Bruce Siegel, MD, MPH, CEO of American’s Essential Hospitals led the first general session at the Vermont Association of Hospitals and Health Systems (VAHHS) Annual Meeting. Siegel represents the 300-some hospitals in the United States that receive referrals for services like trauma, burn care, neonatal ICU, emergency psychiatric care and disaster relief. University of Vermont Medical Center is among them.
Siegel began his remarks with an allusion to the “rollercoaster” of policy proposals in Washington D.C., as Republicans scramble to repeal and replace the Affordable Care Act. At the time of the VAHHS meeting, lawmakers were considering the Graham-Cassidy bill, which would replace current Medicaid funding with block grants to states, effectively moving money from states that had expanded the program to those states that had not.
“We have opposed the various Republican proposals that have come out before this one,” he noted. “If they had passed, experts posited that more than 20 million people would lose coverage over 10 years. The bills would have also substantially increased premiums for older people.”
The Graham-Cassidy bill, he said, would do even more damage.
“The Commonwealth Fund estimates that this proposal could lead to loss of coverage for more than 30 million people,” he explained. “It would end Medicaid as we know it; it would allow states to waive pre-existing condition rules. It’s even more dramatic than the other (replacement) proposals that came before it,” he remarked.
Siegel discussed a number of items under fire in Washington, including SCHIP coverage for children, which funds our Dr. Dynasaur program, and 340B proposals that could cut funding for prescription drugs in hospitals.
“Long term, I don’t know where we’re going with a lot of these things,” he noted. Folks like VAHHS will have to help members navigate events as they happen. I do think the movement to guided care, the movement to outcomes-based care, will continue. It may have a different emphasis in the future, but that train has left the station. Vermont is a tremendous leader in this type of thought.”
Our investment will continue to pay off, he said.
Ironically, he pointed out, the activity in DC has drawn the eye of the public toward Medicaid, making more people aware of how many individuals receive coverage through the program.
“Medicaid, based on state innovation will be an important driver,” he stated. He congratulated Vermont on its efforts to bring payers together to solve problems.
“The good news is that you have been focused on that in Vermont, where other states are only beginning to look at it. Population health and social determinants of health are more important than ever today,” he stressed.
Siegel described a recent survey by the Robert Wood Johnson Foundation, the results of which pointed to US readiness to walk down the path of population health. The survey asked hospitals what they saw as their role. Was it to improve the health of those whom they were actively treating? Was it to improve the health of all who used their hospitals? Or was it to improve the health of all people in a particular geographic area? He was encouraged to learn that the huge majority saw it as their duty to improve health within an entire region.
“We have come light-years in 25 years—we are better primed for moving ahead,” he said.
He expressed the progression of health care in three steps.
“Healthcare 1.0 is episodic, non-integrated care,” he explained. “Health care 2.0 is managing people in the optimal setting, reducing unnecessary care, providing the right care in the right intervals at the right time.”
He asserted that we are on our way to health care 3.0—integrated health care. To get there, we must begin doing something about the food, housing and other social determinants of health, building environments for those we serve that can support prolonged improvements in health.
“Housing can be a threshold issue,” he noted. “If families don’t have a secure roof over their heads, they can’t think about how to manage their health.”
Siegel gave several examples of how communities like Chicago, Baltimore and Detroit are learning to focus on health in all things.
“Labor relations, sustainability policies—they’re finding that everything they do has to be focused on health. We need to gather all this information (from work by communities throughout our country) and piece it together, crowd-sourcing it nationally. Many hospitals around the nation are saying, ‘We want to do this work. We don’t know where to start.’”
Siegel ended by saying he’s seen a lot more support for universal health care in recent days and expects that support to continue to grow.
He pointed to legislation that Vermont Senator Bernie Sanders recently introduced—it calls for Medicare for all.
“People didn’t take him seriously when he has introduced a similar bill in 2013,” Siegel remembers. “Who’s laughing now?” he said, noting that 15 Democrats, among them possible Presidential contenders, signed onto this year’s bill.
“That’s not trivial,” Siegel relayed. “They did that for a reason. This is a huge sea change, with big implications for the 2018 and 2020 elections.”
Of course, Siegel pointed out, that’s one side of a highly polarized divide. There’s still a huge debate about paying for health care in this country.
“Many Republicans have a long-standing feeling that Medicaid has to go away. They have promised to appeal Obamacare. They believe that if they don’t deliver on that promise, it will be disaster--their base will punish them. Nothing concentrates the minds of politicians like the fear of not getting not elected