Ep 194 – Forming a More Perfect Union: Strategic Advocacy in Value-Based Payment Policy, with Andrew Schwab

With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy.  By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union.  While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country!

On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington’s internal game.  He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care.  Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health’s first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health.

Episode Bookmarks:

01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending.

02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers.

02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies.

05:30 The glacial pace of the value-based care movement.  Is there truly bipartisan consensus on the aims of health value?

07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”)

08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”)

09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.”

10:00 Explosive growth of the Medicare Advantage program.

11:00 Consumer-centric innovation and higher quality of care in MA plans.

11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”)

13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service” to those leery of privatization.

13:30 The incredible popularity of MA and the research showing it has superior outcomes.

14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years.

15:00 MA is paid more than Traditional Medicare, but it offers mor