‘The responsibility is to work together’: HFMA’s Jordan, other healthcare leaders discuss how stakeholders are navigating turbulent times

With a new presidential administration bringing the potential for drastic changes and emotions about the industry running high, significant strain is on healthcare leaders.

The best response is to search for opportunities to collaborate in the promotion of patient-centered policies, according to insights from a Jan. 24 conference hosted by the University of Miami’s Herbert Business School.

The 14^th annual Business of Health Care Conference included panel discussions featuring Ann Jordan, JD, president and CEO of HFMA, and leaders of seven other industry associations, among them AHIP (formerly America’s Health Insurance Plans), the American Medical Association and American Nurses Association.

This year’s conference took place the same week as the start of President Donald Trump’s second term. His administration’s potential influence on healthcare was on the minds of the panelists.

“It’s so complex in terms of what we’re hearing from the different voices in the administration, many of whom are nontraditional healthcare actors who are going to have a significant impact on [the] healthcare [system],” Jordan said.

Big changes afoot

In the new administration and Congress, the possibility of substantial cuts to Medicare, the Affordable Care Act (ACA) and especially Medicaid “gets you a little nervous because you’re wondering who they’re going to rely on in determining what and how those are going to be impacted, and what’s the outcome then to our most vulnerable populations,” Jordan said.

While hospitals will face the prospect of spikes in unreimbursed care if Medicaid funding gets slashed by hundreds of billions of dollars and ACA marketplace enrollees lose access to enhanced subsidies, insurers likely would experience a steep decline in customers.

Mike Tuffin, president and CEO of AHIP, said record numbers of Americans have “the peace of mind of quality, affordable health insurance coverage,” including 25 million in an individual-insurance market that has “more choice, more competition than ever before.”

“It is vital that we build on and keep that market strong,” he said.

Cuts to Medicare benefits appear to be off the table, but consideration is being given to enacting comprehensive site-neutral payment, among other provider-focused cutbacks.

“If the providers are squeezed, it becomes hard not to reduce services or to change what beneficiaries get,” said Steven Landers, MD, the CEO of the National Alliance for Home Care and Hospice.

Another issue to watch is whether immigration policy affects the availability of frontline caregivers, especially in home care, he said.

On the positive side, panelists foresee the likelihood of a streamlined regulatory environment that will reduce administrative burden and foster advances in products and processes.

Forward-looking approaches

While fee-for-service models work for some providers, Jordan said, “When you talk about AI and maybe looking at preventive care and making America healthy, and nutrition, that speaks to value-based care and payment model innovation, which is where we’re hoping we can jump in as the numbers people to be a good collaborator going forward.

“Can some people do [fee for service]? Well, yes, some can, but for the society as a whole in advancing [healthcare], we’ve got to do better.”

AI can support value-based care by improving diagnostics and treatment plans. If deployed well, it also can weed out some of the inefficiency that has long plagued the industry.

Referring to “the administrative morass in healthcare,” Tuffin said AI is “really the key to tackle that drag on the system.”

“If payers and providers work together, I think there’s substantial improvement that could occur from a cost standpoint,” Jordan said. “If AI leads to a battle of the bots with respect to the claims process where humans aren’t involved and we’re adding 10 different layers without any administrative improvement, I’d say [it’s] not being applied correctly.”

She cited Mayo Clinic as an example of a health system that allows the workforce to experiment with AI to forge applicable use cases and understand the impact on individual roles.

“That’s going to be critical because if some of these AI decisions are made top-down without understanding the impact on the workforce, it could go the other direction,” Jordan said.

Innovation in drugs

The issue of GLP-1 drugs was an area of divergence during the panel discussions. Stephen Ubl, the president and CEO of the Pharmaceutical Research and Manufacturers of America, touted the potential of the drugs to address the nation’s obesity problem and numerous related health issues. He said concerns about side effects and the impact on healthcare affordability will be mitigated over time.

“We oftentimes hear from critics of the industry or [from] the payer community that the sky’s going to fall when there’s a new advance,” Ubl said. “We heard it with hepatitis C medicines, which now save the Medicaid program something on the order of $43 billion over the last several years.”

Tuffin nonetheless urged a cautious approach.

“One difference from the hep C example, which is an incredible success story, is just [that] the number of people indicated for GLP-1s is potentially a majority of the country, as indications keep growing,” he said. “We’re going to need some payment models that are affordable for people and sustainable for the country.”

Jordan said HFMA has been scrutinizing the issue because of the obvious interest among the Association’s members. For finance leaders, one concern entails the ongoing affordability and coverage questions, while another involves trying to gauge the long-term impact on both health and fiscal sustainability.

“We’re saying the case is still out,” Jordan said. “We want to understand where we’re seeing success stories [and] opportunities for standardization.”

The popularity of the drugs among consumers will mean additional pressure on stakeholders.

“When you have consumer demand and the jury’s not clear, you’re in a very difficult position to make policy,” said Patrick Geraghty, president and CEO of GuideWell, the holding company for Florida Blues plans.

Ensuring a viable future

Jordan described a 2024 HFMA initiative to examine the issue of financial sustainability in the healthcare system. In a focus group composed of more than 30 of the industry’s top thought leaders, 94% said the current track is not sustainable.

With that finding in hand, HFMA considered its responsibility to help craft solutions.

“In a nutshell, the responsibility is to work together,” Jordan said. “That starts with the payer-provider divide. We can have conversations and look at ways to have solutions, to become solve-based.”

Amid an uncertain environment for policymaking, she added, “We need to be serious about what our goals are to deliver at the end of the day. And we’re the numbers people, so what can we do? We can help [the industry] understand: Is [a policy] going to be affordable and sustainable long-term?”

In closing messages for attendees, most of whom were students at the business school, Ubl touted the opportunity to drive innovation in treatments and medications. With public vitriol being directed toward his constituency, Tuffin said health plan employees are mission-driven and conscientious about making the system work better for everybody.

“We also know this system’s not working good enough, and we absolutely accept the shared responsibility to partner with everybody to make it better, to close gaps in care, to keep people in coverage, to get us toward sustainability, to tackle chronic disease,” he said.

To the students, Jordan said, “As you continue your professional development and career, embrace the beauty that you’ve chosen to be in an area that is the epicenter of humanity, that touches the lives of everyone. When you wake up every day, you should really feel invigorated by the fact that you’re a part of that mission.”