- Improving patient choice, cutting healthcare costs, and supporting consumer-centered care design are key action areas for the Department of Health & Human Services, the agency said in a recent report.
The report, “Reforming America’s Healthcare System Through Choice and Competition,” outlined the bureaucratic hurdles that HHS said litter the healthcare industry and create logistical or financial barriers to patient care.
“Health care bills are too complex, choices are too restrained, and insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue,” HHS Secretary Alex Azar wrote in a letter to President Trump introducing the report. “Health care markets could work more efficiently and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition.”
The report, which was written in partnership with the Departments of the Treasury and Labor, the Federal Trade Commission, and several offices within the White House, specifically looked at how choice and competition could fuel improvements in care quality while cutting patient and government healthcare costs.
“The United States healthcare system increasingly imposes a bewildering array of complexity and inefficiency on consumers, employers, workers and taxpayers while powerful institutions that benefit from the status quo resist efforts at reform,” the relevant agencies wrote in the report’s introduction.
“Moreover, our nation’s healthcare system is encumbered with mandates and regulations that raise costs, decrease competition, and sometimes do little on net to improve the nation’s health. These inefficiencies, mandates and regulations contribute to higher costs and higher health insurance premiums.”
Improvement areas were broken into four central categories.
First, the agencies outlined how regulatory changes could fix challenges with the healthcare workforce and labor markets. The United States is currently staring down a considerable provider shortage – the nation could be short up to 120,000 providers by 2030, according to 2018 data from the Association of American Medical Colleges.
Provider shortages limit patient access to care and decreases industry competition. In turn, costs increase, HHS said. Previous government regulations have restricted scope of practice, the agency added.
The healthcare industry and policymakers should consider broader scope of practice rules as well as the use of health IT tools such as telehealth. Additionally, allocation of taxpayer funds to promote better graduate medical education opportunities could supplement the medical workforce.
Next, the report looked at healthcare provider markets and the impacts that Certificate of Need documents have on competition. A Certificate of Need (CON) is a document certified by a state agency that gives a provider permission to build a new healthcare facility, expand an old one, or offer certain services.
Although CONs were intended to improve patient access to care and cut costs, evidence suggests that they have not fulfilled those purposes, HHS reported. As such, the agency recommended states repeal or scale back CON laws.
Additionally, HHS recommended introducing better value-based care reimbursement that does not place undue burden on smaller or rural providers.
Health insurance markets must also be freed of government regulations, HHS asserted. Government requirements for individual health plans have reduced competition while creating products that have features that consumers may not want or need.
This introduces an expense that does not necessarily improve a consumer’s life, HHS said.
“Regulations that limit coverage choices should be changed so that states have more flexibility to develop policies that account for diverse consumer preferences,” Secretary Azar wrote in his letter. “This report recommends scaling back government mandates, eliminating barriers to competition, and allowing consumers maximum opportunity to purchase health insurance that meets their needs.”
Finally, increasing patient financial responsibility will empower patients to seek out the best-value service and incentivize them to price shop and compare, HHS said. The HHS report suggested promoting health savings accounts (HSAs) to give consumers more control of their healthcare expenditures.
Additionally, HHS promoted the use of reference pricing, price transparency tools, and quality transparency tools to empower patients to make informed healthcare decisions.
HHS has already begun some of its work to deliver on promises of lower healthcare costs, more competition, and more consumer choice, Azar said in his introductory letter.
August 2018 rules allowed for more short-term insurance options that come with lower premiums but fewer protections and significantly higher deductibles. A June 2018 rule also allowed for the creation of association health plans, which offer similar coverage.
The May 2018 drug pricing blueprint outlined the agency’s efforts to curb the growing cost of prescription drugs, although critics of the report stated it raised more questions than answers.
Additionally, changes to the 1332 waiver program allows states to make more customized changes to Affordable Care Act (ACA) regulations.
Carrying out these newly-outlined guidances will require strong change management in HHS and the rest of the administration, Azar said.
“While American consumers and many providers would significantly benefit from the reforms laid out in this report, there are entrenched and powerful special interest groups that reap large profits from the status quo,” he concluded in his introductory letter. “It will take bold leadership to confront these incumbents and implement reforms, but under your direction, we are convinced we can significantly improve the American health care system.”
“The American Association of Nurse Anesthetists (AANA) applauds the impressive message the report sends to policymakers, the medical profession, allied health professionals, and the public about the need to fully utilize all healthcare professionals to ensure patient access to the widest possible spectrum of safe, affordable healthcare options,” said AANA President Garry Brydges, DNP, MBA, ACNP-BC, CRNA, FAAN.