Gabriel Perna | April 21, 2021
Health care leaders would be wise to pay attention to the details of the newly passed American Rescue Plan (ARP).
“Right now, the focus in Washington and in the Biden administration is obviously on COVID response, but much of the American Rescue Plan, aside from the COVID emergency funds, took steps in making health care more affordable,” said Mark McClellan, MD, PhD, Director, Duke-Margolis Center for Health Policy & Robert J. Margolis, M.D., Professor of Business, Medicine and Policy. McClellan is also the Co-Chair of the Health Evolution Forum Roundtable on New Models of Care Delivery.
McClellan shared details about government funding opportunities during the first Health Evolution Forum Town Hall. In the New Models of Care Delivery Roundtable discussion, McClellan talked about particular facets of the ARP that health care leaders from the private sector could leverage to improve affordability for patients.
He said the law passed through budget reconciliation opened up substantial funding for state Medicaid programs and Affordable Care Act exchanges. This includes lower premiums and enhanced subsidies to higher income levels for the ACA marketplaces and strong financial incentives for states to expand Medicaid (if they haven’t done so already). He also expects future legislative efforts to try and expand these efforts even further down the road past their current 2022 expiration date.
Furthermore, the law includes $350 billion in direct assistance to state, local, territorial, and tribal governments to ease budgetary burdens and create potential public health programs that address the social determinants of health. There are grants to rural health care providers in the ARP as well.
But that’s not all. If the Biden administration passes the infrastructure bill, the American Jobs Plan, McClellan said there will be funding opportunities to develop high-speed broadband internet for telemedicine and digital health. There would also be funding for workforce development programs centered on home and community-based care.
There are also initiatives from CMS to encourage private-public partnership in regions that could accelerate the transition to value-based care. The efforts may even be aligned with both the Medicare and Medicaid programs, if possible. All of these opportunities are tied into the government’s larger goals around shifting reimbursement to value, McClellan said.
“There will be opportunities, as some of the Democrats in the administration and close to the administration have said, to encourage linking these additional funding steps to steps that align with [health care leaders’] efforts to move into value-based payment arrangements and move care into the home,” said McClellan. “The additional funding shouldn’t go into fee-for-service medicine…it should be used to leverage a shift to the kind of health care system that we’d all like to see. There’s going to be a lot of infrastructure funding coming in. A lot.”
Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services
Opportunities to address social determinants
During the Forum Town Hall, Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services, also shared her excitement about the number of opportunities that will be available to health care leaders through ARP and other sources of government funding. Cohen is the Co-Chair of the Forum Roundtable on Community Health and Advancing Health Equity. She highlighted the opportunities to address the social determinants of health through ARP funding, but also expressed concern that health care leaders won’t capitalize on the moment.
“[Much of the ARP’s] $2 trillion dollars are going to be flowing to states and local jurisdictions in the form of Medicaid dollars, social services, things for the aging community, early childhood, behavioral health, data infrastructure, and health equity work. It’s really good stuff. It’s not everything you want it to be but it’s significant,” said Cohen.
She said it was particularly useful for organizations in risk-based arrangements trying to invest in food security, stable housing, non-emergent transportation, and other social factors for health. This is a perfect opportunity, Cohen said, to work with state partners on how these dollars will be spent. For instance, if a state doesn’t have a shared infrastructure for referral between health and social service providers, the ARP funding would provide resources to create one.
“This is an opportunity to think about building shared assets that are pretty expensive, but there’s some one-time money here for States to really do it. I particularly think there’s a huge opportunity in the data space. As you think about linking together public health, traditional health care partners, social services, and mental health, this is going to be a huge opportunity,” Cohen said. She implored health care leaders to understand what’s available to them, engage with state leaders and develop a strategic plan to address these issues.
“We all know you can spend a lot of money and not make a lot of impact. But with the right vision and investments into infrastructure and data, there’s an opportunity in building scalable models [to address social determinants of health]. I want to make sure this money gets spent well and that people understand it,” Cohen added.