A.G. Gancarski
Gov.-elect Ron DeSantis’ Transition Advisory Committee on Health and Wellness conferred via phone Wednesday in its second of three meetings.
Lt. Gov-elect Jeanette Nuñez, co-chair of the committee, vowed in the previous meeting that the panel was “well-equipped, eager and ready” to improve health care and lower costs, the Tampa Bay Times reported.
To that end, Nuñez promised a discussion of “empowering patients and expanding provider reach,” one rooted in marketplace solutions to gaps in access to and affordability of health care.
Sal Nuzzo of the DeSantis-friendly, free-market James Madison Institute offered guidance to “facilitate the discussion.”
“A patient-oriented system” with “choice,” said Nuzzo, is the best way forward given expected rapid population growth, especially among those over the age of 60.
Florida is 30th in primary care physicians per capita, a crisis accentuated when we consider the high consumption of health care among the older cohort, and a third of its primary-care physicians over the age of 60.
(As the call progressed, it became clear that age was not the only attrition driver; “doctor burnout” and a shortage of residency spots also diminish capacity and patient access.)
Nuzzo noted that the federal government believes states will have to take more of a lead in health care policy going forward, with “access to innovative … health care products” including the expansion of direct primary-care networks, including to Medicaid populations.
“Resist government intervention into the doctor/patient relationship,” Nuzzo said, pushing concepts like telemedicine and nebulous proposals to get more doctors into “underserved areas.”
“Florida,” Nuzzo said, “is expected to be a leader in the efforts to right the ship.”
Among the discussion points: the relationship between the cost of care and access to care.
Dr. David Kenigsberg, President of the Broward County Medical Association, noted “patients are totally disconnected from costs,” and lack the ability to “affect any change as there’s a third party paying at the end of the day,” including being able to pay more for quality care.
Another issue relates to “network adequacy”: Obamacare plans with high deductibles, ensuring that the patient can not access the insurance and ends up paying for insurance while being subject to a collections action.
“Very large bills,” said Nuñez, from the “underinsured” present-looming issues for hospital bottom lines.
“Health insurance does not equal health care,” Nuñez added.
Gabrielle Bargerstock, Florida Executive Director of the Nurse-Family Partnership, noted also that pregnant mothers in many areas face “OB-care deserts,” including in urban areas.
Mary Lynn Edwards Ulrey, CEO of DACCO Behavioral Health, noted that people with no insurance suffer worst from “chargemaster rates,” essentially list prices imposed by hospitals on patients divested of bargaining power.
Consumer choice had its day as a talking point as well.
Rural areas, with dwindling populations, lose health care along with other amenities. Graduate students were advocated as a potential solution, including incentivizing operating in underserved areas.
Elderly patients, as well, are benefiting from nurse-practitioners; while the model of delivering primary care to the homebound from actual doctors was described as therapeutically productive in keeping patients out of the ER, there was no funding formula for it.
Another problem: rural areas and poor areas often see populations without resources to address issues before they become crises, with services not available.
“We see in ERs our ‘frequent fliers’, who have a number of issues beyond health care,” Nuñez noted.
Also considered: the future role of the Agency for Health Care Administration.
A “center for innovation” may be in AHCA’s future, though it’s currently an open question whether there is statutory authority for it, and whether it’s just better to let the “free market” drive innovation as it does in industries like cellphones.
Whether cellphone plans and health care plans are analogous or not is yet another open question, but a space the incoming administration looks likely to explore, seeing how government can “get out of the way,” to quote the next Lt.-Gov.
Health-care executive Alan Levine, who is helping lead the health committee, said the state should consider creating an incubator that would help link research at the state’s universities with the buying power of Florida’s $26 billion Medicaid program. Medicaid is overseen by the Agency for Health Care Administration, which will be directly under the control of DeSantis.
Levine is a former Agency for Health Care Administration secretary who also sits on the state university system’s Board of Governors.
“This is a great evolutionary opportunity for AHCA to expand its role into innovation,” Levine said. “Maybe it’s a public-private partnership where there is investment funds and ideas brought forward whether they are universities or private entrepreneurs. … AHCA’s in a position to be able to help deploy some of those ideas.
The next meeting will address “protection of vulnerable populations,” with the opioid crisis taking center stage, according to Nuñez.
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Some material from The News Service of Florida is used in this post.
