FOR IMMEDIATE RELEASE
CONTACT: Ann Nguyen
WASHINGTON D.C. (Oct. 3, 2018)— The Alliance for Health Policy is pleased to announce that Dianne Faup, a founding partner of Speire Healthcare Strategies and Dan Mendelson, founder of Avalere Health, have joined the Alliance’s Board of Directors.
“Dianne Faup and Dan Mendelson bring years of health policy expertise and seasoned judgment to the Alliance,” said Reed V. Tuckson, MD, Alliance Board Chair. “Their leadership is a welcomed addition to the Alliance’s mission of providing high-quality and nonpartisan programs that inform the critical conversations required to achieve sustainable health solutions.”
The announcement was made at the 2018 Alliance Annual Dinner, which featured a keynote address from Deputy Secretary of U.S. Department of Health and Human Services Eric Hargan. Deputy Secretary Hargan said, “It’s often said in Washington that it’s understandable that people have sharply different views on many matters, but at the very least, we need to agree on a common set of facts.” He adds, “That’s why it’s so vital to have groups like the Alliance doing the hard work of bringing together diverse perspectives and educating policymakers, journalists, and stakeholders, and it’s why I’m so glad to be here tonight.”
This year’s annual dinner was noteworthy for presenting bipartisan health policy leadership awards that recognized the work of talented policy experts working at the state and national levels. Awardee introductions were made by Dr. Tuckson and Sarah Dash, MPH, president and chief executive officer of the Alliance for Health Policy, with a special introduction by Senator Lisa Murkowski (R-AK) for 2018 Awardee Lori Wing-Heier, who are both native Alaskans.
Bipartisan Health Policy Leadership Award:
(1) Joseline Peña-Melnyk, Maryland State Delegate, District 21
(2) Lori Wing-Heier, director, Division of Insurance, State of Alaska
Bipartisan Congressional Staff Award:
(1) Melanie Anne Egorin, Ph.D., deputy staff director, House Committee on Ways and Means Subcommittee on Health
(2) Nick Uehlecke, professional staff member, House Committee on Ways and Means Subcommittee on Health
Unsung Hero Award:
(1) Holly Harvey, MPP, former deputy assistant director, Budget Analysis Division at the Congressional Budget Office
Sarah Dash said, “The Alliance is proud to acknowledge the outstanding work of this year’s awardees and welcome Dianne and Dan to our Board as we build on our 26-year history as a trusted nonpartisan resource for policymakers, the media, and the broader health policy community.”
View full bios of new Board members below:
Dianne Faup, J.D.
Dianne Faup is a founding partner at Speire Healthcare Strategies, a boutique healthcare consulting firm that provides strategic advisory services at the intersection of policy and strategy. She has over 25 years of experience working in the health care industry as an attorney, a management consultant and a government executive. Her private, federal and state healthcare background includes working with White House, Congressional and U.S. Department of Health & Human Services (HHS) executive leaders. In more than twenty years of management consulting, she advised U.S. and foreign government agencies, payers, technology companies, providers, and nonprofits, helping to solve complex business problems. Previously, she held senior leadership positions in Booz Allen Hamilton and KPMG Europe and served as a senior advisor to then-Deputy Secretary Alex Azar of the US Department of Health & Human Services and chief of staff of the District of Columbia Department of Health Care Finance. While in the Office of the Secretary at HHS, Ms. Faup advised Mr. Azar on health policy issues, core HHS operations, regulatory changes, program integrity and a wide range of healthcare issues.
Ms. Faup holds a Bachelor of Arts in Management from Manhattanville College and a Juris Doctor from University of New Hampshire (Franklin Pierce Law). She has spoken nationally on topics ranging from securing health information to effectively tying compliance to business strategy. She is a frequent guest lecturer at George Washington University and a member of Women Business Leaders.
Dan Mendelson, MPP
Dan Mendelson is the founder of Avalere Health. Avalere is a vibrant community of innovative thinkers dedicated to solving the challenges of the healthcare system through data-driven advisory services and business intelligence products. Dan founded the company in 2000, and lead the organization until the end of 2017. Now, he serves as an advisor to the organization. From 1998 to 2000, Dan served as associate director for Health at the Office of Management and Budget in the Clinton White House. He was responsible for the full healthcare portfolio including Medicare, Medicaid, NIH, CDC, and FDA. His work included development of the Medicare pharmaceutical benefit, Presidential initiatives in health information technology and medical error prevention, the electronic disease surveillance system, and federal policies in reimbursement and technology assessment. Prior to joining OMB, Dan was senior vice president of The Lewin Group and Director of the Medical Technology Practice. Between 1994 and 1996, Dan was also closely involved in the operations of Value Rx, a pharmacy benefit management company (PBM). Dan presently serves on the boards of Champions Oncology (CSBR) and Centrexion Therapeutics. He is executive-in-residence at the Fuqua School of Business at Duke University and serves on the Advisory Board of the Duke Margolis Center. He holds an undergraduate degree in economics and viola performance from Oberlin College (1986), and a Masters in Public Policy from the Kennedy School of Government at Harvard University (1990).
Remarks by Keynote Speaker, Deputy Secretary Eric. D. Hargan of U.S. Department of Health and Human Services, at the 2018 Alliance Annual Dinner
Good evening, everyone, and thank you to the Alliance for Health Policy for having me here tonight.
Groups like the Alliance play an important role in advancing understanding of health policy here in Washington and beyond the Beltway.
It’s often said in Washington that it’s understandable that people have sharply different views on many matters, but at the very least, we need to agree on a common set of facts. The set of facts we’re dealing with on healthcare is about as big and complicated as they come.
That’s why it’s so vital to have groups like the Alliance doing the hard work of bringing together diverse perspectives and educating policymakers, journalists, and stakeholders, and it’s why I’m so glad to be here tonight.
As most of you here likely know, Secretary Azar has outlined four priorities for the work we do at HHS: reforming the individual market for health insurance, lowering the price of prescription drugs, taking on the opioid crisis, and putting in place a healthcare system that places value and outcomes over procedures and spending.
Americans deserve a healthcare system that better meets their needs, and does so at a lower cost. In tackling each of these priorities, we have been attentive to an overarching theme: how outdated or unhelpful government regulations could be getting in the way of individuals and the private sector delivering the care Americans need.
I want to discuss what might seem like a dry topic in part because all of you in this room already understand it. You know that the regulations and payment policies set by rulemaking at HHS have tremendous power over our healthcare system. By one estimate, the FDA alone regulates 20 cents on the dollar every American consumer spends.
But my interest in regulation is also personal. In my previous tour of duty at HHS, I served as the agency’s deputy general counsel for regulations and chief regulatory officer. Now, in my return to the department, I get to be chief regulatory officer again. I’ve also taught administrative law and healthcare regulations as a law professor, and worked as a regulatory lawyer at my former law firm. I feel fairly comfortable, in this room, saying that regulations, and regulatory reform, are truly passions of mine.
Too often, regulatory reform has been viewed as a giveaway to industry, rather than what it really is: an opportunity to examine the barriers we’re putting up between patients, providers, and payers, and discover new ways to give them the freedom to forge solutions to the challenges we face. Let me first explain how this applies to our drive toward value-based care, and I’ll conclude by discussing how it relates to our efforts on drug pricing as well.
To coordinate overall value-based efforts at HHS, earlier this year, Secretary Azar appointed Adam Boehler, who is here tonight, as our senior adviser for value-based transformation and innovation, in addition to the hat he wears as head of the Center for Medicare and Medicaid Innovation.
He’s laid out four avenues for driving toward value, four Ps: patients as empowered consumers, providers as accountable navigators of the health system, paying for outcomes, and preventing disease before it occurs or progresses.
In driving toward value-based care, we are building on the work of previous administrations and many policy thinkers. But one shift is a new emphasis on empowering patients as drivers of value, as consumers and as stewards of their own health.
There has sometimes been skepticism about whether patients can become consumers—do Americans really want to shop for healthcare? First of all, there is robust evidence that transparency and shopping tools do work, when we empower consumers to spend their own dollars and see the savings.
But we are also moving in this direction generally, as a whole country. More and more seniors are now shopping for plans via Medicare Advantage. Most seniors shop for Part D plans.
And younger generations have more experience with HSAs and consumer-driven health plans. Eventually, as we all will, these younger generations will age into being our highest-cost patients—after years of getting used to being consumers.
One piece of the opportunity for empowering and education consumers is the new opportunities we have to use technology and electronic health records. This has been an area of bipartisan interest, reaching back through the previous administration to the time Secretary Azar and I spent under Secretary Mike Leavitt, but today we have new tools to make it a reality.
Back then, when I was a young lawyer, “apps” were what you ate plenty of at an evening event like this one, maybe because you’d skipped lunch at work. It was generally acknowledged that apps really did not make you healthier.
But today, the world of mobile apps has tremendous potential to empower patients and inform clinical decision-making. Through the work of CMS and the Office of the National Coordinator for Health IT, we are leveraging the private sector to let the patient own, use, and understand their data. We’re laying out the what, not the how: the work of ONC and CMS should be able to open up the opportunity for patients to have access to a usable, useful health record on their smartphone.
We do recognize that patients will often need physicians and other providers to help them navigate the healthcare system—and we need to give those physicians the right incentives to produce good outcomes and the freedom to secure such outcomes. The same, of course, goes for all players in the healthcare ecosystem: payers, hospitals, benefit managers, employers, and more. But in some corners, the move to value has been seen as disempowering physicians—when really, it is all about providing them with the freedom to deliver high quality care, and rewards for doing it.
That’s why CMS has made it a priority to engage physicians, and think about what we can do to make them better at driving value for their patients. We closely consult physicians on ideas for payment models, including through the Physician-Focused Payment Model Technical Advisory Committee, or PTAC, an advisory committee that accepts proposals from physicians regarding, well, physician-focused alternative payment models. We have valued the input of the physicians and policy leaders involved in PTAC, and consider their expertise essential in assessing the ideas that we get from the physician community and in understanding how we can make those ideas a reality.
One key element we are looking for in new models is the third P I mentioned, paying for outcomes.
Since the idea of value-based care first caught on, HHS and the private sector have made significant progress in shifting toward new modes of payment.
We have more alternative payment models, more coordinated care, and more value-based compensation than ever before. That is thanks to the hard work of many in this room. Unfortunately, the results we all hope for haven’t always materialized.
What have we learned so far? We’ve seen from CMMI’s models that when they just pay for new services or new bundles, the results are mixed. But when the model involves paying for outcomes, we see some real results.
So we are especially interested in ways that we can expand outcome-based payment and sharing of risk to as many sectors of the healthcare system as possible. In some cases, as Secretary Azar has said, that is going to mean mandatory models from CMMI and other mandatory reforms. But we also do understand that different levels of risk are appropriate for different sectors of healthcare. The final point I want to raise on payments is that we believe this will be a significant driver for innovation: When we move away from micromanaging reimbursement decisions, we believe new treatments and technologies will be put to use for patients much faster than ever before.
A key element of empowering patients, helping physicians take on risk, trying out new payment models, and preventing sickness is reexamining government barriers that impede these efforts. Our country’s thicket of healthcare regulations have gotten in the way of value-based care and care coordination in complicated ways, but we’re not going to make a complicated situation an excuse for inaction.
To show how important coordinated care is to HHS, this summer I launched what we’ve dubbed the Regulatory Sprint to Coordinated Care, which is currently examining the Anti-Kickback Statute, the Stark Law, HIPAA, and 42 CFR Part 2. Four different components of HHS are involved: CMS, the Substance Abuse and Mental Health Services Administration, our Office of Inspector General, and our Office for Civil Rights.
CMS has already launched and concluded a request for information on the Stark Law, and the comment period for the Inspector General’s request for information on the Anti-Kickback Statute closes on October 26.
This is not an ordinary regulatory-burden exercise. It is specifically focused on understanding, as quickly as we can, how current interpretations of these laws may be impeding coordinated care.
We have frequently heard that this is the case, and now we’re taking action to discover how this works and what can be done about it. Such efforts require drawing on the best expertise on all sectors, and we are optimistic about the future of our reforms because we’ve launched lasting successes that built on the best ideas from the public and private sector before.
During President George W. Bush’s administration, both Secretary Azar and I had the privilege of working on implementation of Medicare Part D. The program has delivered great benefits for senior citizens at a cost of billions of dollars lower than projected.
Part D has come in so far under budget that one analysis attributed about 60 percent of the lower-than-expected Medicare cost growth of the last decade to the lower-than-projected costs of the drug program. Just to underline that, drug costs only constitute 15 percent of Medicare spending, and yet this one market-oriented program resulted in 60 percent of the savings we’ve seen.
But Part D can be improved. I like to say that it was a great program for 2003, and it’s still a great program . . . for 2003.
Given the significant role Part D plays in paying for prescription drugs in America, improving it and bringing its lessons to other parts of Medicare is a big piece of our efforts to bring down the price of prescription drugs.
The President’s American Patients First blueprint that we released in May laid out the challenges we currently have in our drug pricing markets and many ideas for addressing them. The release of the blueprint and our plan of action for these ideas have been overseen by the Secretary’s senior adviser for drug pricing, Dan Best, and by another one of the Secretary’s senior advisors, John O’Brien, who is here this evening.
Tonight, I want to highlight two actions we’ve already taken that reflect the importance of thinking about government barriers to innovation.
One was in Medicare Part B, where there is currently no price negotiation at all. Medicare gets the bill, and we pay it—plus an add-on fee calculated as a percentage of the drug’s price. There is no negotiation, which is why the system has long been an area of interest for reform, including by institutions like MedPAC.
For the first time ever, we will now let Medicare Advantage plans use new tools to actually negotiate discounts for drugs covered by Part B—in total, $12 billion in spending for 20 million beneficiaries.
In 2019, plans will now have the ability to use step therapy to require patients to first try one clinically appropriate drug, before moving on to other options. This gives the plans new leverage to negotiate discounts on drugs where they currently pay full price, with at least half the savings required to be passed on to patients in some form.
These new tools will be coupled with strong patient protections: Existing prescriptions will be grandfathered in, an expedited appeals process will be required, and step therapy must be coupled with a care coordination plan.
Most important, patients and plans exercise control over these tools. They will only be as common as patients want them to be: If seniors prefer lower premiums or more benefits, they will vote with their feet toward plans that offer these features. All we are doing is getting out of the way of patients’ being offered more options—while maintaining important protections.
Another example of where we’re getting out of the way of more choices for patients, tougher negotiation, and lower drug prices is giving Part D plans the power to use what’s called indication-based formulary design and management.
Today, when a plan covers a drug for one FDA-approved indication, it has to cover all indications. This can mean that a more appropriate or more affordable drug may not be covered because the plan has already been required to cover a therapeutic alternative. Allowing indication-based management will mean more tailored choices for patients and more power for Part D plans to bring down drug prices.
Those are just two more examples of where rethinking regulations can allow us to open up new avenues for better healthcare at a lower cost, while maintaining important patient protections. As I mentioned at the beginning of my remarks, taking action requires having the best information possible. In the case of these Part B and Part D changes, we are relying on a wealth of experience about how these plans have been successfully adopted by private sector plans in recent years.
Too often, it feels like government programs are frozen in amber, unchanging while the private sector innovates. In the fast-changing world of healthcare, letting a regulation or government program stay the same for a decade or two might as well render it prehistoric.
But to keep government up to speed with the private sector, we need all the input and experience possible: from providers, policy experts, patient advocates—not just people with a passion for regulation but everyone with a passion for health policy.
The scale of ambition that we have for improving American healthcare, and the scale of reform that American healthcare needs, demands that we be deliberative—that we listen to all perspectives in rethinking how our system ought to be function.
So I am glad to be here tonight, among a group of people who share a commitment to thinking big, sharing the facts, and thinking collaboratively.
I look forward to working with all of you on our shared goals for many years to come. Thank you very much for listening, and for having me here tonight.