Daily on Healthcare: Trump administration to experiment with paying healthcare providers based on results

TRUMP ADMINISTRATION TO EXPERIMENT WITH PAYING HEALTHCARE PROVIDERS BASED ON RESULTS: The Trump administration unveiled a new program Monday to pay primary healthcare providers based on patient health and outcomes rather than on specific services and procedures.

Health and Human Services Secretary Alex Azar announced that his agency would experiment with two new payment models to “test out paying for health and outcomes rather than procedures on a much larger scale than ever before.”

The goal of improving healthcare outcomes and lowering costs through value-based payments goes back across several presidencies and is considered an area of bipartisan agreement. Azar credited predecessors under the Obama administration when he rolled out the plan on Monday.

One of the plans involves paying primary care providers a flat fee per patient. If the patient stays healthy, the practice would receive a bonus. But if the patient does not, the practice must pay a penalty.

The second model applies to larger practices and allows them to voluntarily assume different risk level payments. Like the first model, the practices are paid based on patient outcomes. But practices will have more control over how the funds are spent, “allowing them to come up with innovative ways to care for patients, and receive significant savings if they keep patients healthier than expected,” Azar said.

Local entities could also be awarded funds to focus on a specific area, promoting positive patient outcomes on a local, community level.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at [email protected]. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.

HARRIS NOW SAYS PRIVATE INSURERS COULD PLAY A ROLE UNDER ‘MEDICARE FOR ALL’: Democratic presidential candidate Sen. Kamala Harris of California said in a CNN town hall Monday that she believed private health insurers should continue to play a supplemental role under a fully government-financed healthcare system. The comments appear to veer away from another position she expressed earlier this year in which she said private health insurance should be eliminated. The Medicare for All Act that she has co-sponsored allows little room for private health insurers, relegating plans only to be offered for cosmetic surgery.

MEDICARE TO RUN OUT OF FUNDING IN 2026: The part of Medicare that pays for inpatient hospital and hospice care will run out of full funding in 2026, according to the Social Security and Medicare trustees report out Monday. At that point, the program would pay a diminishing amount of reimbursement for medical costs. Medicare Parts B and D, which primarily assist with outpatient care and prescription drug access, are expected to be well funded for the foreseeable future.

But Medicare cost is expected to rise steadily as share of GDP from 3.7% in 2018 to 6% of GDP in 2043.

“Notwithstanding recent favorable developments, current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation,” the trustees say in their report.

“Lawmakers have many policy options that would reduce or eliminate the long-term financing shortfalls in Social Security and Medicare,” write the trustees, who are all Trump appointees, including the secretaries of Treasury, Labor, and HHS. “Taking action sooner rather than later will permit consideration of a broader range of solutions and provide more time to phase in changes so that the public has adequate time to prepare.”

While projections in the near-term are more certain, the trustees caution that their longer-term projections will be affected by a variety of factors, including efforts to cut costs and advancements in medical technology.

Trump administration seizes on report: Officials drew parallels between the findings in the report and some Democrats’ vision to move everyone living in the U.S. onto an expanded Medicare plan. CMS Administrator Seema Verma pointed to efforts by Democrats to shift millions of people onto government plans at a time when the trust fund was becoming depleted. “If we do not take the fiscal crisis in Medicare seriously, we will jeopardize access to health care for millions of seniors,” she said in a statement.

The White House said the report “underscores the recklessness of proposals to dramatically expand Medicare, which amount to a total government takeover of healthcare that would eliminate private sector options and actually jeopardize seniors’ access to healthcare, while further straining the federal budget.”

FEDERAL COURT TO HEAR ARGUMENTS ON TITLE X FUNDING ALLOCATION: The Center for Reproductive Rights, on behalf of Maine Family Planning, will ask Judge Lance Walker of the U.S. District Court of Maine Wednesday to block the Trump Administration’s rules on clinics that receive federal Title X grants. The rules prohibit doctors from directly referring patients to abortion providers or from housing abortion services in the same building as other family planning services. The rule, which critics call the “gag rule,” would force all but one of Maine Family Planning’s 18 clinics throughout the state to close.

HOW THE MEASLES VIRUS IS INFECTING HUNDREDS, AFTER BEING ELIMINATED IN 2000: The Centers for Disease Control and Prevention declared the measles virus eliminated in 2000, but the number of measles cases has skyrocketed to 626 as of April 19 and is almost certain to set a record in 2019 for the most infections since then. The outbreak of measles this year reflects a major increase in recent years of parents refusing to vaccinate their kids and taking advantage of new state laws that have permitted exemptions to vaccine mandates. For an unknown reason, parents have become increasingly skeptical that the vaccine was safe. Most states now permit philosophical and religious exemptions from vaccinations. All but three states, California, West Virginia, and Mississippi, allow parents to refuse otherwise mandatory vaccinations.

TENNESSEE GENERAL ASSEMBLY SENDS ABORTION BILL TO GOVERNOR: Both the House and Senate chambers of the Tennessee General Assembly voted to enact an abortion ban Monday in the event that the Supreme Court of the United States overturns or alters Roe v. Wade. The bill will be sent to GOP Gov. Bill Lee for his signature. The measure would make it a felony for a doctor to perform an abortion, unless he or she can prove that without the procedure, the woman would die. Women seeking abortions would be exempt from prosecution. State legislators were met with protests when the bill was taken up in the Senate.

THE FDA CONFIDENT THAT MMR VACCINE IS SAFE AND EFFECTIVE: The Food and Drug Administration reinforced its support Monday for the measles-mumps-rubella vaccine, which they say is safe, effective, and in no way linked to autism. The FDA urges people to get vaccinated not only for themselves, but to protect those who cannot be vaccinated. While the CDC declared measles eliminated in 2000, the U.S. has seen a sharp increase of measles cases, reaching over 600 as of last week.

PURDUE’S SACKLER FAMILY SEEKS GLOBAL OPIOIDS SETTLEMENT: In rare public comments, Mary Jo White, the attorney for four members of the Sackler family that controls Purdue Pharma (and the former chairwoman of the Securities and Exchange Commission under Barack Obama), spoke with Reuters, saying the family wants to settle the opioid litigation globally. Purdue, the creator of OxyContin, and many manufacturers and wholesalers are facing about 2,000 suits by state, city, and county officials blaming them for the opiate addiction crisis.

COMING UP NEXT WEEK: The Washington Examiner is hosting its next “Examining Healthcare” event on Wednesday May 1 at 8 a.m. The event will feature interviews by Kimberly with Sens. Bill Cassidy, R-La., and Doug Jones, D-Ala. Breakfast is provided. Register here.

OPINION: Trustees say Social Security and Medicare face $59 trillion long-term deficit

The Rundown

Kaiser Health News Sparse treatment options complicate cancer care for immigrants in south Texas

Minnesota Public Radio UnitedHealth clients needed more mental health care; United said no

The New York Times The military wants better tests for PTSD. Speech analysis could be the answer.

The Wall Street Journal Elizabeth Holmes gets delay in trial-date decision

The Eagle-Tribune Shaheen listens to health care worries in Salem

Calendar

TUESDAY | April 23

April 22-25. Atlanta. Rx Drug Abuse and Heroin Summit. Agenda.

House and Senate in recess.

THURSDAY | April 25

April 25-26. Baltimore. Conference of the National Association of Accountable Care Organizations. Agenda.

MONDAY | April 29

8:30 a.m. 1615 H St NW. Chamber of Commerce event on “”Innovations: Redesigning Wellness.”