Slavitt stresses ACA implementation in CMS role

BOSTON—“Right now [the Centers for Medicare & Medicaid Services (CMS)] has the biggest opportunity of any organization in healthcare,” said Andy Slavitt, CMS principal deputy administrator, at the Digital Healthcare Innovation Summit on Nov. 4.

CMS plays a crucial role in implementing the provisions of the Affordable Care Act, and its ability to do that effectively will set the course for years to come, he said.

CMS was formed 50 years ago, and its fee-for-service structure has shaped healthcare for decades. The ACA fundamentally changed that. “Our opportunity to set the course for the next 50 years depends on how well we act in the next two years,” Slavitt said. Making progress requires the agency to be responsive, move quickly and engage the private sector. “That’s more important than policy objectives.”

Slavitt, who played a role in fixing Healthcare.gov while at Optum, joined CMS three months ago. During his experience with helping fix problems with the insurance exchanges, he saw federal officials beginning to embrace private-sector efficiency. They were open to new approaches and didn’t want to go back to their old way of doing things, which “compelled me,” he said.

“Whatever you believe about the ACA, it's in nobody’s interest for it to fail,” he said. Calling the rollout of the health insurance exchanges “the most visible and transparent IT project of all time,” he said its problems rooted more from management and organizational problems than IT problems.

With some states not expanding Medicaid coverage, “there are millions of people falling in gaps where they should be covered,” he said. In his current role, he is working with governors and legislators to promote Medicaid expansion. “I see more states moving in that direction,” he said. “It’s a huge effort.”

His new job is rewarding, he said. “It’s more fun to work on a deal where a half million people get healthcare coverage than any other deal.”

While ACA can be polarizing, Slavitt said that 80 to 90 percent of its provisions are “well-argued bipartisan policy” that stresses personal responsibility, accountable care, wellness and preventive care. To him, it’s a matter of working with the private sector, healthcare organizations and payers to implement it.

Citing second quarter statistics (which he expects to increase), he said seven million have enrolled in exchanges, leading to a national drop of uninsured from 15 to 12 percent. Two out of three enrollees reported that they now could see physicians they couldn’t see before, and the majority of the plans are less than $100 per month, he said. “But this is only year one,” he said, alluding to more to come.

Implementation of the ACA has not hurt stocks as previously feared, he added. “A lot of people had thought the government would eat the lunch of the private sector,” he said, but “there is a lot of opportunity” for businesses to thrive in the new post-ACA world.

When asked about the need for CMS to move more quickly against the fee-for-service reimbursement model, he said it’s complicated. “It’s difficult and complex creating and paying on quality measures if you live in rural America and you don’t have enough integration opportunities,” he said.

But CMS is making its intentions known through its payment codes. Hospital CEOs deciding on investment strategies—like whether to invest in wellness or surgeons—should study codes to understand the signal the agency is sending out in its reimbursement choices.

In other comments, he said for startups and other companies to truly bank on health IT reform, “we’ve got to complete the journey on interoperability,” adding, “CMS plays a role in that.” Once interoperability is realized, that’s when the true opportunity for startups comes into play. “The EHR becomes the place where all innovation happens.”

Slavitt also took time to talk about politics, as his talk occurred on Election Day. No matter who is in charge, he said his focus is on implementing the ACA well, which is “the law of the land.”

“In corporate America, you know who your boss is. In Washington, it’s not always clear who your boss is,” he said. While the agency answers to all branches of government, he tells his staff to ultimately do what’s right for taxpayers and Medicare beneficiaries.

He also spoke briefly about HHS Secretary Sylvia Burwell. “She’s a tremendous leader. She’s detail-oriented, big picture-focused” and “a zealot for execution,” he said. “She’s easy to work with in making sure we do our job well.”