The potential impact of a Trump presidency on post-acute and senior-living providers
At 7:30 a.m. on Wednesday, November 9, I received a brief yet impactful text message from a client that simply asked "now what?" Just hours before, Donald Trump was elected President and the Republican party retained the majority of seats in the U.S. Senate and House of Representatives.
Although these events may have a significant impact on our healthcare system and initiatives such as value-based payments, I think it's prudent to remain focused on what we know won't change. The growing demand for affordable housing and healthcare due to the demographic realities of an aging population will not change. The demand for qualified workers outstripping supply will not change. The increasing burden of chronic disease management will not change. I'm sure you can think of your own realities to add.
If you aggregate the environmental certainties shaping healthcare today, logic dictates that value will continue to drive new policies and initiatives. As a result, alternative payment models (APMs) will continue to garner support for accelerated adoption. The Medicare Access and CHIP Reauthorization Act (MACRA) also provides substantial incentive for physicians to migrate into APMs and was passed by Congress with overwhelming bipartisanship. In addition, MedPAC, the nonpartisan legislative branch agency that provides analysis and policy advice on the Medicare program, has been supportive of APMs.
So when answering the "now what" question, my advice is to continue developing organizational attributes that will build your community's competitive advantage as a participant in APMs. A great way to learn more about what APMs entail – and stay up-to-date with emerging research, ideas, and discussions about their advancement – is to join the Healthcare Payment Learning & Action Network (LAN). The Department of Health & Human Services launched this nonprofit in March 2015 to speed the transition to APMs by combining the innovation, power, and reach of the private and public sectors.
On October 25, I had the opportunity to attend the LAN Summit in Washington. This event brought together nearly 800 participants representing senior leaders from across the healthcare community, including providers, payers, patients, consumer groups, health experts, and government agencies.
Here's the singular most important message that I would like to share from my participation there: APMs are not unicorns. They are being tested, learned from, and gaining increased support daily. The advance toward APMs is accelerating and I do not see that being abated by the results of the presidential election.
Sadly, I believe there will come a time in the not-too-distant future when many nonprofit and smaller senior-living organizations that depend on post-acute and long-term care revenue for survival will find that their communities have waited until the decision of whether or not to participate in APMs has been taken out of their hands. For-profit organizations are investing millions in learning how to compete and win in value-based care delivery models – and nonprofit communities must begin taking similar action now.
The first step in this process is performing a gap assessment to determine whether and how your organization can remain competitive:
- What attributes must you have to compete under APMs compared to your organizational current state – and what investments are required to bridge that gap?
- Do you have the financial wherewithal to make those investments?
- How much time do you have to effectuate change?