Michigan Physician Running for Congress to Preserve ACA, VBC

Matt Longjohn, MD, frustrated by the Republican attempts to repeal-and-replace the ACA last year, is running for Michigan's sixth congressional district.

In a bellwether race in Michigan's sixth congressional district, Matt Longjohn, MD, is challenging Republican Congressman Fred Upton, who has served on Capitol Hill since 1987.

Longjohn, who won the Democratic primary in early August, is a physician who formerly served as the national health officer for the YMCA (the Y) in Chicago. While in that role, Longjohn orchestrated an 8,000-person clinical trial for diabetes prevention that the Center for Medicare & Medicaid Innovation authorized to expand next year as a Medicare benefit.

In an interview with HealthLeaders, Longjohn discussed the current status of the Affordable Care Act, the future of value-based care, and the Democratic Party's embrace of single-payer legislation.

The following transcript has been edited for brevity and clarity.

HL: You declared your candidacy in response to Rep. Fred Upton's involvement with the GOP's attempts to repeal the ACA last year. What should the future of healthcare in America look like and does it involve revising the ACA in any way?

Longjohn: No matter what you say about the ACA—and it certainly wasn't perfect—the core of that bill was insurance reform and making sure that you couldn't sell junk on the insurance exchange without coverage for central health benefits and preexisting conditions. I think we've seen this year with the junk plans being sold that people are going to think they're buying coverage, [but] they're not going to get what they want. Ultimately, we're going to be back where we were with people being underinsured and uninsured, emergency rooms picking up the slack, and people going bankrupt because of insufficient coverage.

What I think our healthcare system needs besides protecting the aspects of the ACA related to essential health benefits and preexisting conditions, is to do a lot more of what I did at the Y with a focus on prevention and community integrated health.

We have to unlock the value of community and preventive services in our healthcare system, which are hard to pay for in a procedure-driven health economy. That's where these value-based models and bundled payment models are really compelling. They incentivize patient-centered outcomes and long-term outcomes at 90 days with a minimum of four quality measures that can be used to trigger payments. I think that as long as we are only working with procedure codes and billing codes that foster short-term solutions, we're not going to bend the cost curve. I believe in the four points of health reform: cost savings, improved healthcare quality, patient-centered outcomes, and health equity. I will also offer that I believe that we need to expand Medicare both qualitatively and geographically into different corners of our population.

HL: You previously referred to Medicare-for-All as the "North Star" for healthcare policy in America. Where do you currently stand on a proposed single-payer system and Medicare for All?

Longjohn: I think that everyone should have access to and be able to afford the essential health benefits as protected by the ACA.

There are many ways to achieve universal healthcare besides single payer, but single payer is also attractive in a number of philosophical ways. Just like it took four years to test and demonstrate cost savings from a preventive service like the diabetes prevention program, we're going to have to see a lot of experimentation, especially at the state level, to be able to figure out the ultimate question of how exactly to pay for universal healthcare.

We can't just get locked in on this idea of single payer; we have to focus on making sure that service delivery reform around those four principles of healthcare—improving healthcare, quality, health equity, and patient-centered outcomes—are as much a part of the conversation as insurance reform, whether it's driving towards single payer or not. I think insurance reform is only part of the discussion, so I don't get too tripped up on the single-payer conversation, and I try to make sure that what we focus on is a system of universal healthcare delivery.

HL: What do you think Congress' role should be in either monitoring or regulating these association health plans that go outside of the ACA regulations for available health plans?

Longjohn: Congress needs to be providing some expert oversight over HHS and the administration and CMS when they are going beyond, what I think, are reasonable interpretations of existing law to gut provisions of the ACA that protect patients.

I think that we need a bigger voice of people with healthcare expertise in the House who are willing to talk about these things in technical and expert terms that are also related to the political discussion, but the goal has to be improving people's health.

HL: What do you think would be some effective ways for HHS to contain drug prices and increase price transparency for consumers?

Longjohn: This is not a huge mystery. We let the VA negotiate for lower drug prices for the same medication and the same purposes administered to a military population versus those administered to a Medicare population. The studies that I've seen found it's about $12.5 billion a year cheaper, and in many cases, that's because we've allowed the VA to negotiate for lower drug prices. We have to take the prohibitions off of Medicare [Part D] for negotiating lower drug prices. I appreciate that there is also a need for things like price transparency, not just in pharmaceuticals, but also in routine encounters in the healthcare system.

I do support price transparency, but I think to suggest that's the main way we're going to get consumers to choose lower drug prices when the whole distribution chain is set up to promote profit and shareholder value for pharmaceutical companies, is misguided to say the least.

HL: What are your thoughts on the push toward value-based care? Is it a practical expectation for the healthcare industry to achieve, and if so, how?

Longjohn: I've had an opportunity to work on [alternative care] models, demonstration models, and innovation models that showed me that [value-based care] could be a powerful incentive to driving healthcare service delivery change.

It's not like someone can just plant down a value-based model and say, "We're done," like the comprehensive joint replacement (CJR) bundle, for example. Clearly there were issues with CJR as there are with any kind of policy change that is implemented in a hyper-partisan political environment. But I think that the idea is sound.

In my experience at the Y, [I witnessed] the development of local care models where hospitals, when trying to implement value-based models up through ACOs or other service delivery models, were waking up and seeing the value of community-based organizations in their neighborhoods and figuring out that their community health needs assessments can best be addressed outside of the silo of medicine. It inspired them to partner and share savings with organizations that can help them achieve patient-centered outcomes and lower-cost care delivery models by partnering.

HL: What should hospital executives and health system leaders take away from your candidacy?

Longjohn: I'll be honest, I don't think it's the fact that I'm an MD that should speak to [healthcare executives] most strongly. I think it's that I've been involved in healthcare service delivery reform; I've done everything from rewriting billing codes to testing alternative payment models [to] demonstration projects for Medicare. That has given me a clear view of what administrators of healthcare systems are looking for in the healthcare [industry]. Having been [around] for 20 years, working in charitable organizations, universities, healthcare systems, and organizations like the Y, [and] always focused on patient outcomes, I think that I share their mission and have a lot of experiences that they would want to see in Congress.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.