looking agency while addressing a legacy of challenges and pressures. Here are the top four areas demanding attention:
1. Imminent threat of Medicare insolvency
In September 2020, the Congressional Budget Office (CBO) issued a worrisome outlook on the solvency of the Hospital Insurance (HI) Trust Fund, which pays for Medicare Part A hospital stays, skilled nursing facilities as well as hospice care The CBO forecasted the HI fund would become insolvent by 2024, a full two years sooner than originally forecast by an April Medicare Trustees report. Facing economic impacts from the pandemic and increased baby boomer enrollments, the new CMS administrator can help restore longer-term solvency by:
- Targeting addressable high cost care such as sepsis, clostridioides difficile (C.diff) and other healthcare-associated infections (HAI)
- Focusing on digital models for more effective opioid stewardship and clinical surveillance for hospitals
- Accelerating tech to increase value-based reimbursement adoption
2. Accelerating CMS innovation and advocacy momentum
CMS has historically been a leader in promoting healthcare data innovation. The new administrator can reinvigorate that charge by:
- Going beyond the information blocking rules and transform data practices to improve reporting, access, exchange, and use of electronic health information (EHI)
- Supporting artificial intelligence (AI) initiatives that enable large-scale data interoperability and better population health analytics
3. Fragmented approaches to health disparities and inequities
The COVID-19 pandemic has shone a glaring spotlight on systemic health inequalities. The new administrator will need to take a cohesive, multi-pronged approach to address the big picture by:
- Applying advanced data science to target social determinants of health (SDoH), especially by unifying and mobilizing vast troves of data collected during the pandemic
- Proactively dismantling work verification requirements for Medicaid that have been burdensome for enrollees and increased the risk of losing healthcare in the near-term during a pandemic
- Applying a population health approach to get patients back in to see their doctors for care that has been postponed by the pandemic
4. Daunting implementation of the Biden administration's American Rescue Plan (ARP)
CMS will play a notable role in this wide-reaching $1.9 trillion economic stimulus package. For example, the AARP calls for expanding Medicaid. This will be achieved with incentives for states to expand their Medicaid rolls.
Who: Healthcare industry veteran Frank Jackson, vice president and general manager of Health Language at Wolters Kluwer, Health is available for further comment and discussion on the challenges that lie ahead for the CMS nominee.
Contact: To arrange an interview with Frank Jackson on this or any other healthcare sector-related topics, please contact Ashley Beine, 262-685-8721.
