Four Questions Series: Sean Cavanaugh, Former Head of Medicare

Four Questions Series: Sean Cavanaugh, Former Head of Medicare

Welcome to another edition of the Four Questions blog series. This time, we’re sitting down with Sean Cavanaugh, former Head of Medicare to talk care coordination, payment reform, and challenges facing healthcare providers today.

Keep an eye out for more in this series in the future. We’re tapping into the healthcare thought leaders, advisors and the knowledge base surrounding us to hear unique thoughts and ideas around transforming healthcare. Who will be up next? Sign up below to get the next article delivered direct to your inbox.

Do you expect investments in care coordination to increase or decrease over the next 10 years?

Clearly, investments in achieving the triple aim will continue to grow in the next 10 years.  But, I think this growth won’t be uniform throughout the delivery system. Organizations that are wholly committed to the triple aim will continue to attract capital and invest in care improvements. These investments will get smarter over time, too, as we learn which interventions work for which patients. And these investments will extend well beyond care coordination – which is necessary, but not sufficient, to improve healthcare delivery – into shared decision making, better medication management, remote monitoring and many other exciting areas. 

However, I feel too many healthcare organizations continue to thrive under volume-based fee-for-service and still don’t see a sustainable business path that involves the triple aim. These organizations will probably continue to make modest or symbolic investments in care coordination until they are convinced the world has truly changed and their success depends upon it.

What challenges are value-based care programs facing today?

The biggest challenge is how to coordinate the actions of public and private payers so that health care providers are receiving consistent signals.  Public/private coordination is always difficult, but the CMS Learning and Action Network was created to tackle this challenge.  We face a conundrum that all payers understand the power of incentives is increased through coordination, but commercial payers need to distinguish themselves in the market which works against coordination. Beyond that, we are still learning which payment systems provide the right incentives for care improvement and a sustainable business case for providers.  We are still learning how to measure quality in ways that are clinically meaningful, incorporate patients’ priorities, and don’t require costly new data collection. 

What are some of the biggest challenges or hurdles for healthcare providers?

All healthcare providers need to do is totally transform the clinical and financial models they’ve developed over the last 50 years. What’s so hard about that? All kidding aside, I do think it’s a real challenge for providers to define a pathway to value-based care that balances their capability for change (including capital) with the business case offered to them by payers.

What technologies or companies have you seen making an impact across the healthcare landscape?

I think doctors and hospitals have learned some hard lessons about the promise of healthcare technology.  They have grown skeptical of companies that promise the moon and fail to deliver.  I think the companies and technologies that will succeed are those that can implement quickly to provide actionable information and that integrate seamlessly into existing workflows.  Technology needs to serve the doctor, not the other way around. 

Thanks, Sean!  Contact Bamboo Health to learn more about coordinating your healthcare services today!