Health Reform Election Outcome and What it Means for You recap

by Cynthea Ryder

Remember how difficult it was to launch Medicare Part D? Implementation seemed nearly impossible given the complexities, the tight timeframes and the ever-changing requirements of a government sponsored healthcare program.

“Medicare on steroids” is how panelist, Kevin Rigby, Novartis VP/country head of public affairs and HBA Mentor of the Year, described healthcare reform. There is an incredible amount of confusion about what is actually included, who will be impacted and how it will all be funded.

The HBA panel event “Health Reform Election Outcome and What it Means for You”, sponsored by Novartis, kicked off with a high level presentation of the Affordable Care Act key milestones and the budget debate by Bobby Clark and Christopher Khoury. Alison Mount moderated the panel discussion. All three are Senior Managers from PwC.

Changing how healthcare is paid for and delivered as well as moving from volume to value is requiring payers, Pharma and providers to redefine how they interact with each other. Payers are seeking real world effectiveness and engaging in risk-sharing arrangements with Pharma, ensuring both parties are on the hook for paying for value.

Outcomes in quality performance are driving providers to organize in new ways, shifting costs to gain more negotiating power with payers and suppliers. Hospitals, well versed in analyzing their own data, are integrating with other health data including remote monitoring.

The mandate for patient-centered outcomes places the consumer first in this new framework, which previously has been largely business-to-business focused. Panelist Margaret Johnson, Horizon VP and chief pharmacy officer, has a huge job ahead of her. Besides meeting the regulations to fully define network benefits, to certify as a qualified health plan on the federal exchange and to launch open enrollment, she also has to change the company culture to become more consumer-focused.   Directly impacting Pharma, the Sunshine Act now requires specific reporting when anything of value is transferred to physicians. As stated by Meryl Zausner, panelist and Novartis Pharma CFO & US country chief financial and administrative officer, there isn’t a standard way to handle the reporting mandate with current systems. Sounds like a niche start-up opportunity for our entrepreneurial HBA members.

Another topic that generated discussion was whether the 2.3% medical device excise tax would be repealed. Although there is bipartisan support for a repeal, it would come at a cost of $38 billion to the government according to panelist Shawn O’Neail, executive director, federal government affairs at Novartis. A loss this significant to the federal budget would need to be made up elsewhere.

Who would have thought that Medicare’s formulary, co-insurance and donut hole could seem so simple?

 

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