Gregg Masters 00:07 This is PopHealth Week on HealthcareNOW Radio. Today’s episode is sponsored by Health Innovation Media. We bring your brand messaging alive on the ground and now in the virtual space for a major trade show, conference and innovation summits via our signature pop up studio connect with us at www.PopUpStudio.productions. I’m Gregg Masters Managing Director of Health Innovation Media publisher of ACOwatch.com and your PopHealth Week co-host with my partner, co-founder Fred Goldstein, President of Accountable Health LLC, a Jacksonville, Florida based consulting firm. On today’s show, our guest is Deanne Kasim, Executive Director for Health Policy at Change Healthcare. Deanne provides us with their top five COVID-19 health policy related updates. Change Healthcare is a Nashville, Tennessee based provider of revenue and payment cycle management and clinical information exchange solutions connecting payers providers and patients in the US healthcare system. So with that brief introduction, Fred over to you help us get to know Deanne.
Fred Goldstein 01:16 Thank you so much, Greg. And Deanne, welcome to PopHealth Week.
Deanne Kasim 01:18 Thank you. Thank you for having me.
Fred Goldstein 01:20 Yeah. Thanks for joining us, Deanne. Perhaps we could start with you telling us a little bit about your background and Change Healthcare.
Deanne Kasim 01:25 Absolutely. So I’ve always worked in the health care system, whether it be working on the technology side, I’ve worked on payer stuff having worked for AHIP for a while having worked for EDS back before it became HP working with state Medicaid programs from an IT side. And also worked for a pair of health IT vendor have also worked as a government contractor. Specifically on AHRQ. That’s the Agency for Healthcare Research and Quality and ONC contracts, worked a little bit looking at provider health IT and for the last, just a little over two years I’ve been here at Change Healthcare leading the policy and advocacy efforts for the company. Now Change Healthcare is a public company. We are a large Health IT with wraparound services, solutions that really sits at the nexus between patients, providers and payers. About 60% of our business comes from the provider segment and about 40% comes from the payer segment.
Fred Goldstein 02:29 Fantastic. And you’re involved now in policy. So obviously there’s a lot going on with COVID. And all the changes we’re seeing in healthcare even prior to that was looking at changing. So let’s talk a little about policy. What are you seeing as some of the top areas that are going to be impacted or are being impacted by what’s happening now?
Deanne Kasim 02:46 That’s a great question. You know, earlier today, when I start get started, get ready for my day, I was listening to ZDoggMD, if you’ve ever seen his his speaking engagements or his multi-social media channels, this happened to be he’s now on Instagram. And he was really talking about and I totally agree with this, by the way how this was just absolutely this whole pandemic has laid bare the things that don’t really work very well in this health care system. So there’s so many things we can choose from can choose from, I think, listening to the policymakers, most notably, Seema Verma had a conversation with StatNews, talking about all the different regs that have been relaxed. I mean, we’ve certainly seen the emergence of telehealth and one of the things she said is telehealth is here to stay. So I know that there’s going to be some work that Congress has to do in conjunction with the regulatory portion of the equation. In order to make some of those enablement’s stick, you know, they need to look at how to do that in a budget-neutral way. They also need to look at how state governments can help with a couple things. One is the whole conversation of providers practicing across state lines, I can tell you that regulators and some private sector groups including the Health Care Leadership Council, our CEO, Neil de Crescenzo is actually the current chair of the board of the Health Care Leadership Council, they looked at working with the administration to really see how we can get more practitioners to be able to practice across state lines, whether it be in a virtual environment, or an emergency type of environment. And turns out that that actually would be unconstitutional to do that at a federal level that really is up to the states to have to push that forward. So more more work to be done there. I think also looking at the public health infrastructure, huge, huge need.
Fred Goldstein 04:55 Got it. When you’re thinking about telehealth, I know there’s been a big push obviously a lot of people have been using it really liking it from what you hear. And even the physicians are finding out that they’re able to do things with it and, and function well with telehealth. And the government, you know, seems, has come out and said, Hey, we’re gonna push this. Do you see the private insurers also coming on board with that there’s been some question about whether or not they may, in effect, say, well, at the end of June, now we we relaxed for a few months, we’re going to tighten that back up, they’re going to go with that as well.
Deanne Kasim 05:25 I think that, first of all, the private insurers realize that it just augments the care system so much, and the pandemics not going away anytime soon, this virus will be with us, whether it’s, you know, the next nine months, 12 months, 18 months, even maybe, possibly 24. This is an important modality to keep the vulnerable in places where they cannot, they can minimize their exposure. But in terms of payment, Seema did say in her interview that they’re not going to look at necessarily 100% parody for telehealth, in terms of paying as much for it as they would for in-person visits, because in-person visits has other costs that go with it, such as cleaning the rooms and staffing. So I can see their perspective. But I don’t think that anyone’s going to you know, really discount the importance of this, you know, what have you been seeing and hearing Fred on that topic?
Fred Goldstein 06:24 Yeah, I think you’re right on target. And it’s good to hear about the whole issue of payment, whether it’s parity or not. I know Greg and I have discussed this issue before, that you really do have the ability with telehealth and some of this transformation, to take out some fixed costs in the system, that should be reflected inability to provide it at a lower cost. You know, the other issue you touched upon was public health infrastructure. And when you talk about public health infrastructure, what were you referring to? Where do you think we’re gonna see some of those changes,
Deanne Kasim 06:50 really important? In fact, I have done two podcasts. Now with Arian Malec discussing this. There’s been a couple of major policy proposals on that one that we discussed, and that he was actually involved in with the Duke Margolis workgroup not included Scott Gottlieb Farzad Mostashari, Scott McClellan, a couple other folks, really important research there. There was one that Avik Roy and his team was championing and the gist of it is, there’s things that Congress can do now, to start putting that groundwork together. For So, so many years, we have as a country, not given enough funding to public health. And I’ll share with you this story. I sit on the Public Policy Committee for HIMSS. And as part of our health IT week in September, the Public Policy Committee and the HIMS Board of Directors has a variety of speakers that came in, we actually had a presentation and an interactive discussion with Dr. Schuchat, from the CDC. And when she told us how different states have really put in some infrastructure in some is way more advanced than the other, but to all too often, disease registries at the state level are kept on Excel spreadsheets, and those are emailed in to the CDC or often faxed. It’s, it’s really disconcerting. To think about that, you know, we’ve made all these gains and data interoperability with EHRs at the clinical level for everyday health care. But public health is definitely missing that infrastructure. And whether it’s things that can be considered for a possible fourth COVID rescue package this summer, or whether it’s something that needs to be put more long term into 21st Century Cures 2.0, which representatives DeGette and Upton’s offices are working on right now, wherever we put this, there’s a real need to really think about what is that infrastructure needs to do? And how do we fund it?
Fred Goldstein 08:54 Yeah it’s fascinating talking about using an Excel spreadsheet to track this stuff. And obviously, given what we’ve seen in the response, it’s been a struggle. Some of this tracking also has to do with another area I know you’re interested in which is this whole idea of contact tracing and and how that fits in obviously with COVID. And any future pandemics we might have?
Deanne Kasim 09:14 Oh, absolutely, that there’s so many different approaches to contact tracing and so many different funding. I’ll just give you a story here in Maryland for IM, you know, the state has done their approach and the governor and the health commissioners have looked at how to fund that and make it happen. And then on a county level, you know, we had one county in Maryland, hire 1,000 of their own contact tracers. So what I think has been pretty clear is the federal government can put out guidelines, but it’s really up to state and local and take that that approach and that burden, if you will on and then we can look at technology tools and how they might augment that such as what Apple and Google are doing. I’m not quite sure we’re 100% there yet in terms of using smartphones. And contact tracing technology in this country on a broad scale, I think it will get there. And I think it needs to get there. It’s an important tool to augment whatever we do with good old fashioned people doing the manual work.
Fred Goldstein 10:14 That raises an interesting issue as we move to some more technologically based approaches. And that’s the whole thing of privacy where where is privacy falling out in this policy discussion? Is it being heard? Are there some concerns in the Capitol about that? Or is it just a few people out there really worried about that?
Deanne Kasim 10:31 That’s a good question. There’s definitely a lot of concern. We’ve seen bills come out of the Senate, one sponsored by Senator Wicker, another one sponsored by Senators Cassidy and Cantwell, we here on my team have been a numerous discussions, whether it’s through groups that we belong to, such as a Confidentiality Coalition, or the Future of Privacy Forum, or even any health initiative. I mean, everyone’s really looking at this the biggest problems we have, whether it’s contact, tracing for the pandemic, and privacy concerns for that, or whether it’s the larger privacy bills, that we’re addressing all kinds of aspects of privacy, not just in health care, but also social media advertising. There’s really it comes along two lines, the Republicans want a federal legislation, federal legislation regulation that will preempt state law, like basically the federal is consistent, Democrats do not Democrats support a private right of action, meaning consumers have the right to sue if they’re harmed, and Republicans do not support that. And those seem to be the two lightning rods that is really preventing some bipartisan cooperation here. But it’s a really important issue. And I’m glad you brought that up.
Fred Goldstein 11:42
Yeah, so you know, speaking of that, we’re in the middle of this pandemic, or maybe the early days of it, as we consider this. And this whole policy debate going on in DC? Are we beginning to see is there any chance of those groups, the republicans and democrats sort of beginning to say, Hey, we got to really pull this together? You seeing some of that maybe in some of the committees or groups meeting?
Deanne Kasim 12:06 That’s another good question. You know, I think in terms of privacy legislation moving this year, whether it be the specific bills, addressing contact tracing and things related to the pandemic, or definitely the larger privacy bills that started last year, and even some warm introduced back in January, it’s looking like we’re running out of time in Congress, unfortunately, with everything that they have to do. And remember, as we all know, this is an election year. So there’s going to be time taken away in October, November. And then if we come back for a lame-duck session, I’m just really concerned that the workload and the things that we have to do to agree on and the fact that Congress is really sort of struggling to figure out how to operate business as usual, when it’s not business as usual, when they don’t have all their staffers there. You know, we as a technology company did an incredible thing to move all of our employees to work from home at a very quick, short timeframe. And that’s just something that Congress has just that’s not their operating model. So a lot of lot of hurdles.
Fred Goldstein 13:14 So, if this doesn’t get done, before the election, and there’s just too much to get done, how much how far does that push us back? Or does that push us back in terms of our response to the virus?
Deanne Kasim 13:28 I think in terms of the contact tracing, you know, different states are as they have been doing coming up with their own privacy rules? Just to talk about that one issue for a second. I don’t know that it really hinders contact tracing, as much as the concern is, with particularly with the technology approaches, whether it be a smartphone Bluetooth enabled type of app, you know, there’s there’s part of that discussion is the genie could be out of the bottle. Like once that data is out there. And we’re combining geolocation. With all these other forms of data and health data. There is a concern that it could be used for nefarious purposes, I think, or too early right now, that’s just my personal opinion, to really tackle that. In all the conversations we’ve been with been in. There’s been some principles, there’s been some thoughts, but this is really a new topic that I think people in general are a little challenged to get their head around, right. This is really the new frontier. So I think in terms of, to answer your question, and contact tracing is going to needs to happen, we need more of it. We’re a little slow to get this done. But what I foresee in January, if nothing moves on privacy this year, is that you not only will have a congress that will come back and look to address this perhaps on a more global scale, meaning some of the more comprehensive privacy legislation, but you will have states doing this as well. And that’s where we start getting into the idea of how much is this going to, to really tax compliance departments in terms of the real possibility, say a year from now we’re looking at new privacy bills in the state, and possibly things moving on the federal level. You know, in a perfect world, we would have had these conversations a couple years ago. But, you know, here we are with different approaches and different ideas.
Gregg Masters 15:19 And if you’re just tuning in, you’re listening to PopHealth Week on health care. Now radio, our guest is Deanne Kasim, Executive Director for Health Policy at Change Healthcare, Deanne provides us with her top five COVID-19 health policy related updates. For more information, go to www.changehealthcare.com. And do follow them on Twitter via @change_hc.
Fred Goldstein 15:45 Right. One of the area’s that’s really been troubling to watch is the fact that because the system itself has been set up on his fee for service chassis, that once the services stopped, and we cut off all the elective procedures and other things, providers, physicians, hospitals, and others really got hurt financially, and many of them are struggling to survive, is that the impetus that we need to begin to see to move to some of these alternative payment models?
Deanne Kasim 16:13 You know, I really hope it is, I’ve been a part of so many conversations in the last six weeks alone about the fact that the health care system has taken such a financial hit, because all of that preventive care, elective care, elective procedures, people avoiding the ER for things that perhaps they normally might have gone to or same thing with urgent care because of this fear of contracting COVID. In those settings, it just really illustrates that our system is so heavily dependent on volume. And I know that there’s there if there’s ever been a rallying cry for the need to move to a value-based system. This is it. You know, the bad news is our system has we’ve really illustrated all the things all the areas that need improvement with this pandemic. The good news is, hey, we’ve got nowhere to go. But up, sir. Yeah, looking for silver linings, wherever I can.
Fred Goldstein 17:11 I know that they’ve had to pull back on some of the measurements and things like that, and Congress for the various programs out there to give physicians and others some room and things like that. Do you think they come back now and begin to move faster? Once we get through this from a federal perspective on moving to value-based care?
Deanne Kasim 17:29 I really hope so I really hope that and I know that you’ve spent so much time looking on this topic. But I really hope that part of the problem it seems to the last I don’t know, however long we’ve been talking about these different models five years, 10 years, I know that there’s been some challenges getting everyone on the same page, you need to get the payers and the providers on the same page, you need to have trust, you need to have financial equations. That makes sense. I hope now we all come out of this thinking, yeah, this is really important. We’ve got to find a way to do this. Otherwise, there’s going to be some big changes, big consolidation, perhaps the survival of the fittest. And where’s that going to leave us as a healthcare industry? A lot of unanswered questions in my mind on you know, what could happen if we don’t really take this seriously in terms of moving in a more value-based care direction?
Fred Goldstein 18:20 Yeah, absolutely. And let’s talk about another area now, which is the gist of this show, for the most part, although we cover a wide wide, you know, swath of health care, is this whole population health and this concept of population health is public health. We’re getting to hear that rallying cry. Where’s that?
Deanne Kasim 18:40 Yeah, yeah, I think I think we can make t shirts with that slogan. When we, when we look at how the pandemic has exposed the public health problems in this country, and the fact that, you know, disparities were always there. But now, it’s just so much more evident. We look at the uninsured, and we’re looking at a significant increase in the uninsured right now, because of the economic fallout from this. It’s it’s really taken, I think, so much of the attention span is shown up on so many people’s radar. But the idea is when you when you have these disparities, when you have the uninsured people are not getting care when you have the infectious disease agent like this. All of our health care matters. Because we all can be carriers, we can all be sources of infection. So my hope is that what you do and everyone else on the population health field, there can really be this nexus between looking at how to do that viz a viz how to improve public health at the same time.
Fred Goldstein 19:43 You You mentioned early on that, you know, we talked about technology and you also said it’s important for the people have the people in this net. You talked about contact tracing and the fact getting people there too. Are we going to see more funding directed to that basic public health infrastructure the department’s of public health In the States and things like that, you know, the agencies that work that is that being talked about as well on the hill.
Deanne Kasim 20:05 It is. And just yesterday, Senator Alexander who, of course, chairs the Senate HELP Committee, he released a white paper. And I would encourage listeners to really check this white paper out, giving sort of the first the first 20 pages is a history of what we funded and why and how we got to this place. And then it’s proposing some recommendations. And they’re asking for stakeholder input input, I believe the deadline is June 26. But I can be wrong on that. I know it’s it’s the last part of this month. And, you know, this is his last year, the senator is retiring, at the end of this year, you will not he’s not running for reelection. And this is such an important issue. for him. Health care has been always one of his important issues. He is really in the spirit of bipartisanship. And my hope is that we get some comments, we move something. And I know there’s there’s just there’s a lot of interest in doing this. It’s a bipartisan issue. So I’m hopeful.
Fred Goldstein 21:03 That’s great to hear. And I’ve had the good fortune of meeting with the senator. And he clearly is very interested in healthcare and trying to get things done up there. So on this whole issue of you sort of touched upon it, and it’s something that Greg and I have talked about and getting this show more focused on the coming weeks, is this whole issue of health disparities that we’re seeing with this with this virus, and how it’s just really impacted those in lower socio-economic groups, African Americans and other minority populations. Is that beginning to get or is it already there with enough knowledge now that it’s a general understanding that we need to do something there?
Deanne Kasim 21:41 Yeah, there absolutely is a general understanding that we need to have better data that we need to serve as populations. I spent 10 years as a subcontractor to AHRQ and one of the missions of that agency was always to look at research that would support how to better address inequalities and disparities in health care. And now I think that mission is even more important, particularly in the socio-political discussions of the day. I mean, we have a critical point, both in health care and as as a society as a global community, but to broaden it to really improve our systems, whether both healthcare and both racial justice, equality, not just for race, but for gender, you know, sexual preference, there’s this is just such a hallmark moment. I know, there’s a bill that was introduced by Representative Robin Kelly in the house that would direct HHS to, to really study more outcomes and the different factors behind the pandemic, and other other health care conditions. And I think we need to do that. And looking at how COVID has disproportionately affected the African American community, the Latino community, there’s just so many unanswered questions. And I don’t think all of the states have been collecting all of those data points that we so need to look at. So I’m hoping we, you know, this is one of the more important lessons learned.
Fred Goldstein 23:13 And, obviously, as we’ve seen a whole bunch of people became unemployed by this event, by the pandemic, and we’ve had this healthcare system in the United States built upon employer-sponsored health insurance. And we’ve had some states expand Medicaid and others haven’t. Do you see that beginning to be looked at more from a policy perspective? And maybe we need to be moving in a little different direction in terms of how we insure and provide access to health care in this country?
Deanne Kasim 23:42 Yeah, great question. I, I think this is really going to shine a spotlight on how coverage is obtained. And, you know, there’s there’s numerous conversations about this. I mean, certainly during the whole Democratic candidate debate, you know, we saw the different proposals ranging from Bernie Sanders and Medicare for All to the different flavors of Medicare for more, Medicaid for some, Medicaid eligibility lowered, I mean, Medicare eligibility lowered in any of them the idea of expanding Medicaid even more, I think, also, there’s a very valid argument to be made for building upon with the ACA started preserving the ACA and trying to build that systems, but like so many other things in the health care industry, where light is now shining on these things that are not perhaps as efficient as they need to be. This is definitely a conversation that will happen.
Fred Goldstein 24:32 Yeah, it’s going to be really interesting to watch and hopefully, I think sometimes I guess it takes a big knock on the side of the head or something to get things moving, but it appears like and and you seem to be reflecting that what’s happening on the Hill and and pop in policy. corners around the country are really beginning to look at these issues, and try to figure out how do we fix some of these systemic problems we have in healthcare today?
Deanne Kasim 24:55 Agreed. Agreed. Yeah. There’s so many conversations that are going on, I think this is going to be going on for many years to come. And then as soon as we start getting vaccines that work, cures that work, that’s all great. But then we need to look at the next steps, right? How do we prioritize it gets a vaccine? How do we fund treatments so that they’re affordable to all? And how do we prepare the system for the next pandemic or disaster because there will be one, whether it’s infectious or manmade, or natural disaster? This is the way the world, unfortunately, works in terms of these occurrences happening.
Fred Goldstein 25:33 Yeah, and just a final question or thought maybe to discuss a bit. You mentioned this issue of vaccines, etc. And obviously, who accesses it, how much they’re going to cost. And there’s sort of this ongoing, I’ve heard a couple people on the Hill etc, discuss, you know, you’ve got to watch it from a pricing perspective. But we have to make sure that the pharmaceutical manufacturers, you know, earn enough to be wanting to do this business. Where are we sort of in that from what you’ve heard on the hill?
Deanne Kasim 25:59 Yeah, good question. I know that drug pricing was a huge issue coming into this, this congressional year. And needless to say, that has all but disappeared. And the conversation does not mean it’s not important. I think we now all are in a completely different place. And we realize that we need innovation right now. We need vaccines and cures more than anything. That said, I know, there’s real concern about making it affordable about who’s going to pay for it and and asking the biopharma companies that are doing all this research and developing this, to be honest with their pricing. I think at this point, you know, ethical companies are going to do just that. What I hope we don’t get into is a global rush to a cure, where we’re not sharing, or where, say, a European company develops and has the first foot out of the gate. And then they’re going to charge a premium to everybody else outside of their their fiefdom if you will. So you know, more to come. But it’s an important issue that I think bears discussing over the next, you know, six to nine months as we move forward, because we have to set the groundwork now to figure out how to, how to prioritize treatments, how to get the vaccines out there, and and, of course, how to pay for all this.
Fred Goldstein 27:16 Yeah, fascinating. Well, Deanne one final question really quick. Is there anything about the opioid crisis still on the radar? Or is that also now not completely off?
Deanne Kasim 27:30 Yeah, you know, such an important question. And I’m going to tie that to the ental health care system just as a global issue. There’s a lot of conversation about how addiction overall, not just opioids, but to all kinds of substance abuse is going to be uncovered, if you will, as we move out of this pandemic. There’s been talk. I know Seema Verma mentioned in her comments about how do we use telehealth to really address overcoming provider shortages and areas like mental health, and I would put substance abuse in there as well. There’s just going to be there as a huge need. And again, it’s it’s a topic that needs to be addressed. I hope we’re making a list we have a lot of issues, this laundry list that we need to address.
Fred Goldstein 28:18 We sure do. And I want to say, Deanne, it’s been fantastic having to the show, you just were able to discuss this area and that area and this policy and that you obviously stay really on top of this, and we really appreciate your insight. So thank you so much for joining us.
Deanne Kasim 28:33 Thank you both. I really appreciate it and it’s nice to connect with you guys.
Gregg Masters 28:37 And that is the last word on today’s broadcast. I want to thank Deanne Kasim, Executive Director for Health Policy at Change Healthcare for her timely insights. For more information on Change Healthcare’s mission and services go to www.changehealthcare.com and do follow them on Twitter via @change_hc. And be sure to follow Deanne’s insights on Twitter via @DKasim.. DKasim. For PopHealth Week, my colleague Fred Goldstein and HealthcareNow Radio This is Gregg Masters saying stay safe y’all will get better together if we toe the line with social distancing. proper hygiene and by all means, wear those masks when in public.