Trump uses page from ‘smart policymaking 101’ on health care

A smartphone app that lets Medicare patients access their claims information. Giving consumers a share of drug company rebates for their prescriptions. Wider access to websites that reliably compare cost and quality of medical tests.

The Trump administration is taking a pragmatic new tack on health care, with officials promising consumer friendly changes and savings in areas from computerized medical records to prescription drugs. New Health and Human Services Secretary Alex Azar has been rolling out the agenda, saying it has the full backing of President Donald Trump.

"They are taking a page out of smart policymaking 101 and hitting on themes that everybody cares about," said Kavita Patel, a health policy expert at the Brookings Institution and a veteran of the Obama administration. "But there is not a lot of detail on how they're going to do it."

The first year of the Trump administration was marked by Republicans' unsuccessful struggle to repeal the Affordable Care Act. With Azar installed as Trump's second health secretary, the administration is shifting to issues of broader concern for people with Medicare and employer-provided coverage. Many of the ideas have bipartisan support and can be advanced without legislation from Congress.

A look at new priorities outlined by Azar and Seema Verma, head of the Centers for Medicare and Medicaid Services:


Most hospitals and doctors now have electronic records, but the systems don't necessarily talk to each other and patients find that their medical information remains hard to access.

The administration wants to write new standards nudging industry to get the systems communicating. That would allow patients to easily transfer records from one provider to another.

"We're not interested in micromanaging how this process happens," Azar said. "Patients ought to have control of their records in a useful format, period."

Medicare is working with software developers on apps that can provide beneficiaries with access to their claims data, which offer important medical details but not a complete picture.

Dan Mendelson, CEO of the consulting firm Avalere Health, says the goal is within reach, perhaps over a three-year period. A lot of the groundwork has been laid by previous administrations, starting with Republican George W. Bush and advancing under Democrat Barack Obama.

"They are definitely taking a new tack on health care," Mendelson said of the Trump administration.



As a candidate, Trump called for Medicare to negotiate drug prices and for allowing U.S. patients to import lower-cost prescriptions from overseas. His administration seems to have dropped those ideas.

But Azar, who spent 10 years as a pharmaceutical executive, has lots of other proposals. They include speeding generics to market, short-circuiting maneuvers that drug companies use to ward off competitors, and changing government policies that may encourage drugmakers to raise prices because federal programs will bear the cost.

Azar praised insurer UnitedHealthcare for its recent announcement that it will pass on drugmaker rebates to some of its customers. That mirrors a Trump budget proposal for Medicare, the government's premier health insurance program, covering about 60 million seniors and disabled people.

Advocacy group CEO John Rother of the National Health Care Coalition says action to lower drug costs is the most nebulous part of the Trump agenda. "There is an open question as to whether the rhetoric is going to produce anything real," he said.



A routine test such as an echocardiogram, an ultrasound exam that can detect heart problems, can cost 10 times as much in a hospital as it does in a doctor's office. And that's just the list price. Real prices paid by different insurers and by Medicare also vary, and can be impossible for consumers to find.

Republicans have a longtime goal of getting true prices for health care goods and services in front of consumers, reasoning that could lead to a market revolution and help curb relentless spending.

Real competition has never been fully tried in our "bizarre" system, Azar told a hospital group. He's promising to use the weight of Medicare and Medicaid, a federal-state collaboration covering more than 70 million low-income people, to pull back the veil on medical pricing. That could help the increasing number of people with high-deductible health insurance who can face thousands of dollars in out-of-pocket costs.

But medical care is not like buying electronics off the shelf at Walmart. Patients rely on intermediaries such as doctors to make decisions.



Changing Medicare's piecemeal payment system so it rewards quality and not just sheer volume of tests and procedures is a long-standing goal for lawmakers of both parties. The Obama administration tried multiple experiments and made some improvements. But results were not clear-cut.

Azar is promising to go further, faster. Spokesman Ryan Murphy said HHS is reviewing all its payment rules to see if in fact Medicare is paying for value.

Azar says he intends to use an agency created under Obama — the Center for Medicare & Medicaid Innovation — to spur change.



As the administration pledges to improve quality and lower costs, it's still pursuing repeal of the Affordable Care Act, which would result in millions of low- and moderate-income people losing coverage.

"Can you really pursue positive changes in health care delivery while at the same time you start losing coverage?" asked Rother. "It is an interesting dilemma."

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