2 weeks Ago
President-Elect Donald Trump has yet to declare a comprehensive healthcare agenda. As the nation gears up to inaugurate President Donald Trump to a second term, in-depth discussions of healthcare have been absent. Nevertheless, improving the system that accounts for 20 percent of our economy remains as important as ever.
Here, then, are ten immediately implementable measures that could markedly improve the U.S. health care system by expanding access, reducing costs, and helping to improve the health and well-being of millions of Americans.
1) The Medicare Eligibility Age Eleven thousand Americans age into Medicare every day, many of them never having had access to preventative medicine. As a result, too many of our healthcare dollars go toward treatment of existing conditions. One way to fix this is to lower the age of Medicare eligibility to 55, which would bring an additional 3.
45 million people into the healthcare system, providing them with the kind of regular, preventative care that improves outcomes—and ultimately, it should be stressed, saves money. This would be a politically popular way to address coverage in a population that often struggles to access it. 2) Antitrust Enforcement There were 1,887 hospital mergers between 1998 and 2021, leading to a 25% reduction in the number of hospitals nationwide.
As long as commitment to care and prioritization of patient needs drives business decisions, consolidation in itself isn’t a problem. However, a growing body of research shows that consolidation in healthcare is leading both to higher costs and reduced quality of care . I’d like to see a full-throated debate about the issue, including suggestions for guardrails to ensure that profit motives do not take precedence over lowering costs and improving outcomes.
Election Betting Odds: Trump Hits 99% On Polymarket, Kalshi As More Election Results Come In Election 2024: Harris Concedes Election—Says ‘We Must Accept The Results’ Celebrities React To Trump Win: Hulk Hogan Calls For Unity, Billie Eilish Calls Victory A ‘War On Women’ 3) Multiyear Plan Enrollment In government-sponsored plans like the Medicare Advantage (MA) plan I work for, people shop around yearly and change plans based on benefit offerings. In private insurance, people switch insurers and plans whenever they change jobs. I’d like to see a new administration consider new models of health insurance under which people would be required to stay with plans for a set number of years and plans would be portable between jobs and periods of unemployment.
Under this arrangement, plans would receive incentives to keep large populations of customers healthy and be required to report regularly on patient population outcomes across a defined set of measures. 4) Medicare Advantage Brokers as Community Health Workers New research shows that trust in physicians and hospitals is declining. A good place to start rebuilding trust in healthcare is with healthcare brokers.
Brokers not only help clients select a plan, they also help them navigate and access the health system, guide them toward community resources, and promote healthy behaviors that can obviate the need for expensive medical care. It’s time to codify, standardize, and incentivize this work to ensure that these services are not nice-to-have benefits, but rather standard offerings one can expect from every broker. 5) Mandate Standardized Benefit Design One of the key reasons Congress created the Medicare Advantage program was to inject competition into healthcare markets.
In recent years, however, we’ve seen some plans take their attempts to gain market share too far by designing benefits that do little to improve customers’ health. For example, a well-known plan recently offered potential enrollees pickleball paddles, fishing rods and golf clubs. Benefits like these, while competitive, do little for people when they need care.
By adopting standardized plan benefits rooted in the provision of healthcare treatments, the federal government could both maintain the competitive incentives in the MA industry while ensuring that consumers are able to choose plans based on health outcomes, which should be the most important metric in their decision-making process. 6) Make STAR Ratings Matter MA Star ratings often measure processes, rather than outcomes. Every health plan, however, should be able to tell prospective customers how well their members have fared after common health milestones.
There is solid data about what separates good from great care on these and other important fronts, so we should compel plans to compete on how well they manage the moments that matter. We might also consider varying broker commissions based on the STAR rating of the plan to incentivize brokers to match Medicare beneficiaries with higher performing plans. 7) Fix Risk Adjustment It’s high time that the Centers for Medicare & Medicaid Services (CMS) used technology to adjudicate risk coding in real time.
Currently, CMS uses small-sample retrospective audits that look at unrepresentative data and require plans to expend resources tracking down old paper charts for diagnosis codes that don’t align with the true cost of caring for members. The government’s correction when anomalies are detected is to demand repayment and fine health plans. A better way forward, in this era of computerized data transmission and algorithmic data analysis, would be to conduct more immediate audits, so that if problems are flagged, health plans can make rapid corrections.
8) National Licensure Under the current state licensure system, if you want to see a doctor in another state, you have to go there. But in an era of telemedicine and virtual care, it should be easier for people to consult with physicians across state lines. Necessary federal reforms of this outdated system of state-based medical licensure would also address the growing physician shortage and improve access to care in rural and medically underserved areas.
9) Solve the Utilization Management (UM) Conundrum by Incentivizing Capitated Care We hear a lot these days about insurers using various utilization management methods to deny care. It's beyond time to change the dynamic between payers and providers through the widespread adoption of global capitation, the payment model by which providers receive a fee to manage all of a plan member’s healthcare expenses. Capitation enables clinicians to make necessary investments to manage costs and to do what’s right for patients.
10) A Maternal Moonshot Maternal mortality rates in the U.S. shot up during COVID.
A study from the CDC shows that deaths from maternal causes were 40% higher in 2021 than they were in 2020. Women who belong to minority groups and those living in rural areas and small cities were most severely impacted. One study attributes the increase to the pandemics’ effects on social determinants of health.
Whatever the cause, the U.S. now has the highest maternal mortality rate among developed countries.
It’s time this shameful statistic spurs our government to make radical changes. Options to address this issue include requiring states to provide Medicaid coverage to women for at least a year after giving birth, increasing funding for research around maternal mortality, and expanding community-based programs that advance culturally competent and well-coordinated care. Not everyone will agree with this list, and these ten ideas alone won’t revolutionize our healthcare system.
But we must start somewhere. Let’s urge President Trump and his team to get started where we can all benefit from immediate impact..
