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5 ways the Trump administration may affect health IT

Following every election cycle, the United States experiences a change in policy and direction. During his campaign, Donald Trump said little about his plans for health IT, precision medicine or delivery system reform, so it will take some time for us to have a real sense of his administration’s thoughts on these subjects.

Since his election, I’ve already had many conversations with healthcare policy experts. Insights from these discussions include:

1) Interoperability – Continues to be a priority

Congress remains interested in monitoring success with healthcare interoperability and the possibility of legislative action, including attention to further standards development.  Congress will also be paying close attention to the implementation of the MACRA, gauging whether it is successfully driving the adjusted behavior from clinicians that they are seeking.

2) MACRA – Adjustments may take place, but the core program will remain consistent

The new Quality Payment Program (QPP) will likely remain the same for the foreseeable future, because the MACRA was bipartisan and the work of a Republican-led Congress. There may be some changes – broadening what will count as an Advanced Alternative Payment Model (APM) or adjusting timelines, for example – but it is clear that Congress still sees delivery reforms as a key tool in its continued effort to control healthcare spend.

3) Other value-based programs – Secure where they have bipartisan support

Popular programs that have been coming out of or are supported by Centers for Medicare & Medicaid (CMS)—such as medical homes, Accountable Care Organizations, the Comprehensive Primary Care+ initiative, bundled payments and other value-based care demonstrations – have been showing improved health outcomes and savings, and largely have continued bipartisan support, albeit with some adjustments possible. If the CMS Innovation Center is repealed as part of the Affordable Care Act (ACA), Congress will have to clarify authority to continue to expand those programs.

The Meaningful Use program has been the target of Republican criticism, and could be reformed if not scratched outright for those still receiving the incentives (hospitals and practices outside of the QPP). Capitated flat fee payment models like Direct Primary Care could receive more support.

4) Precision Medicine – No anticipated changes

For programs that aim to accelerate research and incorporate “-omics” into medical care delivery – such as the Precision Medicine Initiative and Cancer Moonshot – we don’t expect changes at this time. Funding will continue to be a debate, but the basic premises of both programs are strongly supported across Capitol Hill.

5) ACA: Repeal and Replace?

Repealing ACA will not be an easy process, however a partial repeal is likely to happen quickly. Parliamentary procedures will allow Congress to pass a law without the normally-required 60 votes that can beat back a filibuster from the opposing party. Components that affect consumer insurance coverage (and thus healthcare organizational revenues) may be cut, but they are likely to include a transition period to attempt to keep consumers from being without coverage in advance of the 2018 election (yes, they’re already thinking of that!).

Replacing the ACA is harder than the repeal, as there is no consensus. Expanded use of health IT and medical apps (which is frequently how Congress refers to consumer participation in health care) is a centerpiece of many Republican proposals. Paul Ryan’s entitlement plan “A Better Way” may serve as a playbook of sorts. It focuses on “market-based choices for healthcare, such as portability, transparency and increased access to technological innovations outside of government payment streams” (emphasis mine).

Overall, most expect that President-elect Trump’s policy approach will be light on regulation and dictated more by Congress. The people chosen to lead the Department of Health and Human Services, CMS, and ONC will also be tremendously telling, and will influence strongly the direction of national policy in these areas. We remain focused on understanding these transition plans and building on long-standing relationships to ensure that our product and service strategies remain relevant and accurate.

In the meantime, it’s important to realize that, so far, nothing has changed and regulatory deadlines remain in effect. Uncertainty should not delay our industry’s progress toward delivering better, smarter health care.

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