What we are watching in 2019

It’s a new year and there are five key areas we will be watching:

1. Price transparency efforts. The Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) continue efforts to promote price transparency. Last week was the deadline for hospitals to post their list prices, known as the chargemaster, on their websites. Some did so prominently, while you had to dig for the information on other websites. Nevertheless, the resulting information is relatively useless to consumers in its current form. It is often impossible or difficult to determine what service goes with which price and, for many reasons, the chargemaster price has little bearing on actual costs. There is a lot of room for further standardization of this information and there are ways we could see it potentially being useful to states and consumers in the future.
2. Balance of data and quality metric collection with decreasing regulations and provider burden. CMS committed to decreasing provider burden and recently announced their intent to establish an Office of Regulatory Reform with this mission. However, many of the HHS and CMS payment and delivery system reform efforts rely on regulations and provider burden. We are closely tracking CMS’ next steps on this balancing act.
3. HHS and CMS efforts to promote block grants for Medicaid, as well as other new 1115(a) waiver programs. We are particularly interested in how CMS and HHS will handle the technology funding in any of these arrangements. The technology infrastructure is critical to any modern Medicaid program and states may be wary of a block grant that leaves them on the hook for Medicaid technology funds when projects are delayed.  
4. How will HHS and states diffuse, scale, and pivot successful opioid interventions to address substance use disorder more broadly? There are several states or regions where opioid use disorder is not as great a public health emergency as it is in other places, yet cocaine, methamphetamine, benzodiazepines, and alcohol remain a serious problem. Once the opioid crisis is stabilized, how will the state and federal government resources remain effective to treat these other substance use disorders to ensure that affected individuals are not trading one addiction for another?
5. Provider directories to enable payment reform. We will be watching how states plan for and implement more sophisticated, unified, cross-payer provider directories to more fully enable outcomes-based payment systems. We have heard a few CMS and HHS officials note that states need modern provider directories with multiple application interfaces for all payers in the state to reach payment reform goals.