After two years as CMS acting administrator, Andy Slavitt plans to spend his newfound time helping collaboration between lawmakers on the Hill and healthcare providers in the private sector.
Since leaving CMS in January, Mr. Slavitt has signed on at AVIA, a Chicago-based network of health systems using digital technology to drive innovation, and as a senior policy advisor at Bipartisan Policy Center, a nonprofit Washington, D.C.-based think tank. Prior to CMS, Mr. Slavitt worked in the private sector, most recently as the group executive vice president of UnitedHealth Group’s Optum unit.
Becker’s caught up with Mr. Slavitt to discuss how his experience at CMS is driving his post-administration plans and his views on healthcare policy under the Trump administration.
Editor’s Note: Responses are edited lightly for length and clarity.
Question: Due to the instability in Washington, D.C., many hospital leaders are taking a cautious approach to strategy and dialing back their investments. Do you think this is wise?
Andy Slavitt: What the administration needs to understand, particularly because it is so focused on jobs, is one-sixth of the economy cannot easily adjust to long periods of indecision without cutting capital and reducing hiring. Because turnover is so high in healthcare, it’s not hard for hiring to slow down or capital spending to slow down and for that to really impact the economy, particularly in smaller, rural communities where a lot of hospitals are located. Washington would be wise to wake up to this fact and provide some clarity and some timetables and not leave an open-ended negotiation going for too long.
Q: What would your advice to hospital leaders be right now?
AS: Hospital leaders need to start with this: Whatever happens in health policy, or otherwise, focusing on improving patient care, focusing on how to take care of the most difficult to treat and neediest people in the community, will always be beneficial. In my mind, those are important investment areas.
Secondly, innovating in ways, as I think AVIA has shown, that can keep people healthy, keep physicians fulfilled, keep consumers engaged and reduce medical costs are always going to be good investments.
Third, it’s a perfect time to get engaged in the policy conversation directly. We have a CEO-president who is going to value input from people who are job creators. I think people are too frightened of the Trump administration and many are too far on the sidelines. The CEOs I’ve talked to who have engaged with the Trump administration find they can get listened to, but too many are unwilling to speak out as directly as they should.
Q: You’re joining AVIA and planning to serve as a senior advisor at the Bipartisan Policy Center. What will that work entail?
AS: On one hand, I would say my contribution hopefully to AVIA will be no matter what happens in Washington, [to help] people do things differently. We are not going to be successful if we don’t innovate. My interest was to find the best platform to not just see new innovations in healthcare — because quite honestly, that’s not our problem; there are plenty of innovations. The challenge is how do we scale those innovations across really big healthcare systems, communities and the country. What I admire about AVIA is they took big pressing challenges, like clinician burnout or post-discharge success, and they brought an approach to it that said, ‘How do we find the best innovations and scale them across multiple delivery systems in a way that culturally works?’ In my opinion, it’s a very unique approach.
For the Bipartisan Policy Center, I want a forum where the real world needs of the healthcare system can interact in a credible way with policy makers. BPC is a great forum for governors, CEOs, lawmakers and patient advocates to have trusted conversations that put the politics to the side and focus on how to make the system work better.
Q: I know CMS was especially careful in designing the Medicare Access and CHIP Reauthorization Act rollout. Now that you’ve stepped back from your role at CMS, how do you feel the MACRA implementation is going? What is going well and what concerns you?
AS: We need to pay as much attention to implementation as we do to laws themselves. I arrived at CMS to help lead the turnaround of HealthCare.gov, precisely because it was very good policy, but there was not as much focus on implementation and operations. Public policy isn’t that different than business. I believe in the adage that it’s 90 percent about implementation.
In the case of MACRA, what we are really trying to do is help physicians, many of whom are in places where they have never participated in pay-for-value programs before, who don’t have a lot of office resources, who may be small or in rural locations, and can’t just have a bunch of programs heaped on them, particularly on top of everything else they do every day, and be expected to work.
I would urge the people involved in [MACRA] to look at it as a five- to 10-year process of success, not a one-, two-, three-year process, and to take advantage of the fact that we’ve created separate tracks to allow people to evolve at their own pace. [I would] encourage CMS to continue to provide flexibility, but also keep focus on the goal, which is better patient care — period. If it stops becoming about better patient care, people need to throw in the flag and say, ‘This implementation got off track; we need to refocus it.’
Q: What accomplishment at CMS are you most proud of?
AS: We really began to change the culture at CMS to one that was more engaged with patients, physicians and people in the real world that were affected by the actions of CMS, and therefore got a lot more participation from the real world in those actions. Rather than picking any one specific policy, that probably helped us make everything we worked on better.
Q: What strategies did you use to change that culture?
AS: For one, we gave people permission to and the tools to reach out and interact much more vigorously before they did the work on any particular regulation, like MACRA, where we engaged literally hundreds of thousands of physicians. We used social media — and I used social media — much more aggressively. We made it culturally OK and even encouraged being very upfront about our challenges [and] exposing the reasoning behind our challenges.
Q: What was the greatest lesson you learned during your time in Washington, D.C.?
AS: I spent a career in the private sector, and my view is that the public and private sectors are inextricably linked in creating successful healthcare outcomes in this country. There needs to be a greater understanding in D.C. about how the private sector can contribute, and there needs to be a greater understanding in the real world about how policies are made and how to make sure those policies are reality-based.
We tried to make sure we didn’t make any decisions that didn’t have what we call 360-degree input from real world healthcare providers, and we also worked very hard to bring the retail approach to the job — which is to say we didn’t spend all our time in D.C., but we spent it around the country meeting with hospitals, physicians, patient advocates and insurance companies. Those are the kinds of things that have to continue to be done to make Washington a successful part of the healthcare system.