Seema Verma served as the administrator of the Centers for Medicare & Medicaid Services (CMS) from 2017 to 2021.
While that run makes Verma the longest-serving admin in the modern history of the agency, it also gives her a unique perspective on the future of health care in the U.S., including the ongoing shift toward in-home care and decentralization of traditionally brick-and-mortar models.
“The shift to home-based care is a positive development,” Verma told Home Health Care News. “The advent of new technology, from telehealth to remote patient monitoring, is supporting the rapid adoption of home-based care.”
Verma officially stepped down as the head of CMS on Jan. 15, a week before the incoming Biden administration took office. Several other senior officials from the previous Trump administration had already resigned by that point, but Verma viewed such a move as a “dereliction of duty,” considering the COVID-19 pandemic.
Since that time, the Johns Hopkins alumna has stayed active in the health care world by joining multiple companies’ boards. That list includes Lumeris, LifeStance and Monogram Health, the latter of which is focused exclusively on managing chronic kidney disease and end-stage renal disease in the home.
Verma additionally joined the board of Overland Park, Kansas-based WellSky toward the end of September.
“As CMS administrator, I made it a priority to tear down bureaucratic barriers to promote innovation, and I wanted to continue that focus in the private sector,” Verma explained. “WellSky is a leader in innovative health care technology and analytics that power better outcomes and lower costs for stakeholders across the health and community care continuum. Their approach will change the way care is delivered and promote a more sustainable health care system.”
WellSky provides software, analytics and similar technology services to over 1,000 hospital and health systems partners, in addition to tens of thousands of post-acute care providers and other groups. Its CEO, Bill Miller, discussed the impact of Verma’s board appointment last week during the HHCN FUTURE conference in Chicago.
“Her background lends itself very well to [what we’re doing],” Miller said. “Her husband is also a physician. She’s been very close to the fire. When you spend time with her, … you find she’s not very partisan and has very good ideas about the pressures on our health system.”
‘A unique opportunity’
During her time at CMS, Verma spearheaded more than 16 initiatives designed to lower costs, improve quality and increase access to care.
Her specific accomplishments included, for example, the expansion of Medicare Advantage (MA) by allowing plans to do more around social determinants of health and chronic illness. They also included various efforts around slashing insurance premiums for most Americans and the “Patients Over Paperwork” initiative, which Verma and her team created to cut red tape for providers.
Picking a particular accomplishment that Verma is most proud of is a nearly impossible task.
“That’s like asking me to pick my favorite child,” she joked.
One of the last CMS initiatives that Verma helped develop, of course, was the incredibly popular and equally powerful “Acute Hospital Care At Home program,” aimed at boosting hospital capacity during the public health emergency. Broadly, the temporary program gave acute care entities “unprecedented” regulatory flexibility to care for patients in the home, with a new reimbursement pathway to match.
CMS unveiled the hospital-at-home program in November 2020 with the initial participation of Brigham and Women’s Hospital, Huntsman Cancer Institute, Massachusetts General Hospital, Mount Sinai Health System, Presbyterian Healthcare Services and UnityPoint Health.
As of Oct. 5, there were 77 health systems and 177 hospitals in 33 states approved for Acute Hospital Care at Home.
“I was really privileged to help work with CMS on the waiver,” Dr. David Levine, an assistant professor of medicine at Harvard Medical School and the chief architect of Brigham Health Home Hospital, told HHCN at the time. “This allows us to further scale our work. Prior to this, there was not a mainstream fee-for-service payment mechanism.”
Many of the organizations participating in the waiver have recently called for the program to become permanent due to its widely recognized success.
“I am very impressed with the number of hospitals that stepped up to implement the program, and I think it has played a critical role in addressing hospital capacity and saved many lives,” Verma said. “It has also presented a unique opportunity to study this model, and what we learn will influence hospital care and policy in the future.”
Workforce concerns
As far as what she’s currently following, Verma remains intrigued by the increasingly prominent role of telehealth and telemedicine.
Such technology has played a leading role in “ushering in a new era of home-based care,” she said.
“When the COVID-19 pandemic struck, CMS was quick to expand telemedicine,” Verma said. “This allowed beneficiaries living in both rural and urban areas to receive care in their homes and avoid unnecessary travel to their doctor’s office. We saw an immediate and dramatic increase in telehealth services, and innovation continues to drive growth in that part of the industry.”
The former CMS administrator is likewise tuned into the health care’s major challenges, such as the worsening clinician and caregiver shortage in home-based care.
In an HHCN-Axxess survey of more than 750 in-home care professionals conducted, between July 21 and Aug. 6, nearly three-quarters respondents said they’ve had to turn patients and clients away because of staffing shortages.
Long-term care facility operators have faced similar struggles, with 86% of nursing homes and 77% of assisted living providers dealing with a workforce situation that has gotten even worse over the last three months, according to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
“Staffing is a major problem and is rooted in provider burnout,” Verma said.
There’s no silver bullet to bolstering the health care workforce, but continued administrative and paperwork reductions could offer some relief, she noted.
“We are adding 10,000 Medicare patients to the program every year and we must ensure we have a workforce that can address their needs in every sector of the health care system,” Verma said. “Regulatory burdens hamper qualified health care professionals and contribute to burnout. There are ways to increase choices and drive down costs, while still ensuring safe and quality treatment, but it requires government to get out of the way.”
Ultimately, Verma said she believes the U.S. has “one of the best health care systems in the world.” There’s still plenty of room to improve, however, from investing in home-based care to making the overall system more efficient and effective.
“[Home-based care] has the potential to lower health care costs by preventing hospitalizations and reducing hospital and nursing home stays,” she said. “It may also help the senior population stay independent longer. Government programs will need to keep pace with the innovation by changing policies to support more home-based care.”
