Karoline Mortensen, Steven G. Ullmann, and Richard Westlund, Miami Herbert Business School, University of Miami
Contact: sullmann@bus.miami.edu
Abstract
What will you learn? The Miami Herbert Business School of the University of Miami held its tenth annual Business of Health Care Conference. This year’s designated theme was, “Policy, Politics, and the Pandemic- U.S., and Beyond.” The lead panel discussion focused on Policy and Patient Care: A View from Health Care Leaders. Key topics included vaccine hesitancy, value-based care models, telehealth services, stress and burnout, and Biden administration initiatives.
What is the evidence? The authors summarize the discussion at the panel.
Timeline: Submitted: May 28, 2021; Accepted after review: November 5, 2021
Cite as: Karoline Mortensen, Steven G. Ullmann, and Richard Westlund. Insights from the Tenth Annual Business of Health Care Conference at the University of Miami. 2021. Health Management Policy and Innovation (hmpi.org), Volume 6, Issue 2.
The University of Miami recently held its tenth annual Business of Health Care Conference. This year’s designated theme was, “Policy, Politics, and the Pandemic- U.S., and Beyond.” With a national and global audience of more than 1,200 attendees the conference sessions, focusing on such areas as global response, economic impact, and policy issues as seen by former secretaries of the U.S. Department of Health and Human Services, provided significant in-depth insights.
One of the important aspects of this annual conference, organized by the Miami Herbert Business School, is the convening of a panel of high-level health care leaders. This conference is the only venue in which the heads of the major health care organizations come together in one place at one time to discuss issues affecting the health care sector and reflect upon the impact of the health care industry on the economy and society at large. This year there has been even greater impact due to the COVID-19 pandemic.
Panelists for the session, “Policy and Patient Care: A View from Health Care Leaders,” were Susan Bailey, MD, president of the American Medical Association; Matt Eyles, president and CEO of America’s Health Insurance Plans; Joseph Fifer, president and CEO of the Healthcare Financial Management Association; Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association; Ernest Grant, president of the American Nurses Association; and Lisa Kidder Hrobsky, group vice president, federal relations of the American Hospital Association. The panel was moderated by Patrick J. Geraghty, president and CEO of Florida Blue and its parent company, Guidewell.
The Biden Administration’s Response
Kicking off the discussion, the panelists emphasized the success of the Biden administration’s vaccine rollout. With nearly 200 million doses distributed by mid-April, and now, with 50 percent of the population fully vaccinated, the administration had doubled its initial target for May 1, said Eyles. “We still need to focus on vaccine equity, reaching the most socially vulnerable communities across the country, and making care more affordable.”
Another important step was passage of the $1.9 trillion American Rescue Plan (ARP) stimulus package. “We can’t overestimate the importance of the financial support for our hospitals and health systems,” said Hrobsky. Noting that elective surgeries and routine care visits were canceled or postponed, she said the nation’s hospitals were projected to have lost $320 billion in 2020 alone. She added, “Relief from the federal government has been a lifeline for providers across the country.”
The Biden administration also increased access to coverage through the Affordable Care Act (ACA) with lower premiums and an extended enrollment period. “Making premiums more affordable for a broad swath of the population will help transform the market,” said Eyles. Geraghty noted that in Florida, for example, there are now 320,000 more residents eligible for a subsidy as compared to last year, and those subsidies are larger than before.
Eyles added that there is also increasing recognition among federal and state policy makers that the ACA is here to stay, although there is still some uncertainty with regard to a pending U.S. Supreme Court ruling. Hrobsky added, “Now we need to make those ACA provisions permanent as part of the social infrastructure.”
Fifer, Grant and Bailey agreed that insurance coverage improves individual and family health, which in turn, contributes to a better economic climate. “People live sicker and die younger without insurance,” said Bailey. “We believe everyone should have affordable and accessible insurance and the American Rescue Plan has taken a big step forward in that direction.”
Stress And Burnout
One of the concerns discussed by the panelists was burnout and emotional stress experienced by physicians and nurses. The American Nurses Association launched a “nurses’ resilience” site and is seeking increased funding from Congress for healthcare workers.
Bailey indicated that burnout among physicians was high and was of concern before the pandemic. The problem was only compounded by the pandemic. She indicated that burnout is a systems issue, not a reflection of the individual. As per Bailey, “Many physicians are reluctant to ask for help due to the stigma. So, we are helping institutions understand there are things they can do to reduce the stresses on physicians, such as scheduling their coverage and having adequate supplies of personal protective equipment (PPE).” The burden of documentation was also mentioned in the discussion.
Fischer-Wright spoke to the concern regarding the significant increase in retirements of physicians and nurses with the potential for significant negative impact on delivery of health care nationally, with particular concern for the rural communities.
Having said that, several panelists indicated that both medical and nursing school applications are on the rise. “The media has shown how heroic and meaningful it is to take care of a patient at those crucial moments of life or death,” said Bailey. “Despite all the stresses, being a doctor is still an incredibly rewarding profession.”
Grant added that there is a strong uptick in the people interested in entering the nursing profession. The problem is that there is not enough capacity in terms of faculty, buildings and clinical spaces. As Grant indicated, investments are needed in the academic infrastructure.
Reflecting on the upsurge in student interest, Bailey said, “Today’s young people are altruistic, going into the health care professions for all the right reasons. It’s great to see this trend.”
Telehealth Services
One of the very few silver linings coming out of the pandemic was the growth in acceptance of telehealth as a source of safety, convenience, and access fostered further by Medicare now reimbursing for telehealth encounters.
Geraghty noted that telehealth has become very popular for remote mental health visits, especially if the patient already had a relationship with a therapist. “It will be interesting to see how that model fares as we move forward,” he said.
There was consensus that for telehealth to be truly effective in the future, health care providers need to become comfortable and proficient with the technology. Further, with the realization that COVID-19 in general has only highlighted the impact of health disparities in our society, until broadband is widely available in disadvantaged communities, health care access through telehealth will continue to be a reflection of health disparities in this country. Panelists agreed that now more than ever, broadband internet access is a social determinant of health.
Value-Based Care Models
The panelists turned their discussion to the pandemic’s impact on value-based care. Fifer said providers who shared financial risk with an insurance company have done better than practices dependent on fee-for-service methodologies. However, having dozens of value-based care models muddies the waters. “Providers don’t know how the value computations are made, and don’t like financial surprises,” he added. “CFOs like the predictability of fee-for-service arrangements.”
Hospitals are focused on immediate financial concerns, rather than experimenting with new reimbursement models, according to Hrobsky. She added that large health systems typically have more options than rural hospitals in regard to payments.
“COVID-19 has pulled providers out of value-based care,” said Fischer-Wright. “When medical practices have a 90 percent drop in volume, they have no bandwidth for trying something new. Right now, many medical practices are in survival mode, rather than moving to Maslow’s self-actualization phase.”
For physicians, value-based-care can be problematic. “Who decides value? How do you measure it? How do you reward it?” said Bailey. “Small practices can’t negotiate with payers and are forced into a take-it-or-leave-it situation.”
Vaccine Hesitancy
Vaccine hesitancy is one of the pressing health issues of 2021, said Geraghty, who asked the panelists for their thoughts. Bailey said the American Medical Association has seen an improvement in vaccine confidence in almost all demographic groups.
While many nurses have also been hesitant about vaccines, the American Nurses Association has provided extensive educational materials about how they work, Grant added.
Fifer noted that a handful of adverse reactions to the Johnson & Johnson and AstraZeneca vaccines have been given extensive media coverage. However, he indicated that science and the data should drive vaccination decisions, rather than emotions.
Some final thoughts revolved around insurance premiums. When asked what the impact of COVID-19 would be on insurance costs, Eyles indicated that things are uncertain. “On the one hand, there is pent-up demand for care, which would push premiums up. However, telehealth services may help the plans manage affordability. It is a tough time being a health care actuary right now.”
Last year, Florida Blue spent more than $200 million covering claims for members who were unable to pay their premiums, said Geraghty. “We extended a lot of credit rather than leaving the medical community without funds. It was the right thing for us to do.”
The University of Miami’s Business of Health Care conference is an annual event. As we see what develops over the upcoming year, we will be quite interested as to what these industry leaders have to say one year from now. The theme for the next conference on April 1, 2022 is “Business of Health Care: Technology, Access, and the New Normal.” We look forward to their future insights.