I’ve been watching with a considerable degree of fascination the trajectory of the public pronouncements of Seema Verma, Administrator of the federal Centers for Medicare and Medicaid Services (CMS). Verma, who came to her job in March 2017, made quite a splash at HIMSS18 in Las Vegas with her announcement of the MyHealthEData initiative. She—along with Donald Rucker, M.D., National Coordinator for Health IT, and Alex Azar, Health and Human Services Secretary. Indeed, more than ever before, the HIMSS Conference last year offered senior federal healthcare officials a stage for significant new announcements and initiatives with connection to healthcare IT leaders nationwide.
Well, if you thought that last year was a big federal policy year at HIMSS, consider HIMSS19. With the release of two synchronized proposed rules on Monday by CMS and by ONC (the Office of the National Coordinator for Health IT), Seema Verma has been even more present at HIMSS19 than at HIMSS18. She was involved in a telephonic press conference on Monday (technically not connected to HIMSS, but with its timing coordinated to HIMSS), participated in the opening keynote address at HIMSS on Tuesday morning, gave an in-person press briefing late Tuesday morning, and then gave a closing keynote address on Tuesday afternoon, into which a video address by Azar was inserted at the outset. In between, Dr. Rucker also gave a press briefing on Tuesday. And midday on Wednesday, Adam Boehler, Director of CMMI, the Centers for Medicare and Medicaid Innovation, was scheduled to give a press briefing. Clearly, the feds have been out in force this year.
As Healthcare Innovation Managing Editor Rajiv Leventhal and I noted in a report posted this morning, Verma “was not shy in her assertion that the government has done its part in opening up health data silos; now it’s up to the private sector to follow suit.” And, as she said yesterday afternoon, the goal of federal health officials has been crystal clear: empowering patients with their health data. And, she said, her agency, the nation’s largest health insurer, has backed up the talk through a variety of initiatives and regulations, starting with the “MyHealthEData” campaign launched last year at HIMSS18, aimed at revolutionizing the relationship of U.S. healthcare consumers to their patient data.
And now, both with the release of Medicare’s Blue Button 2.0 initiative (which allows Medicare beneficiaries to access and share their personal health data in a universal digital format), and with the release of the new proposed CMS and ONC rules, Verma, Rucker, Azar, and their fellow senior federal healthcare officials have made an even bigger splash at HIMSS19 than they did at HIMSS18.
Nor has Verma in particular been a shy wallflower. In her statements and in her responses to questions either from moderators like HIMSS president and CEO Hal Wolff (in the opening keynote session Tuesday), or from members of the press in her press briefings, Verma has been quite emphatic in her statements. As she said in her closing keynote on Tuesday, “Yesterday [Monday] in the 21st Century Cures Rule, the Office of the National Coordinator, under the leadership of Dr. [Donald] Rucker, provided us all with additional clarity around what information blocking is and what is not. So there is no more room for excuses. We won’t tolerate it anymore, and those of you that continue down this road will see less opportunities to engage in this practice in the future. Information blocking is a thing of the past.”
She continued, “Monolithic, legacy technology is also thwarting our transition to a healthcare system that pays for the results we desire. In the past, as new technologies have entered the market, they were quickly shut down by the complexities around government policy, single technology systems that do it all, and the proprietary data models underlying the whole system. In the future, these opportunities must be allowed in, and nurtured. Our closed, complex system must be opened and simplified to allow the next life-changing, life-saving technologies an opportunity to grow, making our system more effective and efficient to drive down costs and deliver better results.”
Nor was she shy in throwing a few strategic darts here and there in her speech yesterday. “Let me be clear,” she said forcefully, “the idea that patient data belongs to providers or vendors, is an epic misunderstanding. Patient data belongs to patients, period!” As we noted in our report yesterday, her verbal emphasis on the word “epic” caused a ripple of murmurs in the audience, many of whose members caught the allusion.
Further, as we noted this morning, what’s especially noteworthy is that Verma—who admits she is “deregulatory by nature,” noting that CMS doesn’t want to “micromanage the process, which is what [the agency] has [previously] done”— contended that these proposed rules are necessary in this particular instance.
Responding to a question from Healthcare Innovation in a small press briefing Tuesday on how the administration’s free-market philosophy conflicted with this rulemaking, Verma said, “The federal government has invested $36 billion and look where we are. Patients don’t have access to their medical records. There is a time for us to focus on deregulation, but in this particular case, the industry hasn’t done the right thing. People are entitled to have their health information and their records, and because that didn’t happen, it’s requiring the government to step in. “
Verma believes that despite the requirements, which will put unparalleled degrees of accountability on stakeholders, the rules will be generally supported by the industry. “We have talked to variety of stakeholders—from CEOs of insurers and health systems—and everyone knows this is the right thing to do. [They said], ‘We need the government to force us to tell us to do this.’ And if it was being done [already], we wouldn’t have to do what we are doing [now].”
Verma’s statements go to the heart of her policy and political challenge in the moment. Representing a Republican administration in which the concept of deregulation is an important one, she and Azar have emphasized strongly that they want to lift burdens from practicing physicians, an intention that routinely elicits cheers from the provider audiences whom they address. At the same time, this administration has been pushing down more forcefully than any in recent memory to try to elicit some rather specific responses from providers and from the healthcare industry in general.
None of this would strike seasoned federal healthcare policy observers as surprising, given the manifold layers of policy complexity built into our U.S. healthcare delivery and payment system, a wonder of complexity and conceptual, policy, and practical contradictions. Still, it remains fascinating to consider that Verma, who came to the Trump transition team’s attention because as a consultant, she had created the policy framework for work requirements under the Indiana Medicaid program, during the tenure of Mike Pence as governor, is now pressing down so forcefully, using the regulatory power of her position, to compel what she sees as the opening of the healthcare market to market-based disruption.
And now, in releasing CMS’s brand-new proposed rule, Verma has for the first time concretized a federal government demand for private health plans to participate in appropriate clinical data-sharing; and has simultaneously put both hospital systems and EHR vendors on notice that information-blocking will not be tolerated.
Of course, there remains a tetchy debate inside the U.S. healthcare delivery system and EHR and clinical IS vendor sector as to whether information-blocking truly exists. But CMS’s and ONC’s rule releases Monday have essentially made very concrete the feds’ insistence on the reality of the phenomenon. And many will remember, and repeat that “epic misunderstanding” line in Verma’s speech yesterday.
In the end, Verma has made it clear that she wants everyone in U.S. healthcare to be rowing in the same direction, and she, Azar, Dr. Rucker, and their fellow senior federal healthcare policy officials, have certainly made it clear what direction that is. And, as Verma herself has noted in every single appearance in the past two days, within seven years, one in five dollars in the U.S. economy will be spent on healthcare. And that is a burning platform that everyone inside and outside the industry can understand.
So, though no one can say exactly how all the elements of this complex policy mosaic will play out in the next year, and beyond, one thing is clear: Seema Verma has found her voice, and she’s using it. And anyone who thinks she’ll be shy about using it in the future, needs to reassess—because this is only the beginning of what will inevitably be a ramping up of directional guidance coming from federal healthcare officials going forward. In other words, expect more of the same at HIMSS2020.
