Secretary Azar’s four-point plan is ambitious, yet familiar

President Trump’s second Health and Human Services (HHS) Secretary, Alex Azar, is beginning to reveal how he intends to lead his multibillion-dollar department. Although we saw glimpses of his plans before, Secretary Azar’s recent release of four key agenda points gives us the most comprehensive view into his thinking since his late-January confirmation.

Secretary Azar’s four-point plan includes:

• A pledge to move ownership of electronic medical records to patients
• Increasing transparency around health care costs
• Using Medicare and Medicaid to drive innovation and transformation
• The always popular catchall of reducing regulatory burden

{mosads}These are all promising suggestions, but to be fair, they could also be characterized as the same old bromides we have been hearing for years.

These ideas have been kicking around in some form since I was first elected to Congress in 2002. Transferring ownership of electronic records to patients is the latest iteration of the push to protect patient privacy and empower patients with information, including their own. Of the four items on Secretary Azar’s list, it seems to me to be the most achievable in the short term.

Increasing transparency around costs is another policy proposal that goes back years, so far with little success. However, Secretary Azar is right in his tactic of using an incentive-based approach to increase transparency. Rigid mandates are not ideal for increasing transparency; instead, Secretary Azar seeks to create a process where patients, providers and payers are all receiving as much information as possible based on mutual incentives.

This may seem like a small change, but increasing transparency could potentially have a major impact. Not only would patients know exactly what a test or procedure costs, they would also be able to plan future care better with full cost transparency and potentially “shop” around for care that meets their pricing and value criteria.

To my eyes, Secretary Azar’s third point is the most unclear of the bunch. Medicare and Medicaid have been driving industry change since 1966. Everything the health care industry does is done with these programs in mind. The Centers for Medicare and Medicaid Services (CMS), through the Center for Medicare and Medicaid Innovation (CMMI), has been testing new delivery models — with some efforts being voluntary and others mandatory. Secretary Azar is willing to acknowledge previous lackluster efforts, but gives little indication of how his efforts will be more robust.

Government can help spur change, but as a retired physician and elected official, I know that for change to be durable and meaningful it must stem from and have buy-in from the grassroots — the ground up.

Providers — hospitals, health systems, physicians, nurses and other health professionals — are on the front lines of delivery system transformation. In fact, many are leading and driving change — focusing efforts on value, quality and outcomes, instead of volume.

The Medicare Shared Savings Program and other alternative payment models, or APMs as they are known, are arrangements that allow providers to innovate in care delivery and if their outcomes and quality are good — and they reduce costs — they get to share in some of the savings.

Many of these efforts are stymied by red tape and I have heard from participants that they need additional waivers and flexibility to support their efforts. Perhaps what the Secretary will do under his third goal is to make some of these needed changes and leverage and make reforms to the CMMI, which will precipitate greater and faster transformation of the health care system.

Lastly, Secretary Azar repeats the oft-heard pledge of reducing regulatory burden. This near-universal promise among conservatives is harder to pull off than it sounds. Altering one regulation can have a cascading effect in an industry as complex as health care. Any reduction in regulation must be considered carefully, but too often this careful consideration settles into inaction. Yet, I am hopeful that Secretary Azar can deliver on his charge to remove unnecessary regulations.

These four priorities are a tall order, but as I have mentioned, Secretary Azar has a knack for creating solutions, and he might just be the right leader at the right time to leverage his authority, Medicare and Medicaid, and his staff within the Department to make his plan — and an improved health care system — a reality.

Philip Gingrey, M.D., is a former U.S. Congressman who served Georgia’s 11th congressional district from 2003 to 2015. He is currently a senior adviser with the District Policy Group at Drinker Biddle & Reath LLP.