The former acting CMS administrator says his focus now is on using all available tools, from public policy advocacy to venture capital, to solve big problems.
This article appears in the November/December 2019 edition of HealthLeaders magazine.
Andy Slavitt, MBA, has firsthand experience at the helm of the Centers for Medicare & Medicaid Services, having served as the agency's acting administrator for the second half of President Barack Obama's second term. But don't bother asking him about his successor's approach to the role.
Slavitt has plenty to say about the Trump administration, which he criticizes frequently and accuses of sabotaging the Affordable Care Act. When asked about the job performance of current CMS Administrator Seema Verma, however, he demurs.
Slavitt says he makes a point to avoid commenting on individual officials, with the exception of President Donald Trump himself.
"I think some of this is just the tradition of allowing your successor the breadth and the run room to succeed," Slavitt tells HealthLeaders. "I'm happy to talk about the issues."
Slavitt acknowledges that some of the Trump administration's healthcare policymaking may bring positive results. The efforts to increase transparency around drug pricing and the contracts hospitals negotiate with insurers, for example, could prove beneficial even if their impact falls short, he says.
"It's not entirely clear that making prices more transparent is going to bring down costs. It may bring up costs. And it's not entirely clear that it's readily interpretable by consumers," Slavitt says.
"All steps are helpful because there's no one silver bullet," he says. "But I'm going to say that I don't believe the administration is doing nearly enough to grasp the challenge that most Americans face when affording their healthcare."
His Advice for Presidential Hopefuls
Slavitt says the Democratic candidates campaigning for the White House in 2020 need to differentiate themselves from the Trump administration's approach to healthcare policy. The starkest contrast between those two options centers on preexisting conditions, he says.
"I think it's important to remember that the choice the country has to make today is not a choice between Medicare-for-All and some other form of universal coverage," he says. "It's between a party that is focused on indeed allowing everyone to have access to affordable healthcare and a party that wants to end preexisting condition protections and repeal the ACA, and I think that is a major contrast that is going to be at the heart of the 2020 election."
Republican politicians, including the president, have voiced support for protecting people with preexisting conditions. The rhetoric was especially prevalent on the campaign trail ahead of the 2018 midterm, as voters cited healthcare as their top concern. But the preexisting condition protections in the legislative proposals brought forward thus far by the GOP have generally been less generous than the ACA's protections, and the Trump administration has argued before a federal appeals court that the entire ACA is invalid.
Does that mean Republicans are disingenuous when they claim to support preexisting condition protections despite opposing the ACA?
"I think they read polls," Slavitt says.
"I think they recognize that they have to say they're not in favor of taking preexisting condition protections away. But I think the American public is probably smarter now than it ever was before about looking at votes, not quotes," he says. "And I think the Republicans have a very difficult case to make, given their position on the lawsuit to repeal the ACA, given all of the repeal votes they've taken without any valid replacement, without having a plan."
"I would say there are probably some Republicans who believe that people should be able to not be discriminated against for having a preexisting condition, but I have never seen it in any Republican policy yet—and I don't say that with any joy," he adds. "I wish that weren't the case."
His Problem-Solving Motivations
Slavitt, who has worked as a Goldman Sachs investment banker and a McKinsey & Co. strategy consultant, says he got his start in healthcare when his former college roommate died of a brain tumor in 1998. His widow and their kids moved in with Slavitt and his wife shortly after they married.
The following year, Slavitt founded a company focused on trying to help people who were underinsured or lacked health insurance altogether. That company, Health Allies, was acquired in 2003 by UnitedHealth Group, where Slavitt worked in a variety of leadership roles, including group executive vice president for Optum, until he took a job with the federal government to fix HealthCare.gov amid a sputtering rollout.
"I think what motivates me today is I ask myself the question, 'What could be different in this country 10 years from now, and what can we be working on today to get there?' " Slavitt says.
"When I left the Obama administration, I was 50 years old, and I decided that instead of looking through the lens of 'What do I want to do every day?' or 'How much money do I want to make?' or even 'What kind of issues do I enjoy being involved with?' I decided to ask the question, 'What could I help change? What problems could I help solve?' " he says.
Upon returning to the private sector in 2017, Slavitt led town halls, where he spoke with people about the problems they experience in the healthcare system. Then he embarked on a mission to solve those problems, to advance healthcare equality and affordability.
"To do that, we need to focus on policy. To do that, we need to focus on innovation. To do that, we need to focus on the ecosystem of people who provide care," he says. "It's not one of those things. Unfortunately, in our system, it's all three of those things."
Hence his tripart approach:
- Influencing public policy: Slavitt is a founder and the board chair for the nonprofit policy foundation United States of Care, which aims to push for principles that will make healthcare affordable. The organization's founder's council includes some big industry players, including Haven CEO Atul Gawande, MD.
- Funding promising innovation: Slavitt is a founder and general partner for the venture capital organization Town Hall Ventures, which he says exists to support innovators who wish to meet the healthcare needs of lower-income communities and underserved populations.
- Shaping provider ecosystems: Slavitt is also working with AVIA and health system CEOs from across the country on the Medicaid Transformation Project, which aims to use digital tools and innovative care models to better serve vulnerable populations. The team has identified four "challenge areas": substance use disorder, women and infant care, and avoidable emergency department visits.
"We operate through several different platforms, but all really focus on the same end, which is how to do we get every American access to affordable healthcare that they can use to take care of their family," Slavitt says.
His Enjoyment and Aspirations
When asked whether he would like to return to a government job someday or perhaps run for public office, Slavitt says he feels like he's "sitting in the perfect place."
"I don't think I've ever really had political aspirations. I have deep, ambitious problem-solving aspirations," he says.
"What excites me is to be able to say, how do you take a problem like that, use all the tools in our tool chest, get innovators solving the problem, get policymakers to put out better policies, get health systems to change the way they practice, and bring a lot of attention to the problem and use that to deliver real results using everything, everything we have in this country and going all-out—kind of what I would call a 'shock-and-awe' approach to solving problems like maternal mortality," he says.
"But I don't kid myself. It's hard work. It requires a lot of involvement," he adds. "But among all of the other people, it requires somebody who will kick and scream and push all of the resources necessary to get these things done. That's what I'm enjoying doing."
Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.
Photo credit: Andy Slavitt, former acting CMS administrator, speaks during the 2019 Avia Network Summit. (Provided/2019 Avia Network Summit)
Democrats running for the White House need to focus on the stark contrast between what each of the two major parties are proposing, Slavitt says.
His multi-pronged approach aims to unleash 'shock-and-awe' solutions on healthcare's big problems, he says.