In a wide-ranging talk with Park Place, former top federal healthcare official Jonathan Blum shared his views on where value-based care (VBC) should focus its attention, expectations for a new stab at nursing home staffing mandates if Democrats get back in control of Washington, and what he laments most about the state of the healthcare system.

One of the nation’s foremost experts on the policy development and administration of federal health insurance and financing programs, Blum is the co-founder and co-managing partner of Health Transformation Strategies, a strategic advisory and consulting firm, supporting leading healthcare companies and organizations. He is also a non-resident senior scholar at the USC Schaeffer Center for Health Policy and Economics.

But most people in the world of SNFs know Blum from his duties at the Centers for Medicare and Medicaid Services (CMS), where he worked most recently during the Biden Administration as the principal deputy administrator and COO. 

Staffing Again?

As reported recently in Park Place, the talk of staffing mandates has returned to the policy debate, notably because Democrats like their chances to win back control of Congress in the midterms this year, and further out the presidency in 2028. Thus, some Democrats are laying out policy proposals based on “what if” scenarios, and one of the healthcare targets remains the nursing home staffing mandate, which the courts and the Trump Administration effectively killed off last year.

Blum said, “I think that Congress and advocates for staffing mandates” will certainly act if Democrats return to power but realistically that would only occur if the electoral tides go their way in the next two elections, putting the time frame for movement on mandates in the 2029-2030 period.

He also said such mandates would be attempted through the legislative process in a nod to the way in which the courts rejected the Biden Administrative rule.

Blum said that a Democratic Congress would also likely examine transparency in the ownership structure of SNFs, Medicare and Medicaid financial pressures, more examination of margins and financial profitability in the sector, and the aforementioned staffing mandates.

Innovation Models

Shifting gears, Blum said skilled nursing providers should definitely be looking at how they can best partake in VBC models that CMS and its innovation department have been promoting in recent months. A provider needs to ask, “what’s the reason to participate in a new model,” and to have a clear understanding of the risk they can take on.

Blum said much of the work being done by CMS on new models of care, like the next-generation LEAD accountable care organization, would be produced under a Democratic or Republican administration, but any new care models need to keep focused on what is most important.

“Too often, a new payment model centers on what’s to gain for the provider and not enough on what VBC is really about, and that is better patient care,” he said.

As to what the future may hold on new payment models, Blum said there is a theoretical debate going on inside CMS, other government agencies, and healthcare payment experts about whether you need downside risk to get better results from Medicare offerings.

“There is some talk coming from CBO that says when a provider faces downside risk that presents a better opportunity for cost savings but taking on more risks has costs for the provider and the system, and it drives consolidation,” he said.

It also may bring in private equity to the market so that providers can build their financial reserves made necessary by the risk. “There is not one right answer on this, but the discussion has to be had on what’s the appropriate level of risk and what those levels mean to better outcomes and how do we think of unintended consequences,” Blum said.

Can We Get Along?

Separate from the talk of specific programs and policies, Blum said since leaving government service, he has spent the last two years and even before that after his first stint with CMS during the Obama years, wondering how to alleviate the tension in the healthcare system.

He said he was “surprised to see how much tension and conflict there is among payers and provider organizations.”

“I think we have seen that one cause of the tensions is each side not understanding what the other side is trying to accomplish.”

Blum said more dialogue would help in understanding each side’s goals and even their respective roles in the healthcare system.

“The tension and conflict cause more burden than necessary on the healthcare system, more challenges for patients’ access to care. We need more time and space to resolve those tensions, and the patient will be better off,” he said.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.