Welcome to episode seven of Let’s Talk about Healthcare, a podcast about the challenges and opportunities, the good and the not-so-good, and the moments of joy found throughout the healthcare system today.
Today, we’re speaking with Lauren Haley, an attorney at Strategic Health Law, about her experience working in and around healthcare policy, new CMS leadership, and the changes we can expect under the Biden administration.
The Central Thread of A Career in Policy
Healthcare policy in the US is an ever-evolving sea of complexity. And that’s exactly what Lauren loves about it.
Her career has run the gamut, from working within CMS and at the law firm,McDermott Will & Emery, to serving as in-house counsel for healthcare startups.
Lauren reflects, “Healthcare is so complex, and I am jazzed by it. At the core of that complexity, is a cultural struggle with whether healthcare is a privilege or a right. And that struggle affects how it’s structured, how it’s financed, how it’s marketed, and how providers are licensed.
“Take drugs for example, everyone needs whatever is being advertised, but no one knows how much that costs. In each of my roles, I’ve been impacted by one of these pieces of the puzzle. As soon as I think I understand one side of things, something else pops up and asks: ‘Well, what about this?’”
Policy’s Ebb and Flow Across Administrations
Lauren says that changes to healthcare policy ebb and flow across administrations as depending on the party in power. For example, the popularity of managed care seems to fluctuate. Managed care has been around since the 80s, but the amount of emphasis we’ve seen on it from a policy perspective has gone back and forth. We’re now seeing the same thing with value-based purchasing and care, as well as pay for performance.
“One noticeable highlight of CMS under the Trump administration was that we saw an explosion of models coming out of CMS, each trying to innovatively affect quality and access in a way that favors market competition. The Biden administration has hit pause on those because there were so many models that we were seeing a lot of overlap and confusion.”
Looking Ahead: What’s Next for the Topics and Trends of the Last Few Years
Lauren predicts that we will see telehealth regulations enforced more stringently moving forward, with possible audits and higher civil monetary penalties (CMPs). “From a regulatory perspective, we need to catch up to the rollout and build a structure around what is already happening.”
Payers and providers have been using the technology that’s available and CMS has been regulating through memos by necessity. But at the end of the day, they’ll need to convert that guidance to regulation. So I think we can expect more formal processes from CMS, but Lauren says it’s hard to predict when that will begin to take shape.
What excites you the most about the future of healthcare?
“It will continue to be complex and the complexity will only increase as technology explodes and plays an even bigger role in shaping the future of care.” I think we’ll see more innovative arrangements for value-based care and new opportunities that the industry hasn’t really wrapped its head around yet. I hope these new arrangements will improve quality of care and access.”