Relatively modest investments in social determinants of health for children have demonstrated impressive results.
Healthcare policymakers and industry players alike should devote more attention and resources to meeting kids' health needs, says R. Lawrence "Larry" Moss, MD, FACS, FAAP, president and CEO of Nemours Children's Health System, based in Jacksonville, Florida.
The undertaking is an important long-term strategy to boost outcomes and strengthen the U.S. economy overall, Moss said during a presentation to fellow executives at a recent HealthLeaders CEO Exchange gathering.
"The biggest lever that we have as a society to influence health—and ultimately to influence our economic vitality as a nation—is to invest in the health of children," he said.
Moss, a pediatric surgeon, just completed his first year as the top executive at Nemours, which operates two major medical centers, one in Orlando, Florida, and the other in Wilmington, Delaware. He took his current job after seven years as surgeon-in-chief for Nationwide Children's Hospital in Columbus, Ohio.
While the U.S. healthcare system generally does an excellent job of treating complex medical conditions, it does a relatively poor job of addressing the general population's basic health needs, Moss said.
"If you have a premature newborn with esophageal atresia and congenital heart disease, this is the best country in the world hands down to receive care," he said. "But if you're a kid with asthma living in the inner city or you're [among] the 99% of kids in this country without complex medical problems, you're arguably in the worst country in the developed world to receive healthcare, and your health outcomes are worse than most other developed countries on the planet especially when you look at the amount we spend trying to achieve those outcomes."
Moss used his presentation to explain the problem, as he sees it, and to outline the ways in which he aims to orient Nemours toward sustainable solutions.
He listed three big goals that guide his work:
1. To tout the power of investments in children's health.
As evidence that relatively small investments in health during childhood can return big benefits decades later during adulthood, Moss pointed to The Abecedarian Project, which began in 1972 at the UNC Frank Porter Graham Child Development Center.
Researchers on the project provided a full-time educational environment for 111 at-risk children, from their infancy through age 5, with individualized attention and activities around social, emotional, and cognitive development, with an emphasis on language skills. Participating children also received free on-site healthcare and nutritious meals.
In the years since, researchers have determined that participants in the project perform better academically, earn higher incomes, and have better health outcomes as adults. They determined, for example, that those who participated in the project have significantly lower prevalence of risk factors in their mid-30s for cardiovascular and metabolic diseases, according to a 2014 study.
The total cost of the five-year project was about $67,000 per child, when adjusted for inflation in 2002 dollars, according to the study.
"This is less than treating one adult with severe heart disease or lung cancer," Moss said. "Obviously, the return on that investment is outside the typical budget cycle of a hospital, and it's certainly outside of the election cycle for a politician, but it's very real."
While the short-term cost-reduction benefits of strategic investments in children's health may be modest, the longer-term possibilities are bigger and could lead to healthier generations of American workers, leading to greater economic stability and growth, Moss said.
2. To expand the nation's definition of 'health' in children.
Medical care represents only a fraction of what we should consider when we think about health, Moss said. The rest includes things like social determinants of health, in their various forms, including education, literacy, housing, safety, freedom from adverse childhood experiences, and other social factors.
That idea was foundational to the way Nemours approached a three-year $3.7 million grant it received in 2012 from the Center for Medicare & Medicaid Innovation (CMMI) to improve the health of children with asthma, rather than simply treat their asthma-related medical complications.
Nemours took patient-level actions, such as adding air conditioning units in the homes of kids with asthma, and community-level actions, such as facilitating asthma education efforts and striking a variety of partnerships to identify problems and solutions, Moss said.
"One of the nurses noticed that the metered-dose inhalers in our pharmacy didn't have any readers on them, so you couldn't tell when the thing was empty," Moss said. "There were many hospital admissions because the inhalers were empty and families didn't know that."
Nemours worked with the state agencies to change the formulary. That impacted more than 11,800 children, Moss said.
Nemours found out that school buses were idling outside the schools while waiting for kids, causing significant downstream health impacts and resulting in a number of hospital admissions and ER visits. The health system worked with schools to change that practice, impacting more than 14,000 children, Moss said.
"Simply turning the key and turning off the engines had an enormous impact," he said. "We wouldn't have learned that if we had focused on what happened to these kids after they were in the hospital."
Nemours also backed a smoke-free ordinance in the city of Wilmington, Delaware. That impacted more than 19,200 children, Moss said.
Altogether, the efforts contributed to some impressive results, he said:
60% reduction in asthma-related ER visits;
44% reduction in asthma-related hospital admissions; and
$2,100 reduction in annual medical costs per child.
These results are population-based data from the state of Delaware, Moss said. The details are outlined in a report published by the University of Delaware.
"We essentially changed the complexion of what it meant to have asthma in the region," he said.
"No new drug was introduced, no new genetic discovery was made, no major biological or physiologic change in the way that we treated these kids was made," he added. "We just implemented the social interventions that I talked about. This transformed what it meant to have asthma."
Partnerships are critically important in this process, Moss noted. Nemours is an expert on delivering medical care but not an expert in social services, so the health system sought to partner with agencies who are experts in addressing social needs and worked with them to help these children, he said.
3. To take on full risk for Nemours pediatric patients.
Regardless of what healthcare providers say about where they stand on value-based care or where they want to be, the reality is that health systems are generally still operating in a fee-for-service environment, Moss said.
"That's the world we live in right now," he said.
The irony of the current system is that improving health on the front end reduces demand for revenue-generating healthcare services down the line.
"Until you transform the economic incentives, you can't really transform the health system," Moss said. "We are currently incentivized to create the opposite of what we want, which is health. We're not incentivized for health. We're paid for volume of care and complexity of care, and that's what we're getting."
Even so, Moss said Nemours is committed to invest as heavily as it can afford to invest in its Value-Based Services Office (VBSO), which focuses on four prongs: medical management, data analytics and IT, population health management, and primary care. The goal is to move to full capitated risk for the patients Nemours serves.
Ultimately, the goal is to improve health for everyone.
"I've never met a single adult in my life who didn't use to be a kid," Moss said. "If we can transform a generation of kids, that's the next generation of us."
The HealthLeaders CEO Exchange annually gathers leading hospital and health system CEOs for a custom dialogue on only the critical issues facing the future of their organizations. The 2019 event was held September 25–27 in Park City, Utah. For more information on this and future events, please email exchange@healthleadersmedia.com.
The administration set a record in fiscal year 2017, beat it in fiscal year 2018, then beat it again in fiscal year 2019, with the goal of tamping down drug costs.
The Food and Drug Administration has again set a new record for generic drug approvals.
The FDA had 1,171 generic drug approvals in fiscal year 2019, including 935 full approvals and 236 tentative approvals, according to a report updated Wednesday.
That surpassed the previous record of 971 approvals in fiscal year 2018, which had surpassed the record 937 approvals in fiscal year 2017.
"Three record-setting years of generic drug approvals by the FDA are playing a major role in delivering lower prices and more access to prescription drugs, as evidenced by a historic drop in the Consumer Price Index for prescription drugs," Health and Human Services Secretary Alex Azar said in a statement.
"We congratulate the hard-working men and women of the FDA on the results of their work, which protects and improves the public health by ensuring the safety of our drug supply and boosting competition that drives prices down," Azar said.
"Lower drug prices are an important part of delivering American patients the affordability they need and, ultimately, promoting better health," Azar added. "President Trump will continue to work to put American patients first through competition, negotiation, lower list prices, and lower out-of-pocket costs."
The administration's focus on generic drugs, which account for about 90% of all prescription drug purchases in the U.S., is part of an effort to tamp down drug prices. The FDA's efforts are outlined in a Drug Competition Action Plan.
"We're encouraged to see that the pipeline of generic drug applications is strong and that there is ongoing interest in the development of generic versions of complex drugs and of other drugs with inadequate generic competition," Acting Commissioner of Food and Drugs Norman E. "Ned" Sharpless, MD, said in a statement.
"In the coming months, we plan to publish additional guidances and take other important policy steps to assist generic drug applicants, including planning additional conferences on generic drug development to further engage with stakeholders and generic drug developers," Sharpless said. "We will continue to do all that we can to facilitate a stable, competitive market to increase access to medicines."
The two nonprofit health systems signed a definitive agreement to merge, less than a week after another major New Jersey health system announced parallel acquisition plans of its own.
Englewood Health will become part of Hackensack Meridian Health, if state and federal regulators sign off on a definitive agreement reached by the two New Jersey health systems.
The nonprofits, which have had a clinical and academic affiliation since 2015, announced the signing of their merger agreement Tuesday. The deal, they said, was struck in response to shifting industry dynamics and in an effort to improve local care delivery.
"As a healthcare system, we need to continuously evolve in order to provide our community with increased access to high-quality care and more specialties and services, close to home," said Englewood Health President and CEO Warren Geller in a statement. "This decision is about building the most efficient, most effective health system possible to benefit the communities we serve."
The merger means a hospital that has operated independently in the area for 130 years will join one of the two large health systems that have grown to dominate New Jersey's market, as Lindy Washburn reported for the North Jersey Record. Less than a month ago, Hackensack Meridian announced a partnership with St. Joseph's Health, and a year ago, the system merged with Carrier Clinic, as the Record reported.
The state's other large health system, RWJBarnabas Health, announced just last week that it is in talks to acquire the 554-bed Trinitas Regional Medical Center, a Catholic hospital in Elizabeth.
Closer ties with Hackensack Meridian's medical school will help Englewood become a tertiary academic hub for the region, the organizations said.
As part of the deal, Hackensack Meridian Health has agreed to invest $400 million in capital for Englewood Health.
Hackensack Meridian Health currently has 17 hospitals, including three academic medical centers, two children's hospitals, nine community hospitals, two rehabilitation hospitals, and a behavioral health hospital. The system employs about 35,000 people.
Englewood Health has one 531-bed hospital, more than 3,400 employees, the Englewood Health Physician Network, and the Englewood Health Foundation.
The decision comes as the Trump administration seeks to supplant the Obama-era rule with a version that excludes gender identity protections.
A federal judge in Texas ruled Tuesday that a rule the Obama administration finalized in 2016 to prohibit gender identity discrimination in healthcare violated the Administrative Procedure Act (APA) and the federal Religious Freedom Restoration Act (RFRA).
U.S. District Judge Reed O'Connor's decision came more than two and a half years after he issued a preliminary injunction in the case to prevent the government from implementing the policy, which is based on Section 1557 of the Affordable Care Act.
O'Connor—the same federal judge who ruled late last year that the entire ACA is invalid—vacated the 2016 rule and sent it back to Health and Human Services for further consideration.
"The Court granted HHS two years to complete its review and amend the Rule at issue," O'Connor wrote in his order. "Despite HHS's better efforts, the rule remains on the books."
Under the Trump administration, the HHS Office for Civil Rights has moved to supplant the Obama administration's reading of Section 1557, which prohibits discrimination in certain health programs on the basis of several characteristics, including sex. While the prior administration had interpreted the statute as implicitly prohibiting discrimination on the basis of gender identity or termination of pregnancy, the current administration proposed its own rule last May that interprets sex discrimination more narrowly.
Some healthcare providers had complained that the Obama administration's interpretation of the ACA's nondiscrimination provisions would coerce them into providing healthcare services that contradicted their own medical judgment regarding what care their patients need, such as services related to gender affirmation or transition.
The Becket Fund for Religious Liberty—which represents plaintiffs Franciscan Alliance Inc., the Christian Medical and Dental Society, and Specialty Physicians of Illinois LLC—said in a statement Tuesday that O'Connor's decision means doctors who object to performing gender-transition procedures cannot be forced out of the profession.
"It is critically important that doctors are able to continue serving patients in keeping with their consciences and their professional medical judgment, especially when it comes to the personal health choices of families and children," said Becket vice president and senior counsel Luke Goodrich in the statement. "Doctors cannot do their jobs if government bureaucrats are trying to force them to perform potentially harmful procedures that violate their medical and moral judgment."
"Our clients look forward to joyfully continuing to serve all patients, regardless of their sex or gender identity, and continuing to provide top-notch care to transgender patients for everything from cancer to the common cold," Goodrich added.
When the Trump administration's proposal was released, HHS OCR Director Roger Severino said the change was needed to bring federal policy into compliance with federal law, but he acknowledged that the dispute over what precisely constitutes sex discrimination is pending before the U.S. Supreme Court. The justices heard oral arguments last week over whether Title VII's prohibition of employment discrimination "on the basis of sex" includes sexual orientation and gender identity. The outcome of that case could color the way HHS must interpret other nondiscrimination laws.
"We intend to abide by the injunction and are committed to vigorously enforcing all of the civil rights laws as entrusted to us by Congress, before, during, and after any rulemaking," Severino said in a statement released in response to HealthLeaders' questions.
A spokesperson said HHS OCR is carefully reviewing public comments on the Trump administration's proposed rule.
O'Connor's decision says it severs the plaintiffs' APA and RFRA claims from their claims related to Title VII, the Spending Clause, and the First, 10th, and 11th Amendments to the U.S. Constitution. He stayed the case as it relates to those severed claims.
The decision to vacate the 2016 rule drew condemnation from LGBTQ rights advocates. Tyunique Nelson, a YouthResource activist who identifies as nonbinary, said their right to healthcare shouldn't even be up for public debate.
"As trans and gender-nonconforming young people, it's bad enough every day we have to deal with people who violate our rights and treat us as lesser human beings," Nelson said in a statement released to HealthLeaders. "Allowing health care providers to deny us care is a danger to our health and a direct threat to our lives. I have the right not to experience discrimination when I'm going to the doctor, and so does every other trans and gender-nonconforming young person."
During oral arguments, multiple judges said repeatedly that the government's arguments appear to go beyond the law.
Three federal appellate judges who heard oral arguments Friday in a dispute over Medicaid work requirements sounded skeptical of the Trump administration's position, suggesting they may be inclined to agree with a lower court's decision to toss out the government's approvals of such requirements.
The case at hand deals with only two states, Kentucky and Arkansas. But there are similar legal challenges to Medicaid work requirements in two others, New Hampshire and Indiana, as well. And the administration has approved requirements in at least five more states, with nine additional applications pending, according to the Kaiser Family Foundation.
Proponents of the work rules argue they help beneficiaries climb out of poverty by giving them stronger incentives to find gainful employment and advance the government's interest in operating Medicaid in a cost-effective way. But detractors argue the policies push vulnerable people off of government-sponsored health plans and aren't rooted in the Medicaid program's purpose.
Pushing back against an argument raised by an attorney for the government, Edwards suggested that the U.S. Department of Health and Human Services appears to be advancing its own priorities beyond those enacted by Congress, as Alexandra Marquez reported for McClatchy's D.C. Bureau.
"You're looking for objectives that are not in the statute," Edwards reportedly told the attorney, Alisa B. Klein.
Klein likened the work requirements in Medicaid to those in other programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). Sentelle, however, said the comparison is weak because Congress approved work requirements for SNAP and TANF but didn't do so with the Affordable Care Act and its Medicaid expansion, as McClatchy reported.
Friday's hearing came a day after the U.S. Government Accountability Office released a report finding that the Centers of for Medicare & Medicaid Services had failed to consider the administrative costs of implementing Medicaid work requirements.
Five states gave the GAO estimates of their administrative costs. Their estimates ranged from more than $6 million in New Hampshire to nearly $272 million in Kentucky, according to the report. Altogether, the five-state total estimate was more than $408 million.
The GAO recommended that CMS account for a state's projected administrative costs in assessing whether a state's Medicaid work requirements would be budget neutral. But the agency disputed the GAO's methodology and rejected its conclusion.
Trinitas Regional Medical Center, an acute care teaching hospital, provides care throughout the state. It will retain its Catholic identity.
RWJBarnabas Health, based in West Orange, New Jersey, has signed a letter of intent to acquire Trinitas Regional Medical Center, a 554-bed acute care Catholic teaching hospital in Elizabeth, New Jersey.
The organizations announced the letter's signing Thursday and said they expect to reach a definitive agreement by the end of the year to make Trinitas and its affiliates—which provide healthcare services throughout New Jersey's 21 counties—into the RWJBarnabas Health organization.
Trinitas, which formed as the result of a merger between Elizabeth General Medical Center and St. Elizabeth Hospital in 2000, would continue to be a Catholic institution that abides by the Catholic Ethical and Religious Directives, according to the announcement. It would continue to be sponsored by the Sisters of Charity of Saint Elizabeth, served by the Elizabethtown Healthcare Foundation, and overseen by the Trinitas board.
"I see our eventual move into the RWJBarnabas Health system as an extremely positive and exciting development for our institution—one that will give us the resources and opportunities to greatly enhance the already high level of care we provide to our community," Trinitas President and CEO Gary S. Horan, FACHE, said in a statement.
RWJBarnabas Health President and CEO Barry H. Ostrowsky said his team is excited to collaborate through this potential deal.
"The rapidly changing health care landscape presents new challenges and opportunities," Ostrowsky said in the statement. "Trinitas is a vital resource to the eastern Union County community, and through this agreement we would greatly expand our reach into new communities with our mission of improving the health and well-being of its residents."
RWJBarnabas Health includes 11 acute care hospitals, three acute care children's hospitals, and a pediatric rehabilitation hospital, among many other facilities. It also partners with Rutgers University to create an academic health care system.
The transaction would require approvals from state and federal officials and the Catholic Church.
The health system's top executive wants to relieve patients of unnecessary paperwork. But don't mistake him for a simple technophile.
Atlanta-based Piedmont Healthcare has more than twice as many hospitals today as it did when President and CEO Kevin Brown joined the organization six and a half years ago.
In expanding from five to 11 hospitals, the nonprofit health system has taken an aggressive but tactical approach, Brown said. That approach has taken stock not only of operational opportunities and cultural compatibility but also of the potential friction that tech tools can alleviate or cause.
With each growth spurt, Piedmont has prioritized moving to a unified electronic health record system because cultural and operational integration are really difficult to achieve without that common foundation, Brown said in Boston last month, during a panel discussion at the Kyruus Annual Thought Leadership on Access Symposium (ATLAS).
Having a common platform allows Piedmont to roll out a variety of patient access tools, such as online self-scheduling, to meet consumer expectations and improve the overall experience while still giving physicians the support they need, Brown said.
But there's still plenty of work to do, including some seemingly minor tweaks to the way a doctor's office has historically been run.
"I've got a personal goal this year to eliminate clipboards," Brown said during the ATLAS discussion.
It's not that there's anything inherently wrong with clipboards. It's just that they're often redundant in an organization that has invested so much into being completely electronic, Brown said.
"Patients come into our clinics, they get six pages of forms to fill out that duplicate everything that is already in the system," he said.
Pick Solutions, Not Pet Projects
Banishing the clipboard is a simple goal, and it's one Brown hopes will advance Piedmont's efforts to improve the patient experience through technology. But don't mistake him for some technophile who's easily wowed by the latest digital doodad. Under his leadership, Piedmont has sought to remain picky in selecting which tech to adopt—just as it has sought to remain choosy when vetting potential M&A partners.
Piedmont could have grown much faster, to include as many as 28 hospitals by now, but the system has turned away 17 individuals that sought to join the organization, Brown said.
"We said no because their culture didn't match, they weren't focused on the patient, they were looking for someone to be a bank and not a partner in health," he said, "so we've been very selective about our growth, yet we've grown very aggressively."
Similarly, health systems are bombarded with a glut of offers from firms peddling tech solutions. The challenge, Brown said, is picking only those options that work with Piedmont's core systems and make a difference for patients, not just some pet project.
"There's a million apps, there's a million devices, there's a million disruptors out there that are taking little pieces and parts," Brown said. "The trick is, how do we pick the right ones to make sure that it integrates into the systems that we have?"
Every group within an organization will propose solutions that might work well for their individual teams or departments, but system-level leaders need to ensure that any technology the organization adopts ties back to the overall strategic vision, Brown said.
"We're trying to eliminate the number of systems we have, not add to it, because healthcare is way too complex," he said.
Expect Some Sputtering
When they launched a virtual app for primary care visits about four years ago, Piedmont's leaders thought they were ahead of the curve, Brown said. Now pretty much every health system has a platform for virtual primary care, and some of them are seeing lackluster results.
Piedmont's platform, powered by nurse practitioners, costs $49 and is available anywhere in Georgia, but it had few users last year, notching only about one visit per day, Brown said.
"It's available, we promote it, we push it. It really just has not taken off," he said.
"I've used it myself. My family has used it, my kids have used it. We're the one-a-day, I think," he added with a chuckle, suggesting that patients may simply prefer to see their doctor face-to-face.
"I think there's something about the personal interaction with the clinician that's never going to go away. There's always going to be that comfort and that compassion that our clinicians have and people want to have in their interaction," he said.
ChristianaCare Health System President and CEO Janice E. Nevin, MD, MPH, who participated in the ATLAS discussion with Brown, said her organization has had a more successful experience with its virtual primary care platform by treating it not just as a supplement but as the Patient-Centered Medical Home (PCMH) itself.
"Patients, our employees that have dependents, have the chance to sign up. They get their care virtually and are only directed to see someone or to a facility when there's a very specific need identified," Nevin said.
Secure text messaging accounts for two-thirds of the interactions through the virtual primary care platform, followed by secured video visits and very few in-person visits, she said.
Brown said his market differs from the one ChristianaCare serves but that he sees virtual care as an important long-term strategy.
"I do think it's going to explode at some point because I think the younger generation is more adept to use it," he said.
Piedmont has already found some virtual care success, Brown noted, through a virtual hospitalist program that serves rural hospital patients.
The group will host public discussions and shape future efforts to improve access, quality, affordability, and innovation.
William F. Carpenter III, former chairman and CEO for LifePoint Health, based in Brentwood, Tennessee, will co-chair a healthcare "modernization task force" in the state that has been called "the Silicon Valley for healthcare companies," officials announced this week.
Carpenter and his co-chair, Tennessee Department of Finance and Administration Commissioner Stuart McWhorter, will lead a team of state lawmakers and healthcare executives as they host public discussions to drive the state's efforts to improve healthcare access, quality, affordability, and innovation in the state, according to the announcement.
Carpenter said he is honored to support the task force under Gov. William Byron Lee, a Republican and longtime businessman who was elected in 2018.
"This is a great opportunity to leverage our state's deep bench of health care expertise and bring people together to share knowledge and ideas, and bring innovative solutions to our state's health care delivery system," Carpenter said in a statement.
With a non-binding vote a year ago, shareholders expressed disapproval of more than $120 million in golden parachutes for the company's departing executives. But the terms of the compensation package would be paid out anyway, a company spokesperson told HealthLeaders when the deal closed.
Carpenter was a founding employee when the company formed in 1999. He had served as CEO since 2006 and as board chairman since 2010.
In addition to members from the Tennessee General Assembly, the task force includes a number of other healthcare executives and community leaders:
Mike Carrigan, MD, FACP, FACPE, CPE, Chief Administrator, Premier Medical Group
James Bailey, MD, MPH, FACP, Professor and Director, Center for Health System Improvement, Robert S. Pearce Endowed Chair in Internal Medicine, University of Tennessee Health Science Center
Brian DeBusk, PhD, MBA, First Vice-Chairman, Board of Trustees, Lincoln Memorial University
James E.K. Hildreth, PhD, MD, President, Meharry Medical College
Melanie Keller, RN, BSN, MHA, CEO Meritan, Inc.
Mary Kiger, MPP, Executive Director of TN Charitable Care Network'
The two proposed rules from HHS OIG and CMS aim to make it easier to provide value-based care without running afoul of self-referral and anti-kickback laws.
With a pair of proposed regulations, the U.S. Department of Health and Human Services delivered a highly anticipated overhaul Wednesday of the regulations that interpret the Stark Law and federal Anti-Kickback Statute.
The proposals—which were released by the HHS Office of Inspector General and the Centers for Medicare & Medicaid Services, respectively—aim to make it easier for healthcare providers to coordinate care and offer value-based arrangements, according to HHS officials. The duo of proposals would both reduce the burden of compliance and maintain strong safeguards against fraud and abuse, the department said.
HHS Secretary Alex Azar said government regulations have too often blocked physicians from providing affordable and personalized care.
"Our proposed rules would be an unprecedented opportunity for providers to work together to deliver the kind of high-value, coordinated care that patients deserve," Azar said in a statement praising President Donald Trump's commitment to regulatory reform.
HHS Deputy Secretary Eric Hargan called the proposed rules "a historic reform."
"They are part of a much broader effort to update, reform, and cut back our regulations to allow innovation toward a more affordable, higher quality, value-based healthcare system, while maintaining the important protections patients need," Hargan said in the statement.
Hargan said in January that HHS was in the final stages of updating the regulatory framework around the physician self-referral and anti-kickback laws, and CMS Administrator Seema Verma said in May that she hoped the update would come by the end of this year, in response to providers' calls for greater flexibility.
"We serve patients poorly when government regulations gather dust in the attic: they become ever more stale and liable to wreak havoc throughout the healthcare system," Verma said in the statement.
Administrative costs are pushing overall healthcare costs higher, but the Stark overhaul will help to bring those administrative costs down, she said.
The CMS proposal would create new and permanent exceptions to the 30-year-old Stark Law for value-based arrangements, permitting physicians and other providers to try innovating solutions without fear that their legitimate efforts to coordinate care might violate the law, according to an agency fact sheet. Those new exceptions would apply for Medicare and non-Medicare populations alike.
The HHS OIG proposal would create three new safe harbors for certain forms of remuneration among eligible participants in value-based arrangements and make other changes, according to an OIG fact sheet.
Both CMS and OIG are soliciting public comments on the details of their proposals and related matters.
The hearing, which pertains directly to Kentucky and Arkansas but which could have broader consequences, will take place before a three-judge panel.
The dispute over whether the Trump administration overstepped its legal authority in approving Medicaid work requirements for Kentucky and Arkansas will be back in a federal courtroom this week, this time at the appellate level.
U.S. District Judge James Boasberg ruled last spring that Health and Human Services officials failed to adequately consider what effect the policy would have on coverage in the two states. Boasberg blocked the government's approvals of those Medicaid work requirements, and the government appealed.
Oral arguments in the appellate dispute are scheduled for Friday morning at the D.C. Circuit Court of Appeals, where attorneys for each side will have 20 minutes to make their case, according to the court's calendar.
Friday's arguments pertain specifically to Kentucky and Arkansas, but the government's attorneys acknowledged in a letter to the court last week that there are two similar cases following behind. Boasberg, who was appointed in 2011, blocked Medicaid work requirements in New Hampshire in July, and he's presiding over a challenge to similar rules in Indiana.
Boosters of these requirements argue the policies help beneficiaries climb out of poverty by giving them stronger incentives to find employment.
Centers for Medicare & Medicaid Services Administrator Seema Verma told HealthLeaders earlier this year that Medicaid work requirements align with a "whole person" approach to healthcare.
"There's a lot of discussion about the social determinants of health, and in order to improve health outcomes, we have to look at the person holistically and address those social issues," Verma said. "Part of that is finding employment."
Opponents of the policies, however, have expressed concerns that the added hurdles will simply bar more poor people from coverage.