Meet Chris Jennings

Gregg Masters

Welcome everyone, I’m Gregg Masters managing director of health innovation media the producer and co-host of the AMCP Podcast Series powered by PopHealth Week.

Joining me in the virtual studio is my partner, colleague and co-host of the Series Fred Goldstein, President of Accountable Health LLC.

On today’s show our guest is Chris Jennings, former Obama Administration Deputy Assistant to the President for Health Policy, and current task force member of the Biden transition team. Chris serves as president of Jennings Policy Strategies, Inc., a nationally respected health care consulting firm committed to assisting foundations, purchasers, health systems and other aligned stakeholders develop policies to ensure higher quality, more affordable and sustainable health care. 

With that brief introduction, Fred over to you.

Fred Goldstein

Thanks, Greg. And Chris, welcome to the AMCP podcast series powered by pop Health Week.

Chris Jennings

It's a pleasure to be with you, Fred.

Fred Goldstein

It's fantastic to have you on this our first show and it's really great to have you talking about your experience. So why don't we start there? Give us a little bit of your background.

Chris Jennings

Sure. Well, I'm a long-standing masochist in healthcare policy. I've been doing this since 1983. So coming close to 37, 38 years of working, both through the Senate for 10 years on the Senate Aging Committee worked in two White Houses, both all eight years in the Clinton White House, tour of duty and the Obama White House, worked within the Department of Health and Human Services for a little bit at the Centers for Medicare and Medicaid Services. At that time, it was called the Health Care Financing Administration. And I have my own firm now where I do a lot of consulting, particularly with purchasers of healthcare and also foundations.

Fred Goldstein 

Fantastic. And I know, obviously, there's a lot going on right now, we've got the COVID pandemic going on. And from your sense of having worked with the Clinton administration in the Obama administration, what's your sense of the rollout with the vaccine as compared to what you've seen done in the past?

Chris Jennings

Well, everything in healthcare is complex and challenging. I believe the administration relative and in, in contrast with testing and PPE, but on the development and production of the vaccine, I think it's been quite impressive. I think the great challenge that is yet to be met, really comes down to the distribution of the vaccine and its effects and more importantly, its administration into the arms of people. That's where I think a lot of people are increasingly raising concerns, both at that federal and state partnership and how that's working or not working, and some new directions that we may need to be taking. I think it's fair to say that within any kickoff of any major healthcare implementation projects there, there will be challenges. There's no question about that, and people will need to be a little bit patient. But having said that, we will not achieve our goals if we don't do a lot better. And there's going to be it's necessary for us to have some interventions to improve what we're seeing today, for sure.

Fred Goldstein

Right. And you were involved in the rollout under the ACA and getting that out. And obviously, there were a lot of issues around that, we saw a little bit of politics around, you know, voting for or against it. And then, as it came out some supportive more than others. How did you or the administration at that time work to try to overcome some of those issues?

Chris Jennings

Well, some of them are foreseeable, and some of them are unforeseeable. I think this is a little bit different. I think that the challenge the technological challenge was, was extremely difficult it like, the issue of vaccines, it was a federal state, collaboration. There were complications, there was multiple players involved. In this case, it was health plans, and providers and consumers. In the case of vaccines, it's really going to be manufacturers and pharmacists, and healthcare providers and consumers. So it's very, very, also very, very complex. As I say, because I'm somewhat sympathetic to the early stages of any implementation process, that there will be bugs, there's just no question about that. What you have to do, though, after that occurs, is you really have to evaluate very, very carefully where you are establish a baseline of accountability. Be honest with the assessment of the challenges along the way, do mid-course corrections, implement aggressively, do not do paralysis by analysis, but do the analysis to get it straight up, to as quickly and as accurately as you can, but then move forward. And, and start addressing problems. And, you know, it works out over a period of time because it has to, there's just not going to be, failure is not an option. And neither one of these situations, I know that the incoming Biden administration feels that very, very strongly. As I say also, there's much to be done, we have to be realistic about what we can do in a mass vaccination program, we have to recognize that there's all sorts of different delivery systems and entities that we're going to have to be engaged with at the state, local pharmacy and other levels. We'll have to set up some innovative vaccine program centers, it seems to me, we may need to look at the National Guard and use the Federal Commission Health Corps, we need to eliminate barriers that create friction to achieving quick and efficient vaccine distribution. And specifically, we're going to have to look at the skeptical communities, both within the minority populations and the populations who fall victim to conspiracy theories about vaccinations. And we're going to have to have a very effective messaging campaign with very credible messengers in different communities. And that has really yet to be done in any meaningful or effective way, I think it's going to probably have to wait for the Biden administration to reach a point where it will be successful.

Fred Goldstein

The messaging point you bring up is obviously a critical one. And it was important back in the day, obviously, with the rollout of the legislation you were involved with and now with the vaccine as well. And so as you mentioned, it's really gonna fall on the new administration who seems to be taking a different approach in terms of thought leadership, etc. You think that, that ultimately, is really the key to get that going? Obviously, you've got to do the delivery methods. That the vaccines are here, the pharmaceutical manufacturers have done a great job rapidly with that, and now it's a matter of executing on getting it into people and getting the message out that this is the right thing to be doing.

Chris Jennings

Absolutely. And to do that well. I mean, you still have other companies who will be producing product vaccinations and, and product that you need to get out the door and some of that will be very helpful, particularly in underserved areas in rural settings hopefully. So I think we're going to have at least three different products that we can tap into, over time, certainly after the Biden administration comes into office. And then to your point, both in terms of effective delivery, administration, getting the right providers and the right settings to deliver the vaccination itself, but also an effective message to increase the confidence in the product. My view, truthfully is that there's such a large group of people who do want the vaccinations that we really need to get ahead of that game, be successful. Success begets success. We, as we do that, we're going to need to develop a very, very substantial set of credible messengers within the populations of doubters. They're going to get have to get vaccinations publicly, they're going to have to communicate clearly and in compelling ways about the importance of vaccinations and link it to how we get back into getting the government working, getting the economy working, getting the workforce working, getting employers working, getting schools up and running, you have to show how this vaccination process links to the success of reopening up our whole country. And I think that the President Elect, President Elect Biden, and his team will be quite effective at doing that. But it will not be without a lot of work. And there will be mistakes along the way. There's no question about that.

Fred Goldstein

Right now, obviously, as you pointed out, this is a critical component to reopen the economy, getting those schools back in place by getting people vaccinated, continuing to practice the safe habits, etc., so we can do those important things that we need to keep doing as the economy, in education, etc. So really fantastic. The other issue that's been going on is obviously, there's been questions regarding the FDA and the CDC. These are really, you know, unique organizations that have been highly respected around the world. And how do you see that in the future, bringing that back, that gravitas that they had, and, recognition of their expertise?

Chris Jennings

Well, you're right, the agencies have taken a hit. It's very disconcerting. Of course, it starts with reestablishing credible leadership, that credible leadership has to be empowered and supported. And where appropriate deferred to, it needs to be clear that we are following the science, we're informed by the science. We aren't we're not enslaved to it, we were informed by it. But we respect it. And we empower the people who we have chosen in leadership positions to do their job. We need to fund those agencies adequately. And we need to get the communities who benefit directly from the work of the agencies to participate in positive public messaging campaign about those agencies, and that includes manufacturers, payers, providers, consumer advocates, etc, that that that have credibility in and of themselves. And over time, if we do all those things, well, I have no doubt that we'll be able to get those agencies back to the credibility levels that they absolutely merited previously, and must secure again in the future, because we have to have trust in our institutions to do their jobs. Right. And here until recently, as you know, FDA and CDC have had worldwide respected reputations.

Fred Goldstein

You mentioned also the public health system. And do you see that being a focus in the coming year, so from a congressional basis to try to ramp that up and increase potentially funding as well as other issues that they need so that they can, then if another one of these pandemics comes, which is certain to happen, be in better situation?

Chris Jennings

Absolutely, I think this debate around in the upcoming year around the pandemic and the next steps, on addressing the challenges that we face must include a serious conversation about how we avoid this problem again, I personally believe that that will require thoughtful conversations about how we build back our hollowed out public health infrastructure, but also how we can automatically in state's support for that infrastructure but also for healthcare and economic supports, that are automatically triggered in place when we face these situations rather than having to deal with Congress of potentially polarized Congress fighting over exactly what it should be. To me it needs, we need to have automatic stabilizers that are automatically triggered into place. And I think we have to, to strengthen our public health infrastructure, not just to deal with these situations, but frankly, to do a much better job of integrating public health within healthcare delivery, writ large. And I think you're seeing even pre-COVID you saw increasing interest in that, but I actually think COVID has justified a much more aggressive intervention and approach to have a both a new vision about how health and healthcare are better integrated in our healthcare system. Otherwise, we will find ourselves in the same or certainly similar situations in the future. And we must do better.

Fred Goldstein

Speaking of a new image of health and healthcare, when you look at that, across the broad spectrum, obviously COVID has made clear to many more folks in this country, about health disparities that we're now seeing that are exemplified by the poorer outcomes in the lower socio-economic groups, etc. Do you think that's going to give us the impetus to make some of those moves that are required, perhaps move further upstream, and get into dealing with more of those social determinants of health?

Chris Jennings

Yes, and I and as I mentioned, we've seen in already some states trying to do a much better job of addressing social determinants of health. Now people call it social drivers of health, for theirs. That's the new, most appropriately politically correct way to discuss them, apparently; but most important thing is, we have to reflect back honestly, about how all of us in healthcare, we actually should indict ourselves even more so. The idea that we did not know about disparities in health care, and did not and fail to address them, as of course, is absurd. We have always known that we've had disparities in health care, we have not built up the appropriate trust levels, there are reasons why particularly minority, particularly black populations, mistrust our healthcare system. And then by the way, it isn't just Tuskegee, it really is the day-to-day operations, of our health care system. And we have to do much, much better. So, it's not just and that includes how we train people who we train people. It includes, yes, SDoH, we have to do a much better job of integrating the public health care system and our healthcare system. But we also have to do a much better recognition of how the roles of housing, income, transportation, education plays in this regard. And we have to do better across the board. And I I actually think that this President Elect, who is very, very committed to addressing equity issues, will do so with great and I think, a very effective and aggressive focus, that that will bring people together. And we'll have to do it not just in the healthcare sectors, but throughout government and the private sector. And this, this is not something that can be taken care of in six months or one year, but the vision can and the infrastructure can, to delay the predicate for those changes. And I anticipate we'll see a very substantial conversation about this in the months to come with, I think, some very effective beginning steps to lay the infrastructure for real change.

Gregg Masters

And if you’re just tuning in, you’re listening to the AMCP Podcast Series powered by PopHealth Week. Our guest is Chris Jennings, former Obama Administration Deputy Assistant to the President for Health Policy, a current task force member of the Biden transition team and president of Jennings Policy Strategies, Inc. For more information on Chris go to www.jenningsps.com and do visit the AMCP Podcast Series Powered by PopHealth Week, at www.AMCP.org/podcast

Fred Goldstein

Yeah, and your point regarding social determinants versus social drivers is a good one. Because it's not truly a determinant. It's an influencer. I've heard social influencer of health as well. And I used to say back in the days when I was running some Medicaid programs, that people can't focus on their health because their life gets in the way. So, let's solve those life problems first. That's exactly what you're pointing out. What do you see as the obstacles to this kind of integration with the public health in the health care system? Is it a financing issue? Is it a business models issue? Is it all of the above?

Chris Jennings

Well, I personally think it's an all the above, you know, our healthcare system silos itself quite frequently. The healthcare side of it from the public health side of it, we do that jurisdictionally on Congress. We do that in our infrastructure, even within the Department of Health and Human Services and how we divide responsibilities within our healthcare system. And to some extent, those are required, you know, differences in roles and responsibilities. But the lack of coordination and integration is just striking. And, as is, by the way, the non-medical contributors to poor health outcomes and poor health status. And, and we really, we can't, we can't do much worse than we have done. So I'm going to be optimistic, because I think there's some low hanging fruit where we can begin to create both bridges amongst all these different elements of these so called silos. Because I think both sides, all sides of health and healthcare status and Health Care Improvement all recognize that you can't, you can't do this any longer. Right? great examples of that, of course, include, you know, mental health, we have such silos in mental health, it happens all the time, we haven't well integrated within our primary care delivery system, we don't have enough healthcare personnel to address the challenges that we face, we haven't really even acknowledged all the various externalities that have contributed to a poor mental health status in our country. And we really need to have a greater focus on this. But the reason why I'm encouraged is I believe that more and more people are looking at creative ways to do this. And that could include, of course, coordinated care, that that creates financing incentives to do it well and does doesn't create barriers to do it poorly, and unnecessarily expensively.

Fred Goldstein

And you talked about creative ways to do this. And obviously, one thing that came out of the Affordable Care Act was the Center for Medicare Medicaid Innovation, which has been doing a lot of work around value-based care, do you see that it's possibly continuing that, that move to that type of payment model tied with outcomes? And as we've talked about with the triple aim, and things like that? Chris Jennings Yeah, I sure do. I think that every administration, Democrat and Republican, they'd sometimes alter some of their terminology, but they're all wanting to move away from traditional fee for service into more of a value-based purchasing approach, you know, the details and the context and the weighting. And, the emphasis changes a little bit. But I think this administration will be very, very committed to doing so. And I think, in particular, I think we could see a lot more in the primary care integration models that people recognize are we're going to have to do to both better reward our primary care, infrastructure and personnel, but also to recognize that they're so integral in making sure that we have a much better Coordinated Health Care System, that recognizes the vast disparities and access to specialties that we have around in this country. So, I'm actually somewhat encouraged and I and I believe that the type of people who will be coming into the federal government will be very committed to that agenda.

Fred Goldstein

And you talk about access to care and the need for primary care. And you've already mentioned this issue of rural versus urban, etc. Do you see technology being actually put in place like we've seen with telehealth and other ideas to help further solve some of those problems? Will that be given a little higher status as we move forward?

Chris Jennings

Well, I think innovation across the board is going to get higher status. And I think openness to it, which has been enhanced through the pandemic experience, will help spur that on even more. So definitely. This will be applicable to telemedicine. My view there is that I always get a little concerned with anyone who suggests that any one approach is a magic pill, or that we have addressed all the concerns that are related to the technology and its use and as appropriate oversight and reimbursement models, but, but in general, yes, I believe people are going to want to tear down the barriers and I think that there are going to be very, very positive uses of technology and telemedicine in particular, to improve how we utilize our healthcare more efficiently and have better outcomes. And I think that will be applicable not just to physical health care, but also to mental health care as well. And I'm encouraged by that.

Fred Goldstein

Yes, and in terms of innovation, you know we've seen incredible you know these vaccines came out quicker than probably anybody really anticipated. The pharmaceutical industry obviously ran at this thing, whole hog to solve it. And what we're seeing now as more and more of these innovations come out is, they then have to get integrated into the system. And there's some talk about preapproval information exchange, ideas like that, to allow for the payers and others to begin to integrate that information earlier, so they can make plans for it. What's your sense on something like that?

Chris Jennings

It's an idea I think in theory, it's a, it's a great idea, I think that there's an application of it in some cases. You know, when you apply these things in the real world, sometimes the various entities don't always come together and their consensus position that it's, it's helpful, and frequently they make their evaluations about that, whether they think it helps their particular interests or not. So for example, people are generally supportive of comparative effectiveness research until it's applied to them. And, or, there's always questions about who makes the decisions, who evaluates on what basis on what metrics, etc, etc. Having said that, I think we're going to be looking at newer models like preapproval information exchange, and looking at healthcare, economic information, for sure, on therapies. And in my opinion, I think it's, we really don't have an alternative, if we're not going to be looking at more traditional capping of healthcare costs or looking at different ways to do it by price regulation, then we're gonna have to look at other ways to evaluate value. And, and doing this in a in a way that's sustainable for, for both sides, rewards true innovations. On the other side, I think is very much worth considering. There are, of course, going to be challenges, there always have been where you have products, and devices that have little or no competition. And we have we have major, major cost problems that a competitive market can't necessarily address in effective ways. But we have to, we have to have an all-in use of tools approach to managing better value. I don't know if you've been looking at the data. But again, we're seeing another uptick in inflation in healthcare, we're going to have a tremendous demographic demand for health care. The baby boomers this year, January, 21, right now, as we speak, are beginning to turn age 75. And, you know, once you turn 75, you're gonna have this big cohort of people going through a very, 8 Transcribed by https://otter.ai very vulnerable and a very expensive care model. And we're gonna have to do better at getting greater value for our investment.

Fred Goldstein

Well, fantastic. Chris, I'd like to thank you so much for joining us on this AMCP podcast series. It's been a pleasure talking with you.

Chris Jennings

It's my pleasure, and I always good to do and I want to thank you and Greg as well.

Fred Goldstein

Back to you, Gregg.

Gregg Masters

And thank you Fred!  That is the last word for today's broadcast. I want to thank Chris Jennings, former Obama Administration Deputy Assistant to the President for Health Policy and president of Jennings Policy Strategies, Inc.  for his time and insights today. Do follow Chris’ work on twitter via @ChrisJenningsDC. And for more information go to www.jenningsps.com/  

For the AMCP Podcast Series powered PopHealth Week, my co-host Fred Goldstein and Chris Jennings this is Gregg Masters encouraging you to follow and subscribe to this series at www.amcp.org/podcast  

And do consider subscribing to the series and if you enjoy the content, do like the show on your favorite podcast platform.