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Outgoing Better Medicare Alliance CEO on Where Federal Health Policy Will Go

Analysis  |  By Jack O'Brien  
   March 18, 2021

Allyson Y. Schwartz, former congresswoman and CEO of Better Medicare Alliance, reviews the Biden policy agenda and what healthcare executives should expect from Capitol Hill this year.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Finance Podcast. Audio of the interview can be found here.

Despite a new presidential administration and change of control in Congress, healthcare remains a contentious issue on the federal level as the nation reels from the impact of the COVID-19 pandemic.

To help parse through the chatter is Allyson Schwartz, who served as a member of the U.S. House of Representatives from 2005 to 2015 and previously worked as a health service executive.

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In recent years, Schwartz has been at the helm of the Better Medicare Alliance, a nonprofit 501(c)(4) advocacy and research group supporting Medicare Advantage, even calling it "the future of Medicare."

Medicare Advantage has surged in popularity in recent years, not only among the insurer community but also among employers and patients alike. To navigate a challenging environment, healthcare leaders need to be able to adapt to changing consumer preferences and emerging market drivers.

Schwartz reviews the Biden policy agenda and what healthcare executives should expect from Capitol Hill this year.

HealthLeaders: Congresswoman, you were on Capitol Hill for a decade, so what are your expectations for how this Congress and the Biden administration will approach healthcare policy? In what areas do you expect to see action take place and how should healthcare leaders prepare for these potential changes?

Schwartz: Healthcare continues to be a top-of-mind policy issue for the Biden administration and for Congress. The [presidential] candidates ran on and talked about healthcare, so it's going to be an important part of the agenda. With COVID-19 persisting, the importance of getting control of the pandemic itself is going to be [crucial] for this administration and for Congress.

You're seeing that in early action, making sure that there are adequate vaccines and that vaccinations are distributed fairly and effectively, as well as making sure that the healthcare industry itself is strong and able to provide needed services.

At Better Medicare Alliance, we have been clear and attentive to what's going on during COVID and how Medicare Advantage itself has driven a more prepared response for seniors and other Medicare beneficiaries during the pandemic.

On the Biden administration and Congress, it's a Democratic House and Senate, both narrowly so, and [any] legislation that gets done will have to be crafted carefully, either to get all Democrats on board or to actually bring in some Republicans, which we all know is [President] Biden’s preference.

In addition to COVID, [other priorities] will [include] fixing the ACA and being responsive to the newly uninsured due to the pandemic and economic downturn. Expanding eligibility and making sure that the exchanges are healthy will be a top priority.

[Additionally,] expanding Medicaid, particularly in states where they've not done Medicaid expansion yet. Doing those two things will address one of the concerns that Democrats have: make sure that healthcare is as universal as it can get and be built on the chassis of the ACA, Medicaid, and Medicare.

While it is not exactly clear where the Biden administration stands on Medicare Advantage, we know that they value the drive to value-based care and want to maintain the promise of Medicare. We expect all the guarantees of Medicare to continue, and to be respectful of the fact that Medicare Advantage now [covers] 42% of all beneficiaries; in some congressional districts, it's over 50% or 60%. So, you're looking at strong growth and enrollment in Medicare Advantage that is working for beneficiaries.

HL: You have been deeply involved in healthcare policy both as a lawmaker and public advocate, so what have been the most meaningful changes to the industry over the course of your career and where is there still room for improvement?

Schwartz: There's always room for improvement and learnings from what we've done; I was on the [House] Ways and Means Committee and was involved in crafting [the ACA] and getting it passed, and I’m certainly proud of the effectiveness and protecting people with preexisting conditions.

I was also a leader in recognizing the important role of primary care and the ability to improve care delivery by focusing on primary care, on integrated care, and pushing care coordination, and recognizing that the needs in healthcare itself have shifted for seniors. [This is] not to exclude acute episodes of care, obviously that is always a concern we want to provide certainty around the big moments in healthcare, but for so many seniors, it's about managing chronic conditions and recognizing that is where so much of the high-risk, high-cost, high spending is in Medicare.

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It’s been a part of my life's work to assure both access to coverage, but then [also] to move the system of healthcare from what has been increasingly recognized as a flawed fee-for-service system, one that incentivizes more procedures and maybe potentially unnecessary interventions, to have a more value-based system, one that appreciates the need for providers to be working together in a more integrated way.

HL: Are you bullish or bearish on healthcare's forward-looking prospects? Why or why not?

Schwartz: I always think we could make things better and it's hard not to be optimistic, even in spite of what has been a difficult year for everyone in this country and worldwide. But for the healthcare community, it's been stressful, difficult, and our thoughts, prayers, and appreciation go out to all those essential healthcare workers who have been steadfast and innovative in their ability to survive and thrive in this particular pandemic that has been so persistent. The scientific community has stepped up and we thank them as well.

For healthcare, I think it's absolutely correct for us to look at what are the lessons learned, what else can we be doing, and what should we be doing?

The top of that agenda is certainly telehealth; the use of telehealth to get people the healthcare they needed [during the pandemic] was just extraordinary. The numbers are amazing; we had some providers who talked about moving from a few hundred [virtual visits] to tens of thousands of beneficiaries. [However,] it’s important to understand that not everyone has the access to the technology we need, some don't have the access to broadband because of where they live, some don't have the finances or the personal skills to be able to handle technology.

We must make this technology simpler, easier to use, and more available. We can't rely on the most sophisticated video chat functions; we need to be able to drill down to make it readily available to many more people.

HL: What was the reason behind your departure from Better Medicare Alliance? Are there plans after you leave the organization?

Schwartz: Well, I’m proud of the work that I've done by taking what was a concept six years ago to what is now, a fully grown organization with 156 allied organizations across the spectrum. It's not always easy to bring together so many different stakeholders, [including] health plans, provider organizations, large systems, primary care groups, community partners, professional associations, and entrepreneurs, all of which are represented within Better Medicare Alliance.

Related: Pandemic Delays Federal Probe Into Medicare Advantage Health Plans

Finding that common ground, which is the interest in Medicare Advantage, [has fueled] the excitement about how Medicare Advantage is an integrated system of care that is transforming care delivery for seniors and Medicare beneficiaries, addressing some social risk factors and inequities, and bringing an integrated system of care to the fore.

We're on [Capitol Hill,] we're engaging with policymakers, and I think it was a moment in time when it was a chance to leave the organization as strong and influential as it could be. I wish Better Medicare Alliance well. I'm going to be around until the end of June, I wanted to give the organization a chance to go through a transition, and I look forward to new opportunities for me.

HL: What parting advice or message would you give to our audience of hospital and health system leaders as they emerge from the pandemic and plot a recovery path forward?

Schwartz: This is known, but it's certainly not easy to change our healthcare system. I'm respectful of the healthcare industry, and hospitals, and payers [and] encourage them to think about the future and embrace this notion of how we can get better care at a better cost to the consumer.

Keep quality in mind; this is not only about access, but it is about quality, which has to include questions about ‘Are we keeping people safe? Are we keeping people in outpatient settings and are we in communities that need us?’

Sometimes we must go to the consumer more than we might have thought of and recognize that the focus is on medical and clinical care itself. Recognizing the social determinants of health and engaging with those community partners in moving some services into the home or the community setting is going to be extremely important for us to be able to provide the kind of excellence of care, that also addresses the needs and expectations of seniors and of all of us going forward.

That's taking a bit of transformation and more financial risk. Driving care delivery in new ways and being open to doing that. I think that's true about behavioral health and some of these other social [factors] and mental illness. These are issues that have often been set kept separate and need to be brought into the fold.

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


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