The J.P. Morgan life sciences conference appropriately triggers a flood of news coverage - at Genomeweb, Endpoints, Stat, and elsewhere. I'm on the lookout for coverage of a January 14 panel called, "What You Won't Hear From the Podium."
This panel was co-chaired by Burt Zweigenhaft (Association for Value-Based Cancer Care) and Lisa Gill (JP Morgan). The five panelists were Shawn Marie Bishop (Akin regulatory law), Marc Samuels (ADVI Health consultancy), John O'Brien (National Pharmaceutical Council), Janet Woodcock (FDA, ret.), and Joe Grogan (DJT White House, USC, Paragon Health Institute).
See Burt's post at Linked In here. See also Joe Grogan's repost and summary here.
Grogan highlights three points:
- The DJT administration will be VERY different that the past four years, in healthcare.[*]
- AI will bring drastic changes, but exactly what, is unknown.
- To understand federal reimbursement changes, track Paragon Health Institute.
Paragon has current PDF briefings on changes for Medicaid, Medicare, private healthcare, and public health. These are one-pagers of key points. The Medicare Initiative at Paragon is led by Demetrios Kouzoukas, one of the top officials for CMS in the first DJT adminisntration.
See also Paragon's 2025 nine-page report on paths forward for Medicare Advantage and for ACOs - here.
See also Paragon's 2023 20-page report on Medicare as-is, called, "Roadblock to Progress."
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Outside Paragon, see also an innovative paper by Abe Sutton, likely to be the next head of the Center for Medicare Innovation / CMMI. In 2024, he published an important proposal for better and less "gamed" risk adjustment in Medicare Advantage, leveraging machine learning in practical ways. "Inferred Risk: Reforming Medicare Risk Scores to Create a Fairer System, Sutton & Drapos, Health Affairs. (AI summary here.)
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[*] In past weeks, I published several blogs where I used AI to mine and extract long interviews and speeches with DJT, RFK Jr, Vivek Ramaswamy, and others on Republican health policy. On January 17, WSJ reported Bill Gates was "impressed" by DJT's interest in health issues.
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AI CORNER
I gave Chat GPT the four Paragon 1-pagers and the 9- and 20-pagers.
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First, here is a deeper dive on the 20-page Paragon report, Medicare, Roadblock to Innovation
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Here are summaries of the Paragon Health Institute's policy documents, focusing on health policy for the 2025 presidential administration. I’ve emphasized actionable insights, with added detail for the 9-pager and 20-pager, while assessing the creative content of the one-pagers.
One-Pagers
Medicaid Reform
- Highlights concerns about Medicaid’s growth (87 million enrollees by 2023) and misaligned priorities from the Affordable Care Act (ACA), favoring able-bodied adults over vulnerable populations.
- Recommendations:
- Equalize federal reimbursement rates across populations.
- Shift able-bodied adults toward employment and private coverage.
- Combat fraud and encourage state-level innovation.
Medicare Reform
- Addresses Medicare's insolvency risks and inefficient government-centered policies.
- Key proposals:
- Expand Medicare Advantage (MA) flexibility.
- Focus funding on care quality, reducing overpayments and improper payments.
- Promote price transparency and empower providers to focus on patient care.
Private Health Insurance Reform
- Critiques ACA subsidies and pushes for more market-driven solutions:
- Expand flexible, affordable private insurance options.
- Enhance health savings accounts (HSAs) for cost-sharing.
- Improve price transparency and reduce regulatory barriers for clinicians.
- Critiques ACA subsidies and pushes for more market-driven solutions:
Public Health and Pandemic Response
- Criticizes public health missteps during COVID-19, advocating for:
- Fewer mandates, more individual autonomy.
- Refocusing agencies like the CDC on infectious disease control, away from politicized topics like social justice.
- Streamlining regulations to foster innovation in treatments and emergency preparedness.
- Criticizes public health missteps during COVID-19, advocating for:
Nine-Pager: Two Paths for Medicare’s Future
- Overview: This report contrasts Medicare Advantage (MA) with Accountable Care Organizations (ACOs) as alternatives to traditional Medicare (TM).
- Key Insights:
- MA: Provides full capitation, incentivizes cost containment through competition, and integrates benefits like Part D drug coverage. However, inflated benchmarks (108% of TM costs) and "coding intensity" raise taxpayer costs.
- ACOs: Focus on shared savings and quality metrics for TM enrollees but face limited flexibility and participation bias.
- Policy Challenges:
- Risk adjustment discrepancies favor MA over ACOs.
- Quality metrics often add administrative burden without clear patient benefits.
- Structural inefficiencies in ACO benchmarks disincentivize long-term savings.
- Outlook:
- The report suggests competitive bidding for both MA and ACOs to provide better cost-control incentives across Medicare.
Twenty-Pager: Medicare as a Roadblock to Innovation
- Core Argument: Medicare stifles health care innovation through regulatory complexity, inconsistent policies, and market distortions.
- Key Barriers:
- Uncertain Coverage Policies: Lack of clear criteria for innovation adoption hinders investments in new technologies.
- Flawed Value Assessment: Medicare’s reliance on administratively set prices undermines efficient resource allocation.
- Regulatory Delays: Programs like Coverage with Evidence Development (CED) trap innovations in "purgatory" with incomplete data collection.
- Impact on Private Sector: Medicare policies spill over to private markets, raising costs and slowing innovation.
- Recommendations:
- Streamline coverage and payment decisions with transparent benchmarks.
- Reduce reliance on centralized decision-making and empower consumer-driven choices.
- Adopt policies like the defunct Medicare Coverage of Innovative Technologies (MCIT) program to fast-track innovation integration.
Analysis for Biotech and Genomics Experts
Medicaid, Medicare, and Private Insurance Reforms (four 1 pagers):
- Proposals to reduce fraud and expand patient choice could indirectly benefit biotech innovators by reallocating public funds toward high-impact care.
Medicare’s Innovation Roadblocks:
- The 20-pager identifies CED inefficiencies and reimbursement unpredictability as barriers to genomics testing adoption in programs like Medicare.
- Simplified pathways like MCIT would better align with the needs of biotech companies.
ACOs vs. MA:
- The 9-pager hints at ACOs’ potential role in genomics-focused precision medicine, given their emphasis on early detection and coordinated, targeted care.
- However, Medicare Advantage's flexibility and bundled payments may offer a mix of opportunities for diagnostics and advanced therapies.
Critique of One-Pagers:
- The one-pagers summarize familiar conservative policy themes like market-driven reform, deregulation, and fraud reduction. They enunciate priorities, but lack the depth seen in the longer documents.