A policy conversation with Healthcare Leadership Council President Mary Grealy

There's no shortage of rancor and debate around healthcare policy, and that has only increased in the past year as Congress attempted an overhaul of the Affordable Care Act (ACA). Throughout this time, the Healthcare Leadership Council (HLC), a coalition of chief executives from the nation's leading healthcare organizations, in 2017 chaired by former Chairman and CEO George Barrett, has been one of the strongest voices advocating for sensible, stable policies.

Mary Grealy, president of the HLC, does see bright spots in this heated debate. Since taking her role with the HLC in August 1999, she's led initiatives focusing on affordable healthcare, coverage for the uninsured, Medicare reform, patient-centered healthcare, and private sector innovation. Grealy spoke recently with Essential Insights contributor Michael Myser about the HLC's role and her view of the nation's healthcare policy, the changes she hopes to see, and how HLC member organizations and other stakeholders can contribute to policy discussions.

Michael Myser: What is the HLC, and how do you go about getting its ideas heard and implemented in a way that can make a positive change?

Mary Grealy: We are a trade association, but are unique in that we represent all types of healthcare organizations, from insurance plans, health systems, pharmaceutical firms and manufacturers, and pharmacies, to healthcare information technology companies.

HLC members attend and speak regularly at hearings and briefings on Capitol Hill, but we also do something that is very different than most trade organizations: each year we hold more than 100 meetings back in Congressional districts and home states, and we don't use paid lobbyists. We put together teams of employees from our member companies, so representatives hear about health policy issues directly from their constituents.

We have a very receptive audience of policymakers both in Congress and the executive branch because Washington knows that our leadership is comprised of the most forward-thinking and respected names in healthcare. We are scrupulously non-partisan and a fair broker of ideas, which really broadens our impact and makes us much more effective.

Grealy: Our mission and strategic approach for the year centers around three categories. One, how do we stabilize the health insurance marketplace and environment? And I don't mean just the ACA and exchanges, but also looking at Medicare and Medicaid, and priorities like the healthcare workforce.

Two, a lot of people see innovation as expensive, but we view innovation as part of the solution in transforming the healthcare landscape and lowering costs. For us, that involves advancing healthcare information and interoperability, and really working on regulatory reform that can enable value-based care.

And three, we look at how to reduce the incidence of chronic disease and ways to manage it better. I'm always shocked when I hear that 85 cents of every healthcare dollar we spend goes to the treatment of preventable chronic disease. We know this is a target-rich environment for reducing healthcare costs.

Grealy: The immediate step we're encouraging the administration to take is to make sure we continue the cost-sharing subsidies that make health coverage affordable for consumers. In fact, it would be unaffordable for many people if they didn't get these subsidies. And we need to see this on a long-term basis rather than the month-to-month reauthorization we're getting now.

Another challenge is how to get enough young and healthy people into these exchanges to offset the high-cost beneficiaries. Congress is pulling back on having the strong individual mandate that requires health insurance, so if they aren't going to stick with the mandate, then we will need some kind of continuous coverage requirement.

Grealy: It's still challenging, for sure. I think we'd all agree that "repeal and replace" turned out to be a third rail that I don't think many members of Congress are eager to come back to. We also know there are problems with the ACA, and we can't continue to ignore those.

That said, I'm encouraged that we're beginning to see some Democrats and Republicans in the Senate and House working on things short-term that show positive movement.

Grealy: It is a huge positive and a great example of bipartisanship, while also involving the private sector. Republican Senator Johnny Isakson from Georgia and Democratic Senator Mark Warner from Virginia are heading up this initiative.

They called in everyone from the health policy world and asked what we would like to see in a bill that would help manage chronic disease. We've worked closely with them and a lot of the provisions we promoted are in there, including expanding the use of telehealth for a range of services in both conventional Medicare and Medicare Advantage plans.

The prognosis is good, as it passed unanimously out of the Senate Finance Committee early this year and we hope to see that move along this fall.