Your Health Data Is Not Secure: What Can We Do About It? (Forbes)

FORBES | When it comes to protecting health data privacy, where do we find balance?

Health and health-related data are fundamental to informing medical innovations and advances that save lives and better outcomes for all patients. These data include a wide range of metrics such as prescriptions, lab results, race/ethnicity, gender, and income and, more recently, they’ve come to include data collected on our fitness devices and social media posts.

But, the misuse – whether unintentionally or otherwise – of personal heath data and information can lead to feelings of discrimination, an encroachment on privacy, and even a loss of trust in our health care system.

Back in 2002, on the Senate floor, I stated: “Scientific advances hold the promise of higher quality medical care, yet there is a pressing need for federal legislation to reassure the public that learning this information will not result in a loss of health insurance coverage or in the loss of a job.”

Yes, medical advances demand robust, comprehensive data and information that allow clinicians and researchers to more effectively and efficiently diagnose and treat illness and disease. But we – as a society and as individuals – demand privacy protections and regulations to protect our autonomy. The former cannot and should not exist without the latter.

Read more at Forbes:

A Road Map For Action On Health Care Spending And Value: Part IV – Value-Based Payment (Forbes)

FORBES | This is the fourth and final installment for my series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value. I served as co-chair of this initiative, along with former FDA Commissioner Dr. Margaret Hamburg. This final piece outlines our recommended actions on value-based payment. Click here to read Part I, Part II and Part III

Over the past few years, the health care sector has undergone a cultural shift toward not only prioritizing better value and more comprehensive care but also in how these services are paid for. The days of strictly fee-for-service payment models – where physicians or health centers are paid for each individual service provided – are dwindling. And value-based payment models have stepped into the fold for both public and private sectors. 

In an effort to drive down rapidly growing healthcare costs, value-based care and payment models have garnered a lot of attention for their potential to curb costs while simultaneously improving outcomes. These models come in variety of shapes and sizes, combining innovative arrangements that prioritize quality of care rather than quantity of services provided. Some examples of these models include bundled payment, accountable care organizations, and even full global capitation.  

But the emergence of value-based payment models has not come without challenges.  

Read more at Forbes:–value-based-payment/?sh=2da6363f5d7a

A Road Map For Action On Health Care Spending And Value: Part III – Spending Growth Targets (Forbes)

FORBES | This is the third in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value. Part three focuses on our recommendations on setting spending growth targets. Read parts one and two here and here.

The Health Affairs Council on Health Care Spending and Value looked to states to be laboratories for policy experimentation and innovation. One area the Council members spent time investigating, with presentations from experts over several meetings, is state efforts to set spending growth targets. Two states in particular have led in this area: Maryland and Massachusetts.

The Maryland Example

Maryland has a long-standing history of setting growth targets dating back to the 1970s when they established all-payer rate-setting for hospital payments. Enabled by a Medicare waiver, Maryland was exempted from certain federal health care regulations in exchange for ensuring that Medicare inpatient payments per admission grew at a rate below the national growth rate. The state set rates for hospital inpatient services, and all third parties paid the same rate. This effort evolved in 2014 to a global hospital budget that encompassed inpatient and outpatient hospital services. Under what became known as the Maryland All-Payer Model, the state created a prospective annual budget for each hospital based on historical spending trends, whereby annual revenues were subject to a fixed cap. Hospitals continued to receive fee-for-service payments, but had the ability to adjust their rates nominal amounts throughout the year to stay within budget.  

Read more at Forbes:–spending-growth-targets/?sh=1911a1843e35

A Road Map For Action On Health Care Spending And Value: Part II – Price Regulation And Supports For Competition (Forbes)

FORBES | This is the second in a four-part series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the US can take a more deliberate approach to moderating health care spending growth while maximizing value. I served as co-chair of this initiative, along with former FDA Commissioner Dr. Margaret Hamburg. This piece outlines our recommended actions on price regulation and supports for competition.

Why does the US spend more per capita on health care than any other nation? Well, according to renowned health care economist Dr. Uwe Reinhardt, “It’s the prices, stupid.”

While that’s putting it simply, many believe, like Dr. Reinhardt so often stated, that our health care spending is more in large part because we are willing to pay more for it. And recent data suggest that we are indeed willing to pay a lot more for health care services. In fact, about 20% of our nation’s GDP was attributed to health care in 2020.

But it’s not just our willingness to pay more for health care in the US – and spending more or paying higher prices than other countries isn’t necessarily a bad thing. But doing either without seeing an improvement in quality of care is a problem. And this is exactly what is happening: high rates of growth when it comes to prices that are disproportional to the health and equity produced. This places a significant and increasing burden on everyone including our families, companies, and government.

Read more at Forbes:–price-regulation-and-supports-for-competition/?sh=b6115f63a2f1

A Road Map For Action On Health Care Spending And Value: Part I – Administrative Waste And Inefficiencies (Forbes)

FORBES | This is the first in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece will detail one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value.

On February 3rd, the Health Affairs Council on Health Care Spending and Value released its report, “A Road Map for Action.” It’s the culmination of four years of study, debate, and collaboration between 21 experts in the healthcare field, each representing diverse sectors of the industry. Our goal was to take a nonpartisan, evidence-based approach to understanding our nation’s growing health care spending, the value we get from that spending, and to make recommendations on how we can maximize value while slowing spending growth.

I served as co-chair of this effort, along with former FDA Commissioner Dr. Margaret Hamburg. When we first embarked on this journey in January of 2019, we knew it would be a difficult challenge – reining in health care spending has been a stated goal of policymakers for decades, with little to show for it. Yet our task became even more complex with the upheavals in health brought on by the pandemic, and by the needed spotlight on inequities in all aspects of American life – including health care – that was raised by George Floyd’s tragic murder. As the world around us shifted, we worked to adjust, and extended our Council work by a year. We released our report this month, the product of four years of research and collaboration.

Read more at Forbes:–administrative-waste-and-inefficiencies/?sh=1e8dc3a9fd74

Recommendations On Health Care Spending And Value From 21 Experts: Why We Should Implement This Road Map For Action Now (Health Affairs)

HEALTH AFFAIRS | Four years ago, an ambitious group of twenty-one diverse health care experts came together at the invitation of Health Affairs to collectively develop recommendations to maximize our nation’s investment in health care. With national health care spending levels reaching nearly a fifth of our economy, it was the right time to evaluate our spending priorities and the value we receive from those expenditures. 

At the time, we anticipated that the Health Affairs Council on Health Care Spending and Value, which we co-chaired, would be a three-year effort.  We did not foresee the first global pandemic in decades, leading to trillion-dollar federal investments in public health, nor the national reckoning on racial and gender-based disparities that brought to light many of the inequities in health care today.  The council continued to meet throughout, although our in-person meetings became virtual, and we continued to adjust and hone our analysis and recommendations as the world around us shifted. 

Even with these changes, we remained steadfast that this work needed to be done. As physicians first, we recognize that patients still struggle with the cost of care, despite policy changes like the Affordable Care Act. We’re seeing increased care avoidance, as a shocking 47 percent of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs. One in 10 Americans has medical debt, which continues to be the number one cause of bankruptcy. Despite the United States outstripping all other nations in per capita health care spending, our life expectancy is surprisingly on the decline. And in the midst of a crisis, when our physicians and nurses were our frontline defense against COVID-19, our health care systems needed billions in federal dollars to keep them afloat. Finally, our health spending continues to grow as a percentage of gross domestic product (GDP) and our federal budget. Taken together, this paints a picture of a system that is failing its people and where change is needed now. 

Read more at the Health Affairs blog:

Bloomberg: The Real Price of Healthcare

Nov. 21 (Bloomberg) — Bloomberg View columnist Lanhee Chen is joined by former U.S. Senate majority leader William Frist, Mayo Clinic CEO John Noseworthy, Boston Consulting Group partner Michael Ringel, John Hopkins Medicine CEO Paul Rothman, Thompson Holdings CEO Tommy Thompson, and Walgreen CEO Gregory Wasson to discuss the state of healthcare in the United States. They speak at Bloomberg’s The Year Ahead: 2014 conference at the Art Institute of Chicago.

Original Post

Need for Affordable Care Cuts Across Party Lines

(The Hill, August 1, 2012)

Need for affordable care cuts across party lines
By Tom Daschle and Bill Frist

On June 28, 2012, the Supreme Court issued a decision that affects the health and well-being of every American, as well as the fiscal future of our nation. By affirming the constitutionality of the Patient Protection and Affordable Care Act (PPACA), the private and public sectors can now turn to implementation, along with natural and needed shaping and modification of the underlying policy along the way.

The court’s decision can and should be a turning point for our national discussion and action on healthcare. Though the upcoming elections might amplify our differences in the short term, it is in the long-term interest of every American to begin now to work together and forge consensus-based solutions for our nation’s most critical healthcare challenges.

The United States currently has an expensive, uncoordinated and inefficient healthcare system. By 2020, healthcare spending will make up one-fifth of our national economy. Excessive and wasteful healthcare spending fuels our nation’s exploding federal debt and imposes unsustainable burdens on our federal and state governments, employers, individuals and their families. This is a grave threat to our nation’s future health, economic viability and ability to compete in an increasingly competitive global marketplace.
As the co-leaders of the Bipartisan Policy Center Health Project, our mission is to bring together federal, state, business and workforce leaders to develop health system solutions that address ongoing budgetary and healthcare reform challenges. We are embarking on a new initiative to confront and curb the country’s out-of-control healthcare cost growth: Our goal is to promote a rational, competitive, accessible and affordable healthcare system. We will be collaborating on this initiative with Alice Rivlin and former Sen. Pete Domenici (R-N.M.), the distinguished co-chairs of the Bipartisan Policy Center Debt Reduction Task Force. The task force is dedicated to reducing the federal deficit and helping America achieve a sustainable fiscal path, which simply cannot be accomplished without significant healthcare reform.

Healthcare cost containment is a profoundly complex and divisive issue, but we are steadfast in our belief that this issue can be addressed in a meaningful way. We as a nation cannot wait any longer. Our broken healthcare system can be fixed; there are solutions to each of the challenges. But we will never devise and apply them until we commit to do so together, reaching across the political aisle to work with one another.

All Americans generally agree on the end goals for health reform — appropriate and effective patient care, lower costs and easier access for all. We might not agree on the individual mandate, but we do agree on the power of embracing personal responsibility for our health and health decisions. We do not always agree on the most effective way to execute state insurance exchanges, but we can agree that these exchanges provide opportunities for states to use the power of market competition to control costs and engage their constituents on the individual level.

We all know that greater transparency in pricing and outcomes will help eliminate duplication, waste and inefficiency. We want to see our system provide frictionless and coordinated care that brings satisfaction to caregivers and peace of mind to patients. We want our health records and data systems to be brought into the 21st century through health information technology, providing vital health information when and where it is needed instantly and securely. The only question is how we get there.

Healthcare is in a period of explosive growth and transformation. Every day, the sector performs technological miracles, creates jobs and saves lives. We must harness this power, but at the same time, strive to do more. The American healthcare system has the power to be more efficient and more accurate, without sacrificing our nation’s capacity for private-sector innovation, productive public-private collaboration and incredible technological advancement.

Allowing healthcare costs to soar at unsustainable levels and allowing America to fall behind on key indicators of care quality and access is not a political victory for either side of the aisle. Assigning blame along partisan lines gets us nowhere.

A healthy population, a happy and productive workforce, and affordable healthcare are vital to the future of our nation. Unless we are willing to work together to transform our healthcare system for the better, these essential goals will remain out of our reach.

Former Senate Majority Leaders Daschle (D-S.D.), now a senior policy adviser at DLA Piper, and Frist (R-Tenn.) lead the Bipartisan Policy Center’s Health Project.

This article was originally featured in The Hill

Why both parties should embrace ObamaCare’s state exchanges

(The Week, July 18, 2012)

By Bill Frist, M.D.

Largely lost in the fight over ObamaCare is a worthy provision that lets states develop insurance systems that are right for them — but they must act soon.

When the new health care reform law was being debated in 2009 and 2010, everyone talked about “death panels.” When challenged in court, everyone debated the individual mandate. After last month’s Supreme Court decision, the conversation has now switched to Medicaid. During all of this, however, we have largely ignored what is perhaps the most innovative, market-driven, and ultimately constructive part of the law: State exchanges.

Originally a Republican idea, the state insurance exchanges mandated under the Affordable Care Act (ACA) will offer a menu of private insurance plans to pick and choose from, all with a required set of minimum benefits, to those without employer-sponsored health insurance. These exchanges are expected to bring health insurance to an additional 16 million Americans. Unlike the Medicaid expansion, these Americans will gain private insurance, and can choose the plan that’s right for them.

The exchanges should facilitate competition among private insurers as they design new benefit packages and cut prices to stay ahead of the game. While I’m slow to favor a mandate, these exchanges will offer those who can benefit from insurance a broad array of tailored options and varying prices that should help them find it. Helping more Americans find and compare the private insurance they need and can afford should be an easy principle both political parties agree on.

As a doctor, I strongly believe that people without health insurance die sooner. Sure, they can eventually go to an emergency room. But it is often too late. They wait longer to get a breast lump checked out. They wait until their nagging cough turns into a fulminant pneumonia. They skip preventive care and then show up to the ER with severe, costly, late-stage symptoms that are harder and more expensive to treat.

State exchanges are the solution. They represent the federalist ideal of states as “laboratories for democracy.” We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation.

Helping more Americans find and compare the private insurance they need and can afford should be an easy principle both political parties agree on.

Want a more conservative, small-business focused exchange that bans abortion coverage in all its plans? Try Utah and its state exchange, originally founded under Gov. Jon Huntsman. Think that President Obama missed a huge opportunity to steer the nation towards a single payer system? Try Vermont, which plans to ultimately transform its state exchange into a single payer system, Green Mountain Care, that will offer coverage to all state residents. With soaring health care costs one of, if not the most, dangerous threats to America’s greatness, a new round of national health care experimentation is exactly what we need.

But the clock is ticking. While the exchanges must be fully operational by January 1, 2014, they are also required to submit a blueprint for approval by mid-November of this year, which will indicate if they plan to run their own exchange or will participate in a federal-state partnership. While almost all of the states have at least planned for an exchange, roughly half took a wait-and-see approach as they awaited the Supreme Court ruling. This means that in the coming weeks we will see a frenzy of state activity and legislation as governors rush to meet this deadline. Enacting some sort of exchange establishment legislation is expected to be crucial to receiving federal approval for a state-run exchange. And though some GOP governors refuse to set up an exchange of their own, I see little advantage for states to default to the federally designed, one-size-fits-all exchange when they can design and run their own.

The silver lining is that with much planning left to do, there is still time to get involved and design the exchange in your state. I urge everyone — citizens, small businesses, health industry stakeholders, churches, large employers — to actively participate in shaping your exchange so that it reflects your state’s values, economy, and common sense. Then, starting in 2014, we can see a variety of big ideas and small tweaks all working together to show our nation what works and what doesn’t.

Simply put, state exchanges represent a distinctly American opportunity to improve our local communities and at the same time help our nation avert a major crisis. Let’s take the plunge.

Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books. Learn more about his work at

This article was originally featured in The Hill

How the Supreme Court’s ‘ObamaCare’ ruling will affect you

(The Week, March 13, 2012)

By Bill Frist, M.D.

The nation’s highest court is about to judge the president’s signature legislative achievement — and it’s not just politicians who are invested in the outcome.

Is the new health care law constitutional? You might think it doesn’t matter — or at least, that it doesn’t matter to you. But the fact is, the Supreme Court’s decision on President Obama’s Affordable Care Act (ACA) will almost certainly affect you directly.

How, exactly? For one thing, the court’s decision could play a key role in determining our next president and possibly your next congressman. If you are poor, the ruling may decide whether or not you have coverage. If you are not poor, it will impact how much you pay for health care. If you own a small business, it might determine if you must purchase health insurance for your employees. And if you work for a large business, it may determine whether you still receive your insurance from your employer. If you’re a doctor, it will likely affect your reimbursement. If you’re a patient, it will determine your benefits.

On March 26, 27, and 28, the Supreme Court will hear extensive oral arguments on the constitutionality of the ACA. This is the culmination of 26 states filing suits in federal district courts and opinions from seven federal appellate courts. A final written opinion likely will be delivered in June, 18 months before the individual mandate kicks in and just five months before the presidential election.

If the individual mandate is ultimately deemed constitutional, then for the first time in our history, you will have to purchase a product to live in America.

The ACA is a highly charged law that, according to the latestRealClearPoliticsaverage, is viewed unfavorably by half of Americans. The law essentially does two massive, controversial things: (1) Mandates that individuals purchase health insurance coverage, and (2) expands Medicaid by 16 million enrollees. This expansion means almost one in four Americans will be on Medicaid, the government program originally intended for our poorest citizens. If you don’t purchase insurance, you will pay a fine of $695 per adult and $347 per child.

Together, these provisions will reduce the uninsured by 32 million, but will still leave an estimated 23 million individuals uninsured in 2020.

The focus of the Supreme Court opinion will be on the constitutionality of these two issues, though two additional items will also be considered. One is whether the entire law falls if a part of it, such as the mandate, is ruled unconstitutional, and the other is whether the court has jurisdiction to rule at all now, since the law has yet to go fully into effect.

There is already plenty of discussion on the legal merits of the case, particularly as it regards the taxing power and the Commerce Clause. But what are the very real implications of the upcoming ruling? Here is what to look for:

1. If the court upholds the individual mandate, it will take effect 18 months later — unless Congress acts to repeal or postpone it (which won’t happen as long as Obama is in the White House). If the individual mandate is ultimately deemed constitutional, then for the first time in our history, you will have to purchase a product to live in America.

2. If the individual mandate is ruled unconstitutional, the court will then decide whether to let the rest of the law stand, including the expansion of Medicaid and the largely popular individual insurance reforms. If the rest is left intact, the Congressional Budget Office projects that 16 million of the 32 million Americans expected to gain insurance under the law would be ineligible for the new coverage and that non-group, individual premiums might increase 15 to 20 percent. It would then be up to each state to decide whether or not to adopt the individual mandate.

3. If the court decides that the Medicaid expansion is constitutional, it will take effect in 2014 — unless Congress acts to postpone, repeal, or not fund it. But if the expansion is left intact, with almost a quarter of all Americans covered by Medicaid, the program would grow to include a portion of the middle class.

4. If Medicaid expansion is overruled, coverage will remain at current, varying state levels, and an estimated 16 million low-income individuals will not be able to take advantage of the new Medicaid coverage that would have begun in 2014.

5. Politically, if the new law is judged constitutional, Democrats will celebrate the judicial affirmation of the spirit and substance of the historic reform, illustrating President Obama’s leadership. Republicans would fan the existing flames of unpopularity among the majority of Americans, citing federal government overreach, rallying around an election call for repeal as they did in 2010. If any part is unconstitutional, the bases of both parties will be emboldened to make health reform the defining issue, after the economy, in the elections in November.

This one is worth following. It will be a game-changer. And not just for the politicians and pundits in Washington. It’s a game-changer for you, too.


Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books. Learn more about his work at


This article was originally featured in The Week

In Case You Missed It… RealClearPolitics : Newsmaker Interview with Bill Frist

RCP: Republican candidates are pledging to repeal the health care bill, and with your background in medicine and also as a leader in the Senate acutely aware of policy-making, what’s the best way for Republicans to proceed?

Frist: Republicans will not repeal the fundamentals of the new law. Because of the law’s unpopularity with so many hard-working, centrist voters, who see their health cost and taxes continuing to rise, the mantra of “repeal and replace” resonates at election time. Republicans will pick up 500 state legislative seats, the majority of governorships, and will regain control of the House. In two weeks, they then become the leaders of the legislative branch. The electorate wants results and their responsibility will be to constructively shape implementation of the new law.

RCP: If they try to repeal parts of the bill, what parts will they start with, and what is realistic?

Frist: Passing a law is 20% of the work (the easy part). Implementing it successfully requires 80% of the effort. As with Medicare and Medicaid in the 1960’s and 1970’s, implementation will ultimately be defined by regulatory language, interpretation of Congressional intent, and the outcome of elections (in this case, a series of elections in 2010, 2012, 2014, and 2016).

Repeal of discrete sections of the law are a possibility but will require solid bi-partisan support. For example, consideration will be given to repeal (or modification of) the Independent Payment Advisory Board. Is it too much power to allow 15 unelected individuals the absolute authority to unilaterally dictate with the force of law how to cut Medicare for as much as 2% a year every year?

RCP: What parts of this bill are solid and should stay in place if changes begin?

Frist: The “individual mandate,” the redefinition of the Medicaid coverage threshold to be 133% of poverty, the demonstration projects of accountable care organizations and medical homes, payment reform, and prevention are solid.

RCP: Do you think Republicans have been entirely correct in how they’ve portrayed the bill; do you think there misperceptions remain about the law as Democrats suggest?

Frist: Those who call the law a federal government takeover are wrong. Yes, there are more government mandates, bureaucracies, and hefty government spending, but our health care sector will maintain its rugged pluralism and its strong employer-based foundation (150 billion people). Care will continue to be delivered by non-government physicians and nurses working in non-government hospitals and facilities.

RCP: What new legislation would you like to see crop up regarding health care delivery in this country?

Frist: The health sector needs breathing room from new legislation. For innovation to prosper, new cost-effective treatments to emerge, accountable care organizations to be established, state exchanges to be operationalized, more laws are not needed. The sector needs some certainty and time to adapt.

RCP: How big of a role do you think health care and the new law will factor into the Republican presidential primary over the next year, and how do you think it will shake up the field?

Frist: The next presidential election will be determined by 2 things: the economy/jobs and Afghanistan. Health care will not be a defining issue in the presidential election in 2 years, but will be cited by voters as supporting evidence of one’s own views on taxes, the role of government, and entitlement spending (the debt).

RCP: If a Republican unseats President Obama in 2012, what’s the first step that president should take regarding health care policy?

Frist: The President must focus “like a laser beam” on health care costs. This will likely begin with provider payment reform which will transform fee-for-service, volume-based payments to value-based constructs. Incentives and markets will work. Government fiat will not.

RCP: What is being ignored currently in the implementation of the health care bill/what do you think will crop up in the debate in the next few years that we’re missing now?

Frist: The law is state-driven, not federally driven. Both the 16 million new entrants to Medicaid and the 24 million in the new health exchanges will be state-administered. Today, the federal government is inadequately serving the states in view of the huge (and I’d argue appropriate) responsibility it has thrust on the states.

RCP: What is the best way to curb health care costs in your view?

Frist: Markets and incentives. When fairly framed by government, they work. Just look at the Medicare Modernization Act of 2003. With transparency, competition, incentives, partnership with the private sector, prescription drug costs for seniors with Medicare have year after year have come in 10 – 20% less than predicted. That is bending the cost curve.

RCP: You’re still very involved in health care policy in the country from Tennessee; what’s topping your agenda on health care policy and what you will be doing over the next few years?

Frist: My life is health. I spend a third of my time on health care policy, a third on global health issues like children’s issues and clean water through Hope Through Healing Hands, and a third marrying private capital to dynamic managers who are constructively and innovatively addressing the “value equation” in health care. I loved transplanting hearts and I love transforming health care.

To read the entire interview on RealClearPolitics, please click here