How the Biden administration, Congress can heal healthcare

Amid the worst health crisis of our lifetimes, American voters ranked the economy and healthcare as top issues in a pre-election Gallup poll, perhaps not a surprise given that an estimated 14.6 million individuals lost employer-sponsored health insurance due to the COVID-19 pandemic.

The incoming Biden administration and the 117th Congress can begin to improve the health of our citizens and the American economy with policies that support a sustainable, value-based healthcare system.

The current system of fee-for service medicine aims to drive up the volume of procedures performed, rather than focus on the health and well-being of patients. As evidenced by the pandemic, this costly, fragmented system is causing the loss of life and livelihood in America. Even physicians who historically benefited from the perverse fee-for-service system felt the pain of its illogic during the pandemic pause in services.

Research shows that a system designed to pay for care differently would improve both care quality and patient outcomes. While such a value-based health care system will take years to fully achieve, here are five ways to make an immediate impact:

Support telehealth and broadband expansion

A healthcare system needs to meet consumers where they are, with the services they need. During this pandemic providers and patients alike have embraced virtual care, a service that both improves access and reduces costs.

Given the enthusiasm for telehealth and the potential savings and convenience it provides, policymakers now have a rare opportunity to sustain the momentum created by the pandemic: expanding coverage and payment outside antiquated site-of-service requirements, allowing care to be delivered in the home, the office or community settings; allowing nonphysician health professionals to deliver telehealth; and providing reliable high-speed internet nationwide.

Strengthen primary care and behavioral health

Vital to improving the health of our communities and individuals is a robust primary-care system with access to behavioral health services. We have seen an increase in the need for and utilization of behavioral health services during this pandemic.

We can learn from our peers around the world: Compared to other industrialized nations, the U.S. spends more total dollars on healthcare per capita, yet we spend less than half as much on primary care. It’s time for targeted investments that can significantly improve our overall well-being. Health systems that offer comprehensive primary care—with a focus on prevention, management of chronic conditions and delivery of appropriate, high-value care—have superior patient outcomes, fewer health inequities and lower overall costs.

Maximize access to high-quality coverage for all

The uninsured unsurprisingly have worse health outcomes than the insured, including higher death rates as a result of less preventive care, fewer screenings, poorer health and more advanced disease upon entry into the healthcare system. While the Affordable Care Act expanded access to quality coverage for millions, improving mortality rates and health outcomes in the last decade, the 2020 pandemic caused a significant setback. The sharp increase in the number of uninsured has devastated access to essential care, impeding the progress of the ACA and furthering existing health inequities.

In the individual market, a national special enrollment period would significantly improve access to urgently needed coverage and care, and the extension of COBRA coverage would help millions of Americans maintain their current health insurance during the crisis. As Medicaid enrollment continues to climb, fortifying and further expanding the program would both protect health coverage for millions and provide relief for vulnerable state budgets.

Address disparities and unmet social needs

Socioeconomic disparities in healthcare are significantly worse in the U.S. than in other wealthy countries, according to a new study of 11 high-income countries. A community-based approach to healthcare puts the patient at the center, surrounded by clinicians, health plans and social service partners to better identify and address social risk factors that impact health. We have seen this work with well-developed programs in communities such as central Pennsylvania, Madison, Wis., and rural parts of Utah and New Mexico in which health plans serve as a connector between the most vulnerable patients and available community-based services.

This hyperlocal partnership model requires strategic federal investments, such as expanding Medicaid’s home- and community-based service programs and granting Medicare Advantage plans with additional flexibility and the full quality bonus to provide services to patients with chronic conditions.

Provide consumers with transparency and privacy

To empower individuals to engage directly in their care, our health system should provide personalized information and easy-to-use price and quality tools that are independently certified. Policymakers should create a new privacy security framework that protects data regardless of where it is stored, maintained or accessed for both HIPAA- and non-HIPAA-covered entities.

President-elect Biden has recognized the need for healing in our country. With so much at stake for the health of our citizens and our economy, that healing needs to start in the American healthcare system.



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