On March 13, the Senate confirmed Seema Verma to be the Administrator for the Centers for Medicare and Medicaid Services on a 55-43 vote, with four Democrats joining 51 Republican Senators voting for confirmation.
Who is Seema Verma and what healthcare philosophy does she bring to the office that affects the businesses of nearly 12,000 home health agencies, not to mention thousands of hospitals, physicians and insurance companies? We took a tour through her history to try to get a feel for what we can all expect.
A first-generation American whose parents emigrated from India, Ms. Verma earned a Masters in Public Health, Health Policy and Administration from Johns Hopkins in 1996 and a Bachelor’s degree in Life Sciences from the University of Maryland in 1993. In 2001, she founded and served for 16 years as President and CEO of SVC, Inc., a national health policy consulting company. In that capacity, she worked with Governor's offices, State Medicaid agencies, State Health Departments, State Departments of Insurance, as well as the federal government, private companies and foundations to redesign policy and strategic projects involving Medicaid, insurance, and public health.
Her passion for Medicaid surfaced in her first official action, minutes after her swearing-in ceremony. With Health and Human Services Secretary Tom Price, M.D., Verma co-signed a letter to the nation's governors affirming the Department's intent to "work with states to improve the Medicaid program and the lives of those it serves."
Letter to Governors
“Today, we commit to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population. We wish to empower all states to advance the next wave of innovative solutions to Medicaid’s challenges—solutions that focus on improving quality, accessibility, and outcomes in the most cost-effective manner. States, as administrators of the program, are in the best position to assess the unique needs of their respective Medicaid-eligible populations and to drive reforms that result in better health outcomes.
“We intend for this to be the beginning of a discussion on how we can revamp the federal and state Medicaid partnership to effectively and efficiently improve health outcomes. We look forward to partnering with you in the years ahead to deliver on our shared goals of providing high quality, sustainable, health care to those that need it most.”
Experience tilts toward Medicaid
Ms. Verma's claim to fame is the "Healthy Indiana Plan," described as the first consumer-directed Medicaid program. She was the architect of the program under Governor Mitch Daniels of Indiana and continued it into the administration of his successor, now VP Mike Pence, who has been called her mentor.
Referred to by SVC as a historic program, Indiana Medicaid under HIP includes premiums, health savings accounts, deductibles and a work requirement for able-bodied adults. Each qualifying participant in HIP receives a $2,500 grant toward the deductible. SVC describes it this way:
"In line with commercial market consumer-driven plans, HIP members receive a $2,500 deductible health plan (HDHP) paired with a $2,500 “POWER” account, similar to a health savings account (HSA). The POWER account is HIP’s paramount feature. It acts as both a payment mechanism and a terminal through which HIP’s incentive structure flows. Members use the POWER account to pay for health care services until the deductible amount is met, at which point the HDHP becomes solely responsible for paying any further claims. Preventive services are provided outside the deductible and members do not face any barriers to seeking these services."
SVC managed every aspect of designing and winning approval for HIP since its inception in 2007, from development of the enabling legislation, negotiating the financing plan with the State’s hospital association, developing the federal waiver, supporting federal negotiations and leading the implementation of the program, including the operational design. One of Verma's final victories before leaving Indiana for Washington was to win approval of HIP under the Affordable Care Act's Medicaid expansion provision.
Criticized by some as confusing for beneficiaries, some of whom have incurred penalties through no fault of their own, Verma defended her approach during her Senate confirmation hearing by saying that low-income people are fully capable of making health care decisions based on rational incentives.
Verma and Mitch Roob, then the head of the Indiana agency that administers Medicaid, touted the philosophy behind the program in a 2008 blog post, outlining a vision for health policy that "melds two themes of American society that typically collide in our health care system, rugged individualism, and the Judeo-Christian ethic."
Former Indiana Governor Mitch Daniels proclaimed that results [of HIP] were clear. Participants in the plan, he said, were much more likely to use generic drugs and seek second opinions. They were also less likely to go to the emergency rooms, probably because of the $25 charge for non-emergency use of the emergency room. "By introducing consumerism," Daniels said, "they demonstrated that low-income people are very good consumers, too. The fatal mistake is to make everything completely free."
In addition to her work in Indiana, Ms. Verma and her SVC team developed many of the recent Medicaid reform programs including waivers for Iowa, Ohio and Kentucky. She helped design Tennessee’s coverage expansion proposal and also provided technical assistance to Michigan as that state implemented its 1115 Medicaid waiver. Ms. Verma and SVC also supported Iowa’s Medicaid transition to managed care, as well as Maine's Medicaid strategy efforts.
Internal Medicare battle looming?
Though there is little to be found in the record for Medicaid expert Verma's thoughts on Medicare, she has stated that she does not support turning the public insurance program for seniors into a voucher plan under which beneficiaries would get a fixed federal contribution to purchase private coverage from government-regulated private insurance plans. On this policy she is 180 degrees from her new boss, HHS Secretary Tom Price, who is a prominent advocate of such an approach. Stay tuned.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org